{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T11:34:09Z","timestamp":1774006449169,"version":"3.50.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T00:00:00Z","timestamp":1621382400000},"content-version":"vor","delay-in-days":138,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Piriformis syndrome is a well-known extra-spinal cause of sciatica characterized by the entrapment of the sciatic nerve by variant bundles of the piriformis muscles in the deep gluteal space. In this case series, we describe the entrapment of intrapelvic portions of the sacral nerve roots by a variant bundle of the piriformis muscle originating medially to the sacral foramina, the surgical technique for the laparoscopic treatment of this condition, and the outcomes of the first eight cases treated with this technique. Five female and three male patients presenting with sciatica, pudendal pain and lower urinary tract symptoms underwent a laparoscopic exploration of the intrapelvic portion of the sacral nerve roots and transection of the abnormal piriformis bundle. Surgical technique is demonstrated in the Supplementary Video. Clinical success was achieved in seven of the eight patients, with a reduction of pain numeric rating scale from 8.5 (\u00b11.2; 7\u201310) pre-operatively to 2.1 (\u00b12.6; 0\u20137), 1-year following surgery. In conclusion, entrapment of intrapelvic portions of the sacral nerve roots by variant bundles of the piriformis originating medially to the sacral foramina are an extraspinal cause of sciatica, which can be treated though a laparoscopic approach.<\/jats:p>","DOI":"10.1093\/jhps\/hnab041","type":"journal-article","created":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T06:11:10Z","timestamp":1621404670000},"page":"132-138","source":"Crossref","is-referenced-by-count":8,"title":["Intrapelvic entrapment of sacral nerve roots by abnormal bundles of the piriformis muscle: description of an extra-spinal cause of sciatica and pudendal neuralgia"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2310-748X","authenticated-orcid":false,"given":"Corey","family":"Sermer","sequence":"first","affiliation":[{"name":"Mount Sinai Hospital, 700 University Avenue, Room 8-917, Toronto, ON M5S 1Z5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrienne L K","family":"Li","sequence":"additional","affiliation":[{"name":"Mount Sinai Hospital, 700 University Avenue, Room 8-917, Toronto, ON M5S 1Z5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo L","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Federal University of S\u00e3o Paulo. Rua Napole\u00e3o de Barros, 608,\u00a0S\u00e3o Paulo, SP, Brazil"},{"name":"Department of Gynecology, Faculdade de Ci\u00eancias M\u00e9dicas da Santa Casa de S\u00e3o Paulo. Rua Doutor Ces\u00e1rio Mota J\u00fanior, 42,\u00a0S\u00e3o Paulo, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augusta M","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Federal University of S\u00e3o Paulo. Rua Napole\u00e3o de Barros, 608,\u00a0S\u00e3o Paulo, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giancarlo","family":"Polesello","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Faculdade de Ci\u00eancias M\u00e9dicas da Santa Casa de S\u00e3o Paulo. Rua Doutor Ces\u00e1rio Mota J\u00fanior, 42,\u00a0S\u00e3o Paulo, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Tokechi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hospital S\u00edrio-Liban\u00eas, Rua Dona Adma Jafet, 91, S\u00e3o Paulo, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Cancelliere","sequence":"additional","affiliation":[{"name":"Mount Sinai Hospital, 700 University Avenue, Room 8-917, Toronto, ON M5S 1Z5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3184-8229","authenticated-orcid":false,"given":"Nucelio","family":"Lemos","sequence":"additional","affiliation":[{"name":"Mount Sinai Hospital, 700 University Avenue, Room 8-917, Toronto, ON M5S 1Z5, Canada"},{"name":"Department of Gynecology, Federal University of S\u00e3o Paulo. Rua Napole\u00e3o de Barros, 608,\u00a0S\u00e3o Paulo, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,5,19]]},"reference":[{"key":"2021092319115086200_hnab041-B1","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1093\/bja\/aem238","article-title":"Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management","volume":"99","author":"Stafford","year":"2007","journal-title":"Br J Anaesth"},{"key":"2021092319115086200_hnab041-B2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1249\/JSR.0000000000000110","article-title":"Piriformis