Endoscopy for sciatic nerve entrapment in deep gluteal syndrome. A systematic review of literature

Abstract

Background: Deep gluteal syndrome (DGS) involves pain in the buttocks due to entrapment of the sciatic nerve (SN) in the deep gluteal space. This condition can be caused by various structures within this space, such as muscles and fibrous bands, which often cause significant pain and mobility problems. Diagnosis is based on clinical evaluation, diagnostic imaging and nerve conduction studies. At the same time, treatment ranges from physical therapy to surgery, with endoscopic treatment gaining popularity due to its reduced invasiveness and fewer side effects.

Material and methods: The systematic review was conducted in accordance with the guidelines established by the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The review involved an extensive search of five major databases: PubMed, Scopus, Embase, Medline and Cochrane. Articles that met the eligibility criteria were carefully evaluated according to predefined levels of evidence (LoE). Retrospective studies were specifically assessed using the Coleman Methodology Score (mCMS). This review was registered with the International Prospective Registry of Systematic Reviews (PROSPERO), ensuring the rigor and reliability of the study.

Results: The review identified 7 studies involving 312 patients (316 hips) with a mean age of 46.8 years and a mean follow-up of 25.1 months. The diagnosis was based on clinical, radiological and injection test results. Initial conservative treatment failed in all cases, necessitating surgery. Endoscopic sciatic nerve release showed success rates between 70 and 100%. Complications were minimal, with a recurrence rate of 2.5%, and revision surgery was required in 1.6% of cases. Postoperative results indicated a significant improvement in pain and function.

Conclusion: Endoscopic treatment of sciatic nerve entrapment in DGS is effective and safe when physical therapy has failed. Surgery offers significant pain relief and improved function with low complication rates. Despite limitations such as the predominance of retrospective studies and variability in patient management, the results support using this minimally invasive approach. Further high-quality research is needed to validate these results and optimize treatment protocols.

Keywords: DGS; Deep Gluteal Space; Deep Gluteal Syndrome; Endoscopic Surgery; Hip Endoscopy; Piriformis Syndrome; SNE; Sciatic Nerve; Sciatic Nerve Entrapment.