Treatment of sciatic posttraumatic neuropathy with chronic neuromodulation and endoscopic technics

OBJECTIVE Sciatic nerve injury in the deep gluteal space is a major clinical problem due to microsurgical manipulations in this region are limited in scope. We offer new endoscopic approach to the sciatic nerve in the deep gluteal space which allows to perform microsurgical manipulations, neurophysiological mapping and electrode installation for the chronic nerve stimulation. MATERIAL AND METHOD 3 patients with sciatic neuropathy have been operated. Before the operation they suffered from neuropathic pain in the the posterior thigh and calf, reaching 7-8 points on the visual analog scale (VAS). Paresis of triceps surae and biceps femur also was occurred. We performed endoscopic approach to the deep gluteal space through a small incision under the gluteal fold. Microsurgical external and internal decompression of sciatic nerve was performed under the endoscopic control. Next, intra-trunk nerve mapping was performed to visualize sensory fibers. Cylindrical electrodes for chronic neurostimulation were directly placed on the sensory fibers of sciatic nerve. RESULTS Pain relief was obtained in all cases after activating the simulator, the patient noted a 50% reduction in pain. Muscle straight restoration was observed in all cases 2-3 months later. The clinical effect was stable in the follow up (6 months). CONCLUSION This technique, combining minimal invasiveness and intraoperative neurophysiological control, makes it possible to optimally position the electrode, both to achieve positive analgesic effect and for potential restoration of nerve function.