syndrome: a cause of nondiscogenic sciatica","volume":"14","author":"Cass","year":"2015","journal-title":"Curr Sports Med Rep"},{"key":"2021092319115086200_hnab041-B3","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1002\/pmrj.12189","article-title":"Piriformis syndrome: a narrative review of the anatomy, diagnosis, and treatment","volume":"11","author":"Probst","year":"2019","journal-title":"PM R"},{"key":"2021092319115086200_hnab041-B4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1002\/mus.21318","article-title":"Piriformis syndrome, diagnosis and treatment","volume":"40","author":"Kirschner","year":"2009","journal-title":"Muscle Nerve"},{"key":"2021092319115086200_hnab041-B5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/ar.1090700102","article-title":"The relation of the sciatic nerve and of its subdivisions to the piriformis muscle","volume":"70","author":"Beaton","year":"1937","journal-title":"Anat Rec"},{"key":"2021092319115086200_hnab041-B6","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/0002-9610(47)90345-0","article-title":"Pyriformis syndrome in relation to sciatic pain","volume":"73","author":"Robinson","year":"1947","journal-title":"Am J Surg"},{"key":"2021092319115086200_hnab041-B7","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1159\/000145121","article-title":"Contribution to the etiological explanation of the piriformis syndrome","volume":"105","author":"Pecina","year":"1979","journal-title":"Acta Anat (Basel"},{"key":"2021092319115086200_hnab041-B8","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s00276-013-1180-7","article-title":"Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome","volume":"36","author":"Natsis","year":"2014","journal-title":"Surg Radiol Anat"},{"key":"2021092319115086200_hnab041-B9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/ca.20893","article-title":"Variations of the piriformis and sciatic nerve with clinical consequence: a review","volume":"23","author":"Smoll","year":"2010","journal-title":"Clin Anat"},{"key":"2021092319115086200_hnab041-B10","doi-asserted-by":"crossref","first-page":"4681","DOI":"10.1007\/s00330-018-5447-6","article-title":"Is it painful to be different? Sciatic nerve anatomical variants on MRI and their relationship to piriformis syndrome","volume":"28","author":"Bartret","year":"2018","journal-title":"Eur Radiol"},{"key":"2021092319115086200_hnab041-B11","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00276-006-0169-x","article-title":"Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome","volume":"29","author":"Windisch","year":"2007","journal-title":"Surg Radiol Anat"},{"key":"2021092319115086200_hnab041-B12","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1080\/13645700410005392","article-title":"The \"Laparoscopic Neuro-Navigation\"\u2014LANN: from a functional cartography of the pelvic autonomous neurosystem to a new field of laparoscopic surgery","volume":"13","author":"Possover","year":"2004","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"2021092319115086200_hnab041-B13","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1007\/s12630-013-0009-5","article-title":"Brief review: piriformis syndrome: etiology, diagnosis, and management","volume":"60","author":"Jankovic","year":"2013","journal-title":"Can J Anaesth"},{"key":"2021092319115086200_hnab041-B14","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.jmig.2018.04.014","article-title":"Vascular entrapment of both the sciatic and pudendal nerves causing persistent sciatica and pudendal neuralgia","volume":"26","author":"Kale","year":"2019","journal-title":"J Minim Invasive Gynecol"},{"key":"2021092319115086200_hnab041-B15","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1097\/00007611-195510000-00004","article-title":"Sciatic syndrome due to endometriosis of sciatic nerve","volume":"48","author":"Denton","year":"1955","journal-title":"South Med J"},{"key":"2021092319115086200_hnab041-B16","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/s00256-008-0486-8","article-title":"Magnetic resonance imaging of the sacral plexus and piriformis muscles","volume":"37","author":"Russell","year":"2008","journal-title":"Skeletal Radiol"},{"key":"2021092319115086200_hnab041-B17","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1053\/apmr.2002.30622","article-title":"Piriformis syndrome: diagnosis, treatment, and outcome\u2014a 10-year study","volume":"83","author":"Fishman","year":"2002","journal-title":"Arch Phys Med