Editorial Commentary: Endoscopic Treatment of Hamstring Pathology Shows Positive Patient Outcomes
Author(s): Quesada-Jimenez R, Kahana-Rojkind AH, Kingham YE, Kuhns BD, McCarroll TR, Domb BG
DOI Link:10.1016/j.eats.2024.103137
Objective:
To describe a minimally invasive, posterior endoscopic technique for sciatic neurolysis and piriformis tendon release in patients with piriformis syndrome unresponsive to conservative treatment.
Methodology:
The patient is positioned prone. The sciatic nerve is identified and tracked from distal to proximal, facilitating safe neurolysis. The piriformis tendon is then released under direct visualization using an endoscopic approach.
Key Findings:
- Posterior access enhances anatomical orientation and safety during nerve dissection.
- The approach enables effective identification and removal of adhesions surrounding the sciatic nerve.
- Minimally invasive release of the piriformis tendon may reduce morbidity compared to open procedures.
Conclusion:
This technique offers a reproducible, safe, and effective surgical option for treating refractory piriformis syndrome, with the benefits of endoscopic precision and reduced tissue disruption.
What Does This Mean for Providers?
For orthopedic and sports medicine specialists, this technique provides an advanced endoscopic solution for patients with piriformis syndrome who have failed conservative management. The posterior approach improves visualization and anatomical orientation, allowing for precise neurolysis and tendon release. This can lead to better outcomes with fewer complications than open surgery. Familiarity with endoscopic anatomy and proper surgical training are critical for successful execution.