Variant anatomy of sciatic nerve and their clinical implications

Z. Aslı Aktan İkiz; Okan Bilge; Hülya Üçerler; Servet Çelik; Erengül Boduç

doi:10.19161/etd.414980

TR EN

Siyatik sinirin varyasyon anatomisi ve klinik yansımaları

Öz

Amaç: Çalışmanın amacı musculus piriformis, siyatik sinir ve dallarının varyasyonlarını göstermek ve klinik önemini tartışmaktır.

Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi, Anatomi Anabilim Dalı’nda formalin ile fikse edilmiş 26 erkek kadavraya ait 52 adet gluteal bölge ve alt ekstremite değerlendirildi. Siyatik sinir ve musculus piriformis arasındaki anatomik ilişki ile uylukta siyatik sinirin dallanma seviyesi kaydedildi.

Bulgular: Alt ekstremitelerin %84.62’sinde siyatik sinir pelvisten tek dal halinde, varyasyonsuz olarak çıktı. Siyatik sinirin dallanma varyasyonu %23.08 olarak tespit edildi. On iki adet olarak bulunan yüksekten ayrılmanın 8’i gluteal bölgede idi (%15.38). Dört alt ekstremitede (%7.69) nervus peroneus communis ve nervus tibialis derin gluteal bölgeye foramen ischiadicum majus yolu ile musculus piriformis’in altından ayrı ayrı girdi. Dört alt ekstremitede ise (%7.69) iki ayrı dal musculus piriformis’in üzerinden, içinden (ya da altından) geçti ve nervus tibialis musculus piriformis’in altından geçerken bu iki dal da nervus peroneus communis’i oluşturmak üzere daha sonra birleşti. On iki örneğin ikisinde, yüksekte ayrılma unilateral olarak uyluğun 1/3 üst bölümünde izlendi. Siyatik sinirin fossa poplitea’da dallarına ayrılması da iki alt ekstremitede görüldü (%3.85).

Sonuç: Siyatik sinirin musculus piriformis çevresindeki veya uyluktaki varyasyonları; piriformis sendromu, total kalça protezi sonrası ortaya çıkan paralizi, gluteal bölgeye uygulanan intramusküler enjeksiyonlar ve başarısız popliteal sinir bloğu yönü ile tartışıldı.

Anahtar Kelimeler

Siyatik sinir,piriformis sendromu,paralizi,kalça replasmanı,anatomik varyasyonlar.

Variant anatomy of sciatic nerve and their clinical implications

Abstract

Aim: The aim of present study was to demonstrate the variations of piriformis muscle, sciatic nerve and its branches and discuss their clinical importance.

Materials and Methods: Fifty-two gluteal and lower limb regions of 26 formalin fixed male cadavers were evaluated in Ege University Faculty of Medicine, Department of Anatomy. The anatomical relationship between the sciatic nerve and the piriformis muscle, and division level of sciatic nerve in thigh was recorded.

Results: The sciatic nerve exited the pelvis as a single branch through the infrapiriform foramen with no variation in 84.62% of the lower limbs. The division variations of sciatic nerve were determined in 23.08%. In 8 of 12 high divisions were observed in gluteal regions (15.38%). The common peroneal nerve and the tibial nerve entered deep gluteal region via the greater sciatic foramen below piriformis muscle separately in four lower limbs (7.69%). Two separate nerve divisions passed above and through (or below) the piriformis muscle and then combined together to form common peroneal nerve while tibial nerve passing below the piriformis muscle in 4 lower limbs (7.69%). In 2 of 12, high division occurred in the 1/3 upper portion of the thigh unilaterally (3.85%). The division of sciatic nerve in the popliteal fossa was seen in two lower limbs (3.85%).

Conclusion: The clinical importance of the sciatic nerve around the piriformis muscle or in the thigh was discussed for piriformis syndrome, palsy after total hip arthroplasty, intramuscular injections in gluteal region and failed popliteal nerve block.

Keywords

Sciatic nerve,piriformis syndrome,palsy,hip replacement,anatomical variations.

References

Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat 2014;36(3):273-80.
Cassidy L, Walters A, Bubb K, Shoja MM, Tubbs RS, Loukas M. Piriformis syndrome: Implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat 2012;34(6):479-86.
Kanawati AJ. Variations of the sciatic nerve anatomy and blood supply in the gluteal region: A review of the literature. ANZ J Surg 2014;84(11):816-9.
Pokorny D, Jahoda D, Veigl D, Pinskerová V, Sosna A. Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat 2006;28(1):88-91.
Smoll NR. Variations of the piriformis and sciatic nerve with clinical consequence: A review. Clin Anat 2010;23(1):8-17.
Adibatti M, V S. Study on variant anatomy of sciatic nerve. J Clin Diagn Res 2014;8(8):AC07-9.
Grgić V. Piriformis muscle syndrome: Etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy. Lijec Vjesn 2013;135(1-2):33-40.
Güvençer M, Iyem C, Akyer P, Tetik S, Naderi S. Variations in the high division of the sciatic nerve and relationship between the sciatic nerve and the piriformis. Turk Neurosurg 2009;19(2):139-44.

