Rémy Coulomb1, Anis Khelifi2, Martin Bertrand2, Olivier Mares2, Olivier May3, Philippe Marchand2, Pascal Kouyoumdjian2. 1. Service de chirurgie orthopédique et traumatologique, CHU de Carémeau, place du Pr-Debré, 30029 Nîmes cedex 9, France. Electronic address: coulomb.remy@neuf.fr. 2. Service de chirurgie orthopédique et traumatologique, CHU de Carémeau, place du Pr-Debré, 30029 Nîmes cedex 9, France. 3. Clinique Médipole-Garonne, 45, rue Gironis, 31036 Toulouse cedex 1, France.
Abstract
BACKGROUND: Endoscopic piriformis release (EPR) is among the available treatments for piriformis syndrome. This procedure typically involves dividing the muscle near the sciatic nerve in the sub-gluteal space, which contains numerous blood vessels and nerves. The objectives of this prospective cadaver study were: 1) to assess the reproducibility and quality of endoscopic piriformis tenotomy near the greater trochanter; 2) to detect iatrogenic injuries to the lateral hip rotators, nerves, and vessels; 3) and to define the surgical safety margins relative to the sciatic nerve and inferior gluteal bundle. HYPOTHESIS: EPR at the greater trochanter ensures full release of the muscle with a limited risk of neuro-vascular injury. MATERIAL AND METHODS: EPR was performed via two portals on 10 cadaver hips preserved in zinc chloride and placed in the prone position. A third, ancillary portal was required in 7 cases. The area was then dissected with the Kocher-Langenbeck approach to allow an assessment of the tenotomy, detect iatrogenic injuries, and measure the distances separating the tenotomy site from the sciatic nerve and inferior gluteal artery. RESULTS: Complete tenotomy was achieved in 9 (90%) cases. The tendon adhered to the capsule in 2 (20%) cases and showed acquired avulsion in 1 case. No injuries to the sciatic nerve or inferior gluteal artery occurred. Mean distances from the tenotomy site were 5.21±0.59cm (range, 4.5-6.6cm) for the sciatic nerve and 7.1±0.89cm (range, 5.4-8.5cm) for the inferior gluteal artery. DISCUSSION: EPR by a tenotomy at the greater trochanter without sciatic nerve release provides full release of the muscle with satisfactory safety margins and a short learning curve. LEVEL OF EVIDENCE: III, prospective cadaver case-control study.
BACKGROUND: Endoscopic piriformis release (EPR) is among the available treatments for piriformis syndrome. This procedure typically involves dividing the muscle near the sciatic nerve in the sub-gluteal space, which contains numerous blood vessels and nerves. The objectives of this prospective cadaver study were: 1) to assess the reproducibility and quality of endoscopic piriformis tenotomy near the greater trochanter; 2) to detect iatrogenic injuries to the lateral hip rotators, nerves, and vessels; 3) and to define the surgical safety margins relative to the sciatic nerve and inferior gluteal bundle. HYPOTHESIS: EPR at the greater trochanter ensures full release of the muscle with a limited risk of neuro-vascular injury. MATERIAL AND METHODS: EPR was performed via two portals on 10 cadaver hips preserved in zinc chloride and placed in the prone position. A third, ancillary portal was required in 7 cases. The area was then dissected with the Kocher-Langenbeck approach to allow an assessment of the tenotomy, detect iatrogenic injuries, and measure the distances separating the tenotomy site from the sciatic nerve and inferior gluteal artery. RESULTS: Complete tenotomy was achieved in 9 (90%) cases. The tendon adhered to the capsule in 2 (20%) cases and showed acquired avulsion in 1 case. No injuries to the sciatic nerve or inferior gluteal artery occurred. Mean distances from the tenotomy site were 5.21±0.59cm (range, 4.5-6.6cm) for the sciatic nerve and 7.1±0.89cm (range, 5.4-8.5cm) for the inferior gluteal artery. DISCUSSION: EPR by a tenotomy at the greater trochanter without sciatic nerve release provides full release of the muscle with satisfactory safety margins and a short learning curve. LEVEL OF EVIDENCE: III, prospective cadaver case-control study.
Authors: Neeraj Vij; Hayley Kiernan; Roy Bisht; Ian Singleton; Elyse M Cornett; Alan David Kaye; Farnad Imani; Giustino Varrassi; Maryam Pourbahri; Omar Viswanath; Ivan Urits Journal: Anesth Pain Med Date: 2021-02-02