scholarly journals Portal placement for endoscopic surgery in the deep gluteal area: a cadaveric study

2020 ◽  
Vol 7 (1) ◽  
pp. 147-152
Author(s):  
F Bataillie ◽  
S Bataillie ◽  
N van Beek ◽  
K Corten
Keyword(s):  
Sciatic Nerve ◽  
Insertion Site ◽  
Proximal Part ◽  
Ischial Tuberosity ◽  
Reference Points ◽  
Horizontal Line ◽  
Safe Approach ◽  
Proximal Hamstring ◽  
Inferior Edge ◽  
Portal Placement

Abstract Partial or complete avulsion of the insertion of the proximal hamstrings at the level of the ischial tuberosity is most often treated by open exploration and reinsertion. However, endoscopic reinsertion could be considered to minimize the soft tissue damage. In this study, we aimed to determine the most optimal location of four endoscopic portals that allow for a safe exploration of the proximal hamstring insertion site. The reference points for the portals run vertically through the center of the sciatic tuberosity and through a horizontal line which lies on the inferior edge of the tuberosity. The distance and relationship between the sciatic, the inferior gluteal and posterior femoral cutaneous nerves and the four proposed endoscopic portals was documented. Our results showed that it was best to start with the inferior portal followed by the medial and lateral portal. The inferior portal allowed for a clear visualization of the sciatic nerve and was along with the medial portal at a distance of >5 cm from any of the surrounding nerves. Care must be taken with the lateral portal, as the distance to the surrounding nerves varied between specimens. A fourth portal could be used as a viewing portal when necessary. Our study showed that the sequence and position of the proposed endoscopic portals provide a safe approach to the proximal part of the hamstrings and the ischial tuberosity. These findings can be helpful for endoscopic procedures to the ischium and the sciatic nerve in the gluteal region.

Magnetic resonance neurography evaluation of chronic extraspinal sciatica after remote proximal hamstring injury: a preliminary retrospective analysis

2014 ◽  
Vol 121 (2) ◽  
pp. 408-414 ◽  
Author(s):  
Matthew D. Bucknor ◽  
Lynne S. Steinbach ◽  
David Saloner ◽  
Cynthia T. Chin
Keyword(s):  
Magnetic Resonance ◽  
Soft Tissue ◽  
Sciatic Nerve ◽  
Hamstring Tendon ◽  
Tendon Injury ◽  
Ischial Tuberosity ◽  
Magnetic Resonance Neurography ◽  
Cross Sectional ◽  
Tissue Abnormalities ◽  
Proximal Hamstring

Object Extraspinal sciatica can present unique challenges in clinical diagnosis and management. In this study, the authors evaluated qualitative and quantitative patterns of sciatica-related pathology at the ischial tuberosity on MR neurography (MRN) studies performed for chronic extraspinal sciatica. Methods Lumbosacral MRN studies obtained in 14 patients at the University of California, San Francisco between 2007 and 2011 were retrospectively reviewed. The patients had been referred by neurosurgeons or neurologists for chronic unilateral sciatica (≥ 3 months), and the MRN reports described asymmetrical increased T2 signal within the sciatic nerve at the level of the ischial tuberosity. MRN studies were also performed prospectively in 6 healthy volunteers. Sciatic nerve T2 signal intensity (SI) and cross-sectional area at the ischial tuberosity were calculated and compared between the 2 sides in all 20 subjects. The same measurements were also performed at the sciatic notch as an internal reference. Adjacent musculoskeletal pathology was compared between the 2 sides in all subjects. Results Seven of the 9 patients for whom detailed histories were available had a specific history of injury or trauma near the proximal hamstring preceding the onset of sciatica. Eight of the 14 patients also demonstrated soft-tissue abnormalities adjacent to the proximal hamstring origin. The remaining 6 had normal muscles, tendons, and marrow in the region of the ischial tuberosity. There was a significant difference in sciatic nerve SI and size between the symptomatic and asymptomatic sides at the level of the ischial tuberosity, with a mean adjusted SI of 1.38 compared with 1.00 (p < 0.001) and a mean cross-sectional nerve area of 0.66 versus 0.54 cm2 (p = 0.002). The control group demonstrated symmetrical adjusted SI and sciatic nerve size. Conclusions This study suggests that chronic sciatic neuropathy can be seen at the ischial tuberosity in the setting of prior proximal hamstring tendon injury or adjacent soft-tissue abnormalities. Because hamstring tendon injury as a cause of chronic sciatica remains a diagnosis of exclusion, this distinct category of patients has not been described in the radiographic literature and merits special attention from clinicians and radiologists in the management of extraspinal sciatica. Magnetic resonance neurography is useful for evaluating chronic sciatic neuropathy both qualitatively and quantitatively, particularly in patients for whom electromyography and traditional MRI studies are unrevealing.

scholarly journals Histological changes of the sciatic nerve in dogs after intraneural application of lidocaine--relation to the established application pressure

