A novel method for sciatic nerve decompression: Cadaveric feasibility study with potential application to patients with piriformis syndrome

Richard Isaiah Tubbs, James C. Barton, Caroline C. Watson, Theofanis Kollias, Robert J. Ward, Marios Loukas, Nicholas Barbaro, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

Abstract

Introduction Approaches for proximal sciatic nerve decompression use a transgluteal route, but are associated with morbidity and complications. An alternative anterior approach to the sciatic nerve was designed. Methods Five adult human cadavers (10 sides) were used. In the supine position and with lower limbs abducted, an incision was made 3-cm inferolateral to the pubic tubercle of each specimen. With blunt dissection, a muscle-splitting approach through the obturator foramen was performed through the underlying adductor muscles and deeper obturator muscles that traversed the obturator foramen. Within the pelvis, a laparoscope was inserted in the surgical corridor, which was extraperitoneal. The obturator neurovascular bundle was identified medially and followed posterolaterally toward the greater sciatic foramen. The sciatic nerve was identified. The piriformis muscle was identified as it exited the greater sciatic foramen. Microscissors were inserted and under visualization with the laparoscope, the piriformis muscle was transected near the spine. Results The piriformis was well visualized and transected. The muscle was best visualized inferolateral to the sciatic nerve. No gross damage to the sciatic nerve or surrounding neurovascular structures occurred. Mean distance from the superomedial edge of the obturator foramen to the ischial spine was 7.2 cm for left sides and 7.3 cm for right sides. Conclusions Use of a laparoscope to approach the piriformis muscle from an anterior intrapelvic, extraperitoneal approach via the obturator foramen is feasible. Clinical use of this method is in order to demonstrate use in patients with suspected compression of the sciatic nerve by the piriformis muscle.

Original languageEnglish (US)
Pages (from-to)40-43
Number of pages4
JournalTranslational Research in Anatomy
Volume1
DOIs
StatePublished - Dec 1 2015

Fingerprint

Piriformis Muscle Syndrome
Feasibility Studies
Sciatic Nerve
Decompression
Muscles
Laparoscopes
Spine
Supine Position
Pelvis
Cadaver
Dissection
Lower Extremity

Keywords

  • Anatomy
  • Endoscopy
  • Gluteal muscles
  • Laparoscopy
  • Piriformis
  • Sciatic nerve
  • Surgery

ASJC Scopus subject areas

  • Anatomy

Cite this

A novel method for sciatic nerve decompression : Cadaveric feasibility study with potential application to patients with piriformis syndrome. / Tubbs, Richard Isaiah; Barton, James C.; Watson, Caroline C.; Kollias, Theofanis; Ward, Robert J.; Loukas, Marios; Barbaro, Nicholas; Cohen-Gadol, Aaron.

In: Translational Research in Anatomy, Vol. 1, 01.12.2015, p. 40-43.

Research output: Contribution to journalArticle

Tubbs, Richard Isaiah ; Barton, James C. ; Watson, Caroline C. ; Kollias, Theofanis ; Ward, Robert J. ; Loukas, Marios ; Barbaro, Nicholas ; Cohen-Gadol, Aaron. / A novel method for sciatic nerve decompression : Cadaveric feasibility study with potential application to patients with piriformis syndrome. In: Translational Research in Anatomy. 2015 ; Vol. 1. pp. 40-43.
@article{2474732fbce641e2899e07b5272f162b,
title = "A novel method for sciatic nerve decompression: Cadaveric feasibility study with potential application to patients with piriformis syndrome",
abstract = "Introduction Approaches for proximal sciatic nerve decompression use a transgluteal route, but are associated with morbidity and complications. An alternative anterior approach to the sciatic nerve was designed. Methods Five adult human cadavers (10 sides) were used. In the supine position and with lower limbs abducted, an incision was made 3-cm inferolateral to the pubic tubercle of each specimen. With blunt dissection, a muscle-splitting approach through the obturator foramen was performed through the underlying adductor muscles and deeper obturator muscles that traversed the obturator foramen. Within the pelvis, a laparoscope was inserted in the surgical corridor, which was extraperitoneal. The obturator neurovascular bundle was identified medially and followed posterolaterally toward the greater sciatic foramen. The sciatic nerve was identified. The piriformis muscle was identified as it exited the greater sciatic foramen. Microscissors were inserted and under visualization with the laparoscope, the piriformis muscle was transected near the spine. Results The piriformis was well visualized and transected. The muscle was best visualized inferolateral to the sciatic nerve. No gross damage to the sciatic nerve or surrounding neurovascular structures occurred. Mean distance from the superomedial edge of the obturator foramen to the ischial spine was 7.2 cm for left sides and 7.3 cm for right sides. Conclusions Use of a laparoscope to approach the piriformis muscle from an anterior intrapelvic, extraperitoneal approach via the obturator foramen is feasible. Clinical use of this method is in order to demonstrate use in patients with suspected compression of the sciatic nerve by the piriformis muscle.",
keywords = "Anatomy, Endoscopy, Gluteal muscles, Laparoscopy, Piriformis, Sciatic nerve, Surgery",
author = "Tubbs, {Richard Isaiah} and Barton, {James C.} and Watson, {Caroline C.} and Theofanis Kollias and Ward, {Robert J.} and Marios Loukas and Nicholas Barbaro and Aaron Cohen-Gadol",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.tria.2015.10.006",
language = "English (US)",
volume = "1",
pages = "40--43",
journal = "Translational Research in Anatomy",
issn = "2214-854X",
publisher = "Elsevier GmbH",

