Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy

Gomes, Berliet Assad; Ramos, Max Rogério Freitas; Fiorelli, Rossano Kepler Alvim; Almeida, Camila Rodrigues de; Fiorelli, Stênio Karlos Alvim

doi:10.1590/0100-69912014006010

Cited by 4 publications

(8 citation statements)

References 16 publications

(16 reference statements)

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“…A total of 45 studies ( n = 7068 lower limbs) were included in the meta‐analysis on the variations with respect to the piriformis muscle and are summarized in Table S4 and Figure S1A–H . The normal Type A variation where the SN exits the pelvis as a single entity below the PM was the most common with a pooled prevalence of 85.2% (95%CI: 78.4–87.0), followed by Type B with a pooled prevalence of 9.8% (95%CI: 6.5–13.2), where the SN bifurcated in the pelvis with the CPN exiting piercing the PM and the TN coursing below the PM.…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies ( n = 795 cadavers) reported data on symmetry of nerve variations . Symmetrical pattern of exit from the pelvis was seen in 88.0% (95%CI: 81.7–93.2) (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Symmetrical pattern of exit from the pelvis was seen in 88.0% (95%CI: 81.7–93.2) (Table ). Of those bodies which were symmetrical, nine studies ( n = 637 bodies) noted whether the exit was symmetrical and normal or symmetrical and anomalous . Out of the bodies which were symmetrical, 91.7% (95%CI: 86.8–95.6) had normal Type A anatomy, as presented in Table .…”

Section: Resultsmentioning

confidence: 99%

“…It has been reported that the SN always needs to be considered because it's location can be as close as 11 mm to the site of posterolateral portal placement . It was noted in the series of dissections by Gomes et al that mean portal distance from the SN was smaller in Type B variants when compared to Type A (2.46 vs. 3.06 cm, respectively) leading to increased susceptibility to injury. Traction is often used as a tool to aid in proper portal placement and once again, traction type injuries often present.…”

Section: Discussionmentioning

confidence: 99%

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Surgical anatomy of the sciatic nerve: A meta‐analysis

Tomaszewski

Graves

Henry

et al. 2016

Journal Orthopaedic Research

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The sciatic nerve has varying anatomy with respect to the piriformis muscle. Understanding this variant anatomy is vital to avoiding iatrogenic nerve injuries. A comprehensive electronic database search was performed to identify articles reporting the prevalence of anatomical variations or morphometric data of the sciatic nerve. The data found was extracted and pooled into a meta-analysis. A total of 45 studies (n = 7068 lower limbs) were included in the meta-analysis on the sciatic nerve variations with respect to the piriformis muscle. The normal Type A variation, where the sciatic nerve exits the pelvis as a single entity below the piriformis muscle, was most common with a pooled prevalence of 85.2% (95%CI: 78.4-87.0). This was followed by Type B with a pooled prevalence of 9.8% (95%CI: 6.5-13.2), where the sciatic nerve bifurcated in the pelvis with the exiting common peroneal nerve piercing, and the tibial nerve coursing below the piriformis muscle. In morphometric analysis, we found that the pooled mean width of the sciatic nerve at the lower margin of the piriformis muscle was 15.55 mm. The pooled mean distance of sciatic nerve bifurcation from the popliteal fossa was 65.43 mm. The sciatic nerve deviates from its normal course of pelvic exit in almost 15% of cases. As such we recommend that a thorough assessment of sciatic nerve variants needs to be considered when performing procedures in the pelvic and gluteal regions in order to reduce the risk of iatrogenic injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1820-1827, 2016.

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Section: Resultsmentioning

confidence: 99%

“…Ten studies ( n = 795 cadavers) reported data on symmetry of nerve variations . Symmetrical pattern of exit from the pelvis was seen in 88.0% (95%CI: 81.7–93.2) (Table ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical anatomy of the sciatic nerve: A meta‐analysis

Tomaszewski

Graves

Henry

et al. 2016

Journal Orthopaedic Research

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“…Stretching of the sciatic nerve or its branches has more risk during surgery in some variations between sciatic nerve and piriformis muscle (4). The variations of the sciatic nerve and the piriformis muscle have also significance for the posterior paratrochanteric portal (posterior portal) during arthroscopic surgery (14).…”

Section: Introductionmentioning

confidence: 99%

Siyatik sinirin varyasyon anatomisi ve klinik yansımaları

et al. 2018

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Aim: The aim of present study was to demonstrate the variations of piriformis muscle, sciatic nerve and its branches and discuss their clinical importance. Materials and Methods: Fifty-two gluteal and lower limb regions of 26 formalin fixed male cadavers were evaluated in Ege University Faculty of Medicine, Department of Anatomy. The anatomical relationship between the sciatic nerve and the piriformis muscle, and division level of sciatic nerve in thigh was recorded. Results: The sciatic nerve exited the pelvis as a single branch through the infrapiriform foramen with no variation in 84.62% of the lower limbs. The division variations of sciatic nerve were determined in 23.08%. In 8 of 12 high divisions were observed in gluteal regions (15.38%). The common peroneal nerve and the tibial nerve entered deep gluteal region via the greater sciatic foramen below piriformis muscle separately in four lower limbs (7.69%). Two separate nerve divisions passed above and through (or below) the piriformis muscle and then combined together to form common peroneal nerve while tibial nerve passing below the piriformis muscle in 4 lower limbs (7.69%). In 2 of 12, high division occurred in the 1/3 upper portion of the thigh unilaterally (3.85%). The division of sciatic nerve in the popliteal fossa was seen in two lower limbs (3.85%). Conclusion: The clinical importance of the sciatic nerve around the piriformis muscle or in the thigh was discussed for piriformis syndrome, palsy after total hip arthroplasty, intramuscular injections in gluteal region and failed popliteal nerve block.

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Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome?

Barbosa

Santos

Targino

et al. 2019

Arq. Neuro-Psiquiatr.

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The sciatic nerve forms from the roots of the lumbosacral plexus and emerges from the pelvis passing inferiorly to the piriformis muscle, towards the lower limb where it divides into common tibial and fibular nerves. Anatomical variations related to the area where the nerve divides, as well as its path, seem to be factors related to piriformis syndrome. Objective: To analyze the anatomical variations of the sciatic nerve and its clinical implications. Methods: This was a systematic review of articles indexed in the PubMed, LILACS, SciELO, SpringerLink, ScienceDirect and Latindex databases from August to September 2018. Original articles covering variations of the sciatic nerve were included. The level of the sciatic nerve division and its path in relation to the piriformis muscle was considered for this study. The collection was performed by two independent reviewers. Results: At the end of the search, 12 articles were selected, characterized according to the sample, method of evaluation of the anatomical structure and the main results. The most prevalent anatomical variation was that the common fibular nerve passed through the piriformis muscle fibers (33.3%). Three studies (25%) also observed anatomical variations not classified in the literature and, in three (25%) the presence of a double piriformis muscle was found. Conclusion: The results of this review showed the most prevalent variations of the sciatic nerve and point to a possible association of this condition with piriformis syndrome. Therefore, these variations should be considered during the semiology of disorders involving parts of the lower limbs.

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Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy

Cited by 4 publications

References 16 publications

Surgical anatomy of the sciatic nerve: A meta‐analysis

Surgical anatomy of the sciatic nerve: A meta‐analysis

Siyatik sinirin varyasyon anatomisi ve klinik yansımaları

Sciatic nerve and its variations: is it possible to associate them with piriformis syndrome?

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