2005 ◽  
Vol 5 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Zakira Mornjaković ◽  
Faruk Dilberović ◽  
Esad Ćosović ◽  
Kučuk-Alija Divanović ◽  
Asja Začiragić ◽  
...  
Keyword(s):  
Individual Differences ◽  
Sciatic Nerve ◽  
Inflammatory Process ◽  
Structural Changes ◽  
Proximal Part ◽  
Serial Sections ◽  
Single Application ◽  
Histological Changes ◽  
Average Value ◽  
Covering System

Histological changes of sciatic nerve in adult dogs 7 days after single application of 2% lido-caine (4 ml dose, speed of injection 3 ml/min) and measurement of the application pressure was studied, with a goal to investigate structural changes of the nerve in relation to the established pressure values. The application pressure was determined by using Bio Bench software. In intrafascicular puncture an average application pressure of 198.23 ± 52 kPa was found, and in interfascicular puncture its average value was 53.3 ± 17.9 kPa, with a note that individual differences are regularly present. Seven days after the injection, a nerve dissection was performed and serial sections covering the region of injection’s puncture and bordering proximal and distal zones, in the total length of 3 cm, were prepared. The found changed show the presence of nerves’ fibers lesions with a strong reactivity of Schwann’s cell, as well as the change of interstitial structure concerning hypercellularity and occurrence of cellular extravasation. The covering system of the nerve in the zone of epineurium manifests changes of inflammatory process and in perineurium a decomposition of lamella layers and the alteration of their tinctorial properties were noticed. A comparison of the found nerve reactivities in intra- and interfascicular application showed their one-way alteration, although the lesions were more noticeable in the conditions of intrafascicular application. The damages were mostly expressed in the zone of local application of anesthetic, than distally from it, while the damage to the structure in the proximal part is of the smallest degree.

scholarly journals Sciatic Nerve Compression Secondary Due to Ischial Tuberosity Osteochondroma

2012 ◽  
Vol 24 (1) ◽  
pp. 65 ◽  
Author(s):  
Hyeon Jun Kim ◽  
Sung Soo Kim ◽  
Chul Hong Kim ◽  
Hyo Jong Kim
Keyword(s):  
Sciatic Nerve ◽  
Ischial Tuberosity ◽  
Nerve Compression

Sciatic Nerve Blockade

2010 ◽  
pp. 405-422
Author(s):  
Adam K. Jacob
Keyword(s):  
Side Effects ◽  
Sciatic Nerve ◽  
Lower Extremity ◽  
Ultrasound Guidance ◽  
Insertion Site ◽  
Needle Insertion ◽  
Clinical Applications ◽  
Nerve Blockade ◽  
Patient Position ◽  
Ankle And Foot

Sciatic nerve blockade is performed to achieve anesthesia and analgesia of the distal lower extremity, including the anterior and posterolateral leg, ankle, and foot. The following aspects of the procedure are reviewed: clinical applications, relevant anatomy, patient position, technique (including neural localization techniques, needle insertion site, and needle redirection cues), and side effects and complications. Use of ultrasound guidance is also discussed.

A Cadaveric Study on the Variation in the Level of Division of Sciatic Nerve in Nepalese Population

2020 ◽  
Vol 9 (1) ◽  
pp. 12-16
Author(s):  
Diwakar Kumar Shah ◽  
Sanzida Khatun
Keyword(s):  
Sciatic Nerve ◽  
Ischial Tuberosity ◽  
Lower Limbs ◽  
Pelvic Cavity ◽  
Terminal Branch ◽  
Middle Region ◽  
Common Site ◽  
Greater Trochanter ◽  
Cross Sectional ◽  
Medical College

Background: Sciatic nerve, the thickest nerve of our body (around 2cm wide at its origin), leaves the pelvic cavity from the greater sciatic foramina below the piriformis muscle and between the greater trochanter of femur and ischial tuberosity. As variations have been reported in the level of division of sciatic nerve into its terminal branches, the current study aims to determine the most common site of division of sciatic nerve in Nepalese population. Materials and Methods: The current study is a cross-sectional and descriptive study which was carried out in the Department of Anatomy, Nobel Medical College, where twenty-three cadavers were used and both the lower limbs were examined. Depending upon the level of division of the sciatic nerve into its terminal branches, it was categorized into six different groups (A-F). Results: It was seen that the sciatic nerve had already divided into its terminal branches before its exit into the gluteal regionin 23.91% extremities. The second commonestsite for the termination of sciatic nerve into its terminal branch was found to be at the middle region of the back of the thigh in 19.57% followed by its division in the popliteal fossa in 17.39%. Conclusion: From the current study we conclude that the level of division of sciatic nerve was variable and it is wise to go for other means to find out the level of termination of sciatic nerve before performing any procedure in that area.

scholarly journals Endoscopic Proximal Hamstring Repair and Ischial Bursectomy Using Modified Portal Placement and Patient Positioning