}

TY - JOUR

T1 - A novel method for sciatic nerve decompression

T2 - Cadaveric feasibility study with potential application to patients with piriformis syndrome

AU - Tubbs, Richard Isaiah

AU - Barton, James C.

AU - Watson, Caroline C.

AU - Kollias, Theofanis

AU - Ward, Robert J.

AU - Loukas, Marios

AU - Barbaro, Nicholas

AU - Cohen-Gadol, Aaron

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Introduction Approaches for proximal sciatic nerve decompression use a transgluteal route, but are associated with morbidity and complications. An alternative anterior approach to the sciatic nerve was designed. Methods Five adult human cadavers (10 sides) were used. In the supine position and with lower limbs abducted, an incision was made 3-cm inferolateral to the pubic tubercle of each specimen. With blunt dissection, a muscle-splitting approach through the obturator foramen was performed through the underlying adductor muscles and deeper obturator muscles that traversed the obturator foramen. Within the pelvis, a laparoscope was inserted in the surgical corridor, which was extraperitoneal. The obturator neurovascular bundle was identified medially and followed posterolaterally toward the greater sciatic foramen. The sciatic nerve was identified. The piriformis muscle was identified as it exited the greater sciatic foramen. Microscissors were inserted and under visualization with the laparoscope, the piriformis muscle was transected near the spine. Results The piriformis was well visualized and transected. The muscle was best visualized inferolateral to the sciatic nerve. No gross damage to the sciatic nerve or surrounding neurovascular structures occurred. Mean distance from the superomedial edge of the obturator foramen to the ischial spine was 7.2 cm for left sides and 7.3 cm for right sides. Conclusions Use of a laparoscope to approach the piriformis muscle from an anterior intrapelvic, extraperitoneal approach via the obturator foramen is feasible. Clinical use of this method is in order to demonstrate use in patients with suspected compression of the sciatic nerve by the piriformis muscle.

AB - Introduction Approaches for proximal sciatic nerve decompression use a transgluteal route, but are associated with morbidity and complications. An alternative anterior approach to the sciatic nerve was designed. Methods Five adult human cadavers (10 sides) were used. In the supine position and with lower limbs abducted, an incision was made 3-cm inferolateral to the pubic tubercle of each specimen. With blunt dissection, a muscle-splitting approach through the obturator foramen was performed through the underlying adductor muscles and deeper obturator muscles that traversed the obturator foramen. Within the pelvis, a laparoscope was inserted in the surgical corridor, which was extraperitoneal. The obturator neurovascular bundle was identified medially and followed posterolaterally toward the greater sciatic foramen. The sciatic nerve was identified. The piriformis muscle was identified as it exited the greater sciatic foramen. Microscissors were inserted and under visualization with the laparoscope, the piriformis muscle was transected near the spine. Results The piriformis was well visualized and transected. The muscle was best visualized inferolateral to the sciatic nerve. No gross damage to the sciatic nerve or surrounding neurovascular structures occurred. Mean distance from the superomedial edge of the obturator foramen to the ischial spine was 7.2 cm for left sides and 7.3 cm for right sides. Conclusions Use of a laparoscope to approach the piriformis muscle from an anterior intrapelvic, extraperitoneal approach via the obturator foramen is feasible. Clinical use of this method is in order to demonstrate use in patients with suspected compression of the sciatic nerve by the piriformis muscle.

KW - Anatomy

KW - Endoscopy

KW - Gluteal muscles

KW - Laparoscopy

KW - Piriformis

KW - Sciatic nerve

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84964374626&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964374626&partnerID=8YFLogxK

U2 - 10.1016/j.tria.2015.10.006

DO - 10.1016/j.tria.2015.10.006

M3 - Article

AN - SCOPUS:84964374626

VL - 1

SP - 40

EP - 43

JO - Translational Research in Anatomy

JF - Translational Research in Anatomy

SN - 2214-854X

ER -