Prakash, Bhardwaj AK, Devi MN, Sridevi NS, Rao PK, Singh G. Sciatic nerve division: A cadaver study in the Indian population and review of the literature. Singapore Med J 2010;51(9):721-3.
Coelho P, Melo C, Bernardes A. Rare anatomical variation of absence of the sciatic nerve: Completely substituted by the tibial and common fibular nerve. Acta Med Port 2013;26(3):283-6.
Battaglia PJ, Scali F, Enix DE. Co-presentation of unilateral femoral and bilateral sciatic nerve variants in one cadaver: A case report with clinical implications. Chiropr Man Therap 2012;20(1):34.
Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: A systematic review. Eur Spine J 2010;19(12):2095-109.
Delabie A, Peltier J, Havet E, Page C, Foulon P, Le Gars D. Relationships between piriformis muscle and sciatic nerve: radioanatomical study with 104 buttocks. Morphologie 2013;97(316):12-8.
Gomes BA, Ramos MR, Fiorelli RK, Almeida CR, Fiorelli SK. Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy. Rev Col Bras Cir 2014;41(6):440-4.
Vloka JD, Hadzić A, April E, Thys DM. The division of the sciatic nerve in the popliteal fossa: Anatomical implications for popliteal nerve blockade. Anesth Analg 2001;92(1):215-7.
Saleh HA, El-fark MM, Abdel-Hamid GA. Anatomical variation of sciatic nerve division in the popliteal fossa and its implication in popliteal nerve blockade. Folia Morphol (Warsz) 2009;68(4):256-9.
Chiang EP, Dangerfield P, Asay D, Cucchiaro A, Berger JS. Ultrasound imaging of the sciatic nerve division in the popliteal fossa: a volunteer study. Open J Anesthesiol 2013;3(5):288-292.
Beaton LE, Anson BJ. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec 1937;70(1):1-5.
Beaton LE, Anson BJ. The sciatic nerve and the piriformis muscle: Their interrelation a possible cause of coccygodynia. J Bone Joint Surg 1938;20(3):686-8.
Pais D, Casal D, Bettencourt Pires MA, Furtado A, et al. Sciatic nerve high division: two different anatomical variants. Acta Med Port 2013;26(3):208-11.
Broadhurst NA, Simmons DN, Bond MJ. Piriformis syndrome: Correlation of muscle morphology with symptoms and signs. Arch Phys Med Rehabil 2004;85(12):2036-39.
Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle Nerve 2009;40(1):10-18.
Moore KL, Dalley AF. Clinically Oriented Anatomy. Fourth Edition. London: Lippincott, Williams & Wilkins; 1999:560.
Khan RJ, Fick D, Khoo P, Yao F, Nivbrant B, Wood D. Less invasive total hip arthroplasty: Description of a new technique. J Arthroplasty 2006;21(7):1038-46.
Sosna A, Pokorny D, Jahoda D. Sciatic nerve palsy after total hip replacement. J Bone Joint Surg 2005;87(8):1140-1.

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Z. Aslı Aktan İkiz ^*
0000-0001-8949-1691
Türkiye

Okan Bilge
0000-0002-8993-2271
Türkiye

Hülya Üçerler
0000-0002-8261-9442
Türkiye

Servet Çelik
0000-0002-1102-4417
Türkiye

Erengül Boduç
0000-0001-8872-1993
Türkiye

Publication Date

June 1, 2018

Submission Date

February 15, 2017

Acceptance Date

April 21, 2017

Published in Issue

Year 2018 Volume: 57 Number: 2

DOI

https://doi.org/10.19161/etd.414980

IZ

https://izlik.org/JA42WB96HZ

Cite

RIS / Bibtex

Vancouver

1.Z. Aslı Aktan İkiz, Okan Bilge, Hülya Üçerler, Servet Çelik, Erengül Boduç. Variant anatomy of sciatic nerve and their clinical implications. EJM. 2018 Jun. 1;57(2):88-93. doi:10.19161/etd.414980

Variant anatomy of sciatic nerve and their clinical implications

Siyatik sinirin varyasyon anatomisi ve klinik yansımaları

Öz

Anahtar Kelimeler

Variant anatomy of sciatic nerve and their clinical implications

Abstract

Keywords

References

Details

Primary Language

Subjects

Journal Section

Authors

Publication Date

Submission Date

Acceptance Date

Published in Issue

DOI

IZ

Cite

Cited By

Sciatic Nerve and Its Anatomical Variations: In-Depth Understanding Acquired During Dissection Classes

Anatomical variations of the sciatic nerve: a literature review on morphology and clinical implications

Racial variations in sciatic nerve anatomy: A systematic review and meta-analysis