2018 ◽  
Vol 7 (11) ◽  
pp. e1071-e1078 ◽  
Author(s):  
Jovan R. Laskovski ◽  
Adam J. Kahn ◽  
Ryan J. Urchek ◽  
Carlos A. Guanche
Keyword(s):  
Patient Positioning ◽  
Proximal Hamstring ◽  
Portal Placement

Surgical Release for Proximal Hamstring Syndrome

2008 ◽  
Vol 36 (12) ◽  
pp. 2372-2378 ◽  
Author(s):  
Ian J. Young ◽  
Roger P. van Riet ◽  
Simon N. Bell
Keyword(s):  
Sciatic Nerve ◽  
Case Series ◽  
State Level ◽  
Postal Questionnaire ◽  
Hamstring Tendons ◽  
Level Of Evidence ◽  
Hamstring Muscles ◽  
Proximal Hamstring ◽  
Surgical Release

Background Pain in the buttock radiating to the popliteal fossa associated with hamstring weakness can be caused by tethering of the sciatic nerve to the proximal hamstring tendons. Contraction of the hamstring muscles produces traction on the sciatic nerve and subsequent symptoms. Hypothesis Surgical release of the proximal hamstring tendons, in particular from the sciatic nerve, will improve symptoms and function. Study Design Case series; Level of evidence, 4. Methods Forty-seven proximal hamstring surgical releases were performed in 44 patients (28 males, 16 females). The initial clinical findings and imaging were obtained from the medical notes, and additional data were obtained from a later questionnaire. The average age at the time of surgery was 29 years (range, 15–58 years). All patients were involved in high-level sports. Long-term follow-up was with a comprehensive postal questionnaire. Results Full follow-up was obtained in 43 patients (46 operations). Average follow-up was 53 months (range, 9–110). No major complications were encountered from the surgery. The average visual analog scale pain score decreased from 6.5 preoperatively to 2.0 ( P < .001). Two patients had increased pain, and pain was unchanged in 4. The average subjective weakness score decreased from 6.6 to 2.8 ( P < .001). Three patients reported increased weakness at follow-up, and 3 patients reported that the hamstring muscles felt equally weak. Thirty-four patients (77%) had returned to their previous sporting activities, with 30 patients still competing at or above state level, or professionally, after surgery. The average satisfaction score was 7.8. Six patients (14%) were not satisfied with the outcome of the procedure, 5 patients (11%) were somewhat satisfied, and 33 patients (75%) were very satisfied. Conclusion Proximal hamstring syndrome occurs mainly in patients participating in competitive sports. Release of the proximal hamstring tendons in this active group resulted in decreased pain and increased strength, and the majority of patients were satisfied with the procedure.

Deep gluteal space anatomy and its relationship with deep gluteal pain syndromes

2020 ◽  
pp. 112070002096625
Author(s):  
Maria J Leite ◽  
André R Pinho ◽  
Miguel R Silva ◽  
João C Lixa ◽  
Maria D Madeira ◽  
...  
Keyword(s):  
Average Distance ◽  
Femoral Anteversion ◽  
Ischial Tuberosity ◽  
Lower Limbs ◽  
Pain Syndromes ◽  
Deep Gluteal Syndrome ◽  
Anatomic Dissection ◽  
Trochanteric Region ◽  
Ischiofemoral Space ◽  
Proximal Hamstring

Introduction: Increasing interest has been seen in understanding the anatomy and biomechanics involved in the Deep Gluteal Syndrome, therefore the main objective of our paper was to define the anatomy of the deep gluteal space concerning the important osseous, muscular and neurological structures. Methods: 12 cadaveric models (24 hemipelvises) were used. We proceeded with classical anatomic dissection and evaluated numerous osseous, musculotendinous and neurologic structures and their relationships. We also determined the femoral anteversion and neck-shaft angles. Results: We found that 15.4% of lower limbs examined presented variations in the sciatic nerve (SN) emergence, and this was significantly longer in men. The distance from the SN to the trochanteric region was also significantly lower in males. The average ischiofemoral distance (IFD) was 2.5 ± 1.3 cm, at the same time that the structures comprised in that space showed superior areas, such as the quadratus femoris (QF) with 5.0 ± 1.1 cm and the SN with 1.4 ± 0.3 cm widths. Besides that, we also evaluated the distance from the SN to the lesser trochanter (LT) and the ischial tuberosity (IT), in the ischiofemoral space, reaching average values of 1.1 ± 0.7 cm and 1.5 ± 0.6 cm respectively. Regarding the relationship between the proximal hamstring insertion, we verified that the LT was at an average distance of 1.6 ± 1.1 cm, that the SN was only 0.2 ± 0.3 cm lateral to it, and the PN is just 2.6 ± 1.2 cm proximal to it. Conclusions: Our study confirmed the extreme variation in the SN origin that can contribute to the Piriformis syndrome. The IFD obtained in our study showed that this distance was small for the structures contained in this space. The proximal hamstring insertion showed a significantly more extended footprint in males, which puts the pudendal nerve (PN) at higher risk of iatrogenic injury.

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