Paper #32 - ISHA Annual Scientific Meeting 2016

Arthroscopic Decompression Of Sciatic Neuropathy Caused By Cysts Arising From Hip Joint

Pilsung Kim, MD, Seoul SOUTH KOREA
Deuk-Soo Hwang, MD, Taejeon SOUTH KOREA
Jung-Mo Hwang, MD, Gumi, Gyeongsangbuk-do SOUTH KOREA
Woo-Yong Lee, MD, Daejeon SOUTH KOREA
Chang-Kyun Noh, MD, Daejeon SOUTH KOREA
Dong-Yeol Kim, MD, Daejeon SOUTH KOREA
Long Zheng, MD, Daejeon SOUTH KOREA

Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, SOUTH KOREA

FDA Status Not Applicable

Summary: Arthroscopic decompression for sciatic neuralgia caused by cysts arising from hip joint was showen clinically successful with minimal invasive methods.

Abstract:
Introduction
Para-articular cysts frequently are seen on routine imaging examinations. We found the cysts causing sciatic neuropathy located posteriorly and reported the techniques and clinical results of arthroscopic decompression of symptomatic sciatic neuropathy caused by cysts arising from hip joint.

Materials and Methods
Between 2007 and 2015, we retrospectively reviewed four patients with the sciatic neuralgia caused by perineural cysts who underwent arthroscopic decompression. Under the semi-prone position on the operating table, we made two portals just posterior margin of the greater trochanteric area with about 5 cm intervals. Under the fluoroscopic guidance, arthroscopic obturator and guide needle were inserted focused to sciatic foramen which the sciatic nerve coming out from anterior pelvic cavity to posterior gluteal area. After examining the perineural cysts through the course of sciatic nerve, we performed cystotomy and drained the fluid using an arthroscopic equipment.

Results
The affected sides were two right and two left sides. The mean age was 52.0 years (range: 40–69 years). The mean follow-up period after surgery was 39.7 months (range: 3–72 months). Preoperative MRI revealed the acetabular degenerative labral lesions in all cases. Pre- and intra-operatively, we found the all cysts were connected to the hip joint with the stalks. The cysts were located around sciatic foramen through the course the sciatic nerve. There were synovial cysts in three cases and ganglion cyst in the other. At the final follow-up after operation, the visual analogue scale for pain score improved from 8 (range: 7–10) to 1 (range: 0–3). There were no recurrence of sciatic neuralgia.

Conclusions
Posterior located cysts which were connecting to the hip joint could compressed the sciatic nerve after penetrating into the sciatic foramen. Arthroscopic decompression for sciatic neuralgia caused by cysts arising from hip joint was showen clinically successful with minimal invasive methods. In addition, More attentions should be paid intraarticular pathology if the symptom would rise from the hip joint.

Keywords: Hip, sciatic neuralgia, para-articular cyst, arthroscopic decompression