Sciatic nerve compression by preexisting heterotopic ossification during general anesthesia in the dorsal lithotomy...

Area of Science:

• Orthopedic Surgery
• Neurology
• Anesthesiology

Background:

• Heterotopic ossification (HO) is abnormal bone formation in soft tissues, often following trauma or surgery.
• Sciatic nerve compression is a known complication, but rarely associated with HO during surgical procedures.
• The dorsal lithotomy position can place the sciatic nerve under significant stretch.

Observation:

• A 25-year-old woman developed sciatic nerve dysfunction post-dilatation and curettage under general anesthesia.
• Preexisting heterotopic ossification above the right greater trochanter was identified.
• The patient had a history of a right femur fracture treated with intramedullary fixation seven years prior.

Findings:

• The surgical position likely displaced the HO, compressing the maximally stretched sciatic nerve.
• Electrodiagnostic studies were crucial for localizing the nerve lesion and confirming the injury mechanism.
• This represents the fourth reported case of sciatic nerve compression by HO and the first during general anesthesia.

Implications:

• Preexisting hip HO poses a risk for sciatic nerve injury during procedures in the dorsal lithotomy position.
• Awareness of this risk is critical for surgeons and anesthesiologists to prevent nerve damage.
• Further research into preventative measures and optimal surgical positioning is warranted.