Rehabil"},{"key":"2021092319115086200_hnab041-B18","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1136\/rapm-00115550-199823020-00020","article-title":"Perisciatic injection of steroid for the treatment of sciatica due to piriformis syndrome","volume":"23","author":"Hanania","year":"1998","journal-title":"Reg Anesth Pain Med"},{"key":"2021092319115086200_hnab041-B19","doi-asserted-by":"crossref","first-page":"172","DOI":"10.5301\/hipint.5000219","article-title":"Piriformis syndrome: treatment of a rare cause of posterior hip pain with fluoroscopic-guided injection","volume":"25","author":"Albayrak","year":"2015","journal-title":"Hip Int"},{"key":"2021092319115086200_hnab041-B20","doi-asserted-by":"crossref","first-page":"206","DOI":"10.14366\/usg.14039","article-title":"Long-term assessment of clinical outcomes of ultrasound-guided steroid injections in patients with piriformis syndrome","volume":"34","author":"Jeong","year":"2015","journal-title":"Ultrasonography"},{"key":"2021092319115086200_hnab041-B21","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s00270-011-0185-z","article-title":"Piriformis syndrome: long-term follow-up in patients treated with percutaneous injection of anesthetic and corticosteroid under CT guidance","volume":"35","author":"Masala","year":"2012","journal-title":"Cardiovasc Intervent Radiol"},{"key":"2021092319115086200_hnab041-B22","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1017\/S0317167100015298","article-title":"The diagnosis and management of Piriformis Syndrome: myths and facts","volume":"39","author":"Miller","year":"2012","journal-title":"Can J Neurol Sci"},{"key":"2021092319115086200_hnab041-B23","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1093\/jhps\/hny018","article-title":"Endoscopic release of the piriformis tendon and sciatic nerve exploration","volume":"5","author":"Ilizaliturri","year":"2018","journal-title":"J Hip Preserv Surg"},{"key":"2021092319115086200_hnab041-B24","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00264-001-0319-z","article-title":"Piriformis muscle syndrome in 19 patients treated by tenotomy\u2014a 1- to 16-year follow-up study","volume":"26","author":"Indrekvam","year":"2002","journal-title":"Int Orthop"},{"key":"2021092319115086200_hnab041-B25","doi-asserted-by":"crossref","first-page":"941","DOI":"10.2106\/00004623-199907000-00006","article-title":"Posttraumatic piriformis syndrome: diagnosis and results of operative treatment","volume":"81","author":"Benson","year":"1999","journal-title":"J Bone Joint Surg Am"},{"key":"2021092319115086200_hnab041-B26","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/jhps\/hnv030","article-title":"Laparoscopic approach to intrapelvic nerve entrapments","volume":"2","author":"Lemos","year":"2015","journal-title":"J Hip Preserv Surg"},{"key":"2021092319115086200_hnab041-B27","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1016\/j.juro.2008.11.096","article-title":"Laparoscopic management of endopelvic etiologies of pudendal pain in 134 consecutive patients","volume":"181","author":"Possover","year":"2009","journal-title":"J Urol"},{"key":"2021092319115086200_hnab041-B28","doi-asserted-by":"crossref","first-page":"99","DOI":"10.3171\/spi.2005.2.2.0099","article-title":"Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment","volume":"2","author":"Filler","year":"2005","journal-title":"J Neurosurg Spine"},{"key":"2021092319115086200_hnab041-B29","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1001\/archsurg.1976.01360240099019","article-title":"Division of the pyriformis muscle for the treatment of sciatica. Postlaminectomy syndrome and osteoarthritis of the spine","volume":"111","author":"Mizuguchi","year":"1976","journal-title":"Arch Surg"}],"container-title":["Journal of Hip Preservation Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jhps\/article-pdf\/8\/1\/132\/40433855\/hnab041.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jhps\/article-pdf\/8\/1\/132\/40433855\/hnab041.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T12:24:52Z","timestamp":1632486292000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jhps\/article\/8\/1\/132\/6278045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,1]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,5,19]]},"published-print":{"date-parts":[[2021,9,23]]}},"URL":"https:\/\/doi.org\/10.1093\/jhps\/hnab041","relation":{},"ISSN":["2054-8397"],"issn-type":[{"value":"2054-8397","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,1,1]]},"published":{"date-parts":[[2021,1,1]]}}}