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Decompression of the Sciatic Nerve Entrapment Caused by Post-Inflammatory Scarring

  • Son, Byung-Chul (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Deog-Ryeong (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jeun, Sin Soo (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Sang-Won (Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2013.11.10
  • 심사 : 2014.04.06
  • 발행 : 2015.02.28

초록

A rare case of chronic pain of entrapment neuropathy of the sciatic nerve successfully relieved by surgical decompression is presented. A 71-year-old male suffered a chronic right buttock pain of duration of 7 years which radiating to the right distal leg and foot. His pain developed gradually over one year after underwenting drainage for the gluteal abscess seven years ago. A cramping buttock and intermittently radiating pain to his right foot on sitting, walking, and voiding did not respond to conventional treatment. An MRI suggested a post-inflammatory adhesion encroaching the proximal course of the sciatic nerve beneath the piriformis as it emerges from the sciatic notch. Upon exploration of the sciatic nerve, a fibrotic tendinous scar beneath the piriformis was found and released proximally to the sciatic notch. His chronic intractable pain was completely relieved within days after the decompression. However, thigh weakness and hypesthesia of the foot did not improve. This case suggest a need for of more prompt investigation and decompression of the chronic sciatic entrapment neuropathy which does not improve clinically or electrically over several months.

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참고문헌

  1. Adams JA : The pyriformis syndrome -- report of four cases and review of the literature. S Afr J Surg 18 : 13-18, 1980
  2. Banerjee T, Hall CD : Sciatic entrapment neuropathy. Case report. J Neurosurg 45 : 216-217, 1976 https://doi.org/10.3171/jns.1976.45.2.0216
  3. Bendszus M, Rieckmann P, Perez J, Koltzenburg M, Reiners K, Solymosi L : Painful vascular compression syndrome of the sciatic nerve caused by gluteal varicosities. Neurology 61 : 985-987, 2003 https://doi.org/10.1212/WNL.61.7.985
  4. Demaerel P, Petre C, Wilms G, Plets C : Sciatica caused by a dilated epidural vein : MR findings. Eur Radiol 9 : 113-114, 1999 https://doi.org/10.1007/s003300050640
  5. Durrani Z, Winnie AP : Piriformis muscle syndrome : an underdiagnosed cause of sciatica. J Pain Symptom Manage 6 : 374-379, 1991 https://doi.org/10.1016/0885-3924(91)90029-4
  6. Filler AG, Haynes J, Jordan SE, Prager J, Villablanca JP, Farahani K, et al. : Sciatica of nondisc origin and piriformis syndrome : diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine 2 : 99-115, 2005 https://doi.org/10.3171/spi.2005.2.2.0099
  7. Fishman LM, Schaefer MP : The piriformis syndrome is underdiagnosed. Muscle Nerve 28 : 646-649, 2003 https://doi.org/10.1002/mus.10482
  8. Henry AK : Extensile Exposure, ed 2. Edinburgh : Churchill Livingstone, 1973
  9. Hughes SS, Goldstein MN, Hicks DG, Pellegrini VD Jr : Extrapelvic compression of the sciatic nerve. An unusual cause of pain about the hip : report of five cases. J Bone Joint Surg Am 74 : 1553-1559, 1992 https://doi.org/10.2106/00004623-199274100-00017
  10. Puranen J, Orava S : The hamstring syndrome. A new diagnosis of gluteal sciatic pain. Am J Sports Med 16 : 517-521, 1988 https://doi.org/10.1177/036354658801600515
  11. Spinner RJ, Thomas NM, Kline DG : Failure of surgical decompression for a presumed case of piriformis syndrome. Case report. J Neurosurg 94 : 652-654, 2001 https://doi.org/10.3171/jns.2001.94.4.0652
  12. Spinner RJ, Tiel RL : Sciatic nerve compression and piriformis syndrome in Midha R, Zager EL (eds) : Surgery of Peripheral Nerves : A Case-Based Approach. New York : Thieme, 2008, pp186-191
  13. Stewart JD. The piriformis syndrome is overdiagnosed. Muscle Nerve 28 : 644-646, 2003 https://doi.org/10.1002/mus.10483
  14. Tiel RL : The surgical treatment of entrapment neuropathies of the lower extremity. Semin Neurosurg 12 : 109-124, 2001 https://doi.org/10.1055/s-2001-13004
  15. Tiel RL, Kline DG : Piriformis syndrome. J Neurosurg Spine 5 : 102-104; author reply 104-108, 2006 https://doi.org/10.3171/spi.2006.5.1.102

피인용 문헌

  1. Bilateral Sciatic Nerve Compression Due to Abnormal Termination of the Small Saphenous Vein Into the Popliteal Vein: A Rare Mechanism of Pseudoclaudication of the Lower Extremities vol.12, pp.9, 2015, https://doi.org/10.7759/cureus.10543