Todd P. Pierce, M. D. , Casey M. Pierce, M. D. , Kimona Issa, M. D

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Presentation transcript:

Arthroscopic Piriformis Release—A Technique for Sciatic Nerve Decompression Todd P. Pierce, M.D., Casey M. Pierce, M.D., Kimona Issa, M.D., Vincent K. McInerney, M.D., Anthony Festa, M.D., Anthony J. Scillia, M.D. Arthroscopy Techniques Volume 6, Issue 1, Pages e163-e166 (February 2017) DOI: 10.1016/j.eats.2016.09.012 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 The patient is placed in the lateral position using a bean bag. The greater trochanter is then identified and the posterolateral and accessory lateral portals are marked using a surgical marker and created. (ALP, accessory lateral portal; GT, greater trochanter; PL, posterolateral.) Arthroscopy Techniques 2017 6, e163-e166DOI: (10.1016/j.eats.2016.09.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 A bursectomy is being performed using electrocautery to expose the short external rotators and the piriformis. The dissection is carried out medially to expose the sciatic nerve with adhesive bands dissected off proximally and distally. Arthroscopy Techniques 2017 6, e163-e166DOI: (10.1016/j.eats.2016.09.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 The piriformis tendon has been identified proximal to the muscular portion of the short external rotators after a complete bursectomy. Arthroscopy Techniques 2017 6, e163-e166DOI: (10.1016/j.eats.2016.09.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 The sciatic nerve has been sufficiently exposed by releasing the nerve both proximally and distally. Arthroscopy Techniques 2017 6, e163-e166DOI: (10.1016/j.eats.2016.09.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 A proximal neurolysis is performed to identify the complete course of the sciatic nerve. Arthroscopy Techniques 2017 6, e163-e166DOI: (10.1016/j.eats.2016.09.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 A distal neurolysis is performed to identify the complete course of the sciatic nerve. Arthroscopy Techniques 2017 6, e163-e166DOI: (10.1016/j.eats.2016.09.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 The piriformis is completely released off the piriformis fossa and the greater trochanter using electrocautery. Care is taken to perform a complete release so as to allow the tendon to heal at a lengthened position to decrease the chances of recurrence of sciatic nerve entrapment. Arthroscopy Techniques 2017 6, e163-e166DOI: (10.1016/j.eats.2016.09.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 A completed piriformis muscle release. Arthroscopy Techniques 2017 6, e163-e166DOI: (10.1016/j.eats.2016.09.012) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions