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Endoscopic Sciatic Nerve Decompression for Deep Gluteal Syndrome: Prone and Supine Approaches

February 10, 2018

Contributors: Amos Dai, BS; Dylan Lowe, MD; Nicholas Ramos, MD; Thomas Youm, MD, FAAOS; Thomas Youm, MD, FAAOS

Purpose: Arthroscopic hip techniques have evolved in recent years, allowing for endoscopic access to extra-articular spaces about the hip, including the deep gluteal space, which is a posterior extension of the peritrochanteric region. These endoscopic techniques are a less invasive treatment option for patients with extra-articular pathology traditionally managed via an open procedure. Deep gluteal syndrome, which refers to entrapment and/or compression of the sciatic nerve as it courses under the gluteus maximus muscle, is a common extraspinal etiology of buttock and lower extremity pain. Traditionally, patients with persistent symptoms after a trial of nonsurgical treatment were candidates for open sciatic nerve decompression and neurolysis. A paucity of literature is available on the technique and outcomes of endoscopic management of deep gluteal syndrome. This video reviews the indications and techniques for endoscopic access to the deep gluteal space for sciatic nerve decompression. Methods: The video presents two case studies of patients with deep gluteal syndrome. The video reviews patient history, physical examination findings, diagnostic workup, pertinent imaging findings, and surgical indications. Two different endoscopic approaches to the deep gluteal space, supine and prone, are demonstrated. Each approach involves a review of key technical points, including operating room setup, patient positioning, portal placement, and endoscopic anatomy. Offending pathology is correlated with preoperative imaging studies, and techniques for safe sciatic nerve decompression are described. Results: After demonstrating the surgical techniques, the video reviews the postoperative protocol for patients who undergo endoscopic management of deep gluteal syndrome. Technical pearls for the procedure are highlighted, and limited outcome studies published in the literature are reviewed. Conclusion: Deep gluteal space pathology has been traditionally managed surgically via an open procedure. Evolving endoscopic techniques afford safe and reliable access to this anatomic compartment, providing a promising minimally-invasive treatment alternative for the management of deep gluteal syndrome.

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