DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20190349

Sciatic nerve: Non-union of its components and clinical implication

Monica Baxla, Hare Krishna, Rati Tandon, Arthi Ganapathy, Saroj Kaler

Abstract


Background: Having prior anatomical knowledge of the anatomical variations is a must for the accurate and effective diagnosis of clinical conditions associated with the sciatic nerve. Sciatic nerve, the longest nerve in the human body has been of great interest for the clinicians and anatomists; though many studies have been conducted in the past to study its anatomical aspect. Till now high division or low formation of the sciatic nerve has been reported but this article highlights the non-union of the components of the sciatic nerve and its clinical outcomes. It had been observed that the common fibular and tibial nerve which arise separately from the sacral plexus remain separated throughout their course. They do not join to form the sciatic nerve. Non-union of the components can result in incomplete blockade of the nerve but selective blockade of one of the components can be done when needed. Aim of the study was to determine the level of formation and the level of division of the sciatic nerve.

Methods: Sixty-two lower limbs were taken from the Department of Anatomy, AIIMS, New Delhi and gluteal region was observed for common fibular and tibial nerve and their joining to form the sciatic nerve.

Results: Out of 62 lower limbs; 52 specimens showed formation within the pelvis but in 10 specimens the sciatic nerve did not form at any point. Division of the nerve in 52 specimens were at various levels on the posterior aspect of thigh.

Conclusions: While giving anaesthesia it’s important to know the formation as well as division of the nerve for an effective lower limb block for various surgical interventions and in case of non union of tibial and common fibular nerve to form the sciatic nerve individual nerve block can be given. 


Keywords


Anatomical variations, Anaesthesia, Common fibular and tibial nerve, Non-Union, Sciatic nerve

Full Text:

PDF

References


Standring S. Gray’s Anatomy. 40th ed. Elsevier Churchill living stone; 2009:1576.

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.

Barton PM. Piriformis syndrome: a rational approach to management. Pain. 1991;47:345-52.

Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin Am. 2004;35(1):65-71.

Brooks JB, Silva CA, Soares SA, Kai MR, Cabral RH, Fragoso YD. Anatomical variations of the sciatic nerve in a group of Brazilian cadavers. Revista Dor. 2011 Dec;12(4):332-6.

Khan AA, Asari MA, Pasha MA. The sciatic nerve in human cadavers-high division or low formation? Folia Morphol. 2016;75(3):306-10.

Sharma S, Khullar M, Ahmad M. Direct origin of tibial nerve and common peroneal nerve from lumbosacral plexus. JK-Practitioner. 2012;17(1-3):54-57.

Benzon HT, Kim C, Benzon HP, Silverstein ME, Jerico B, Prillaman K, et al. Correlation between evoked motor response of the sciatic nerve and sensory blockade. Anesthesiology. 1997;87:548-52.

Hadzic A, Vloka JD, Kitain E, Lesser JB, April EW and Thys DM. Division of the sciatic nerve and its possible implications in popliteal nerve blockade. Anesthesiology. 1996;85(3A):A733.

Paqueron X, Bouaziz H, Macalou D, Labaille T, Merle M, Laxenaire MC, et al. The lateral approach to the sciatic nerve at the popliteal fossa: one or two injections? Anesth Analg. 1999;89:1221-5.

Murray JM, Derbyshire S, Shields MO. Lower limb blocks. Anaesthesia. 2010 Apr;65:57-66.

Mengstu DK, Dawit HW. Anatomical variations in the level of bifurcation of the sciatic nerve in Ethiopia. Exp Clin Anat. 2015;14:1-4.

Sabnis AS. Anatomical variations of sciatic nerve bifurcation in human cadavers. J of Clin Research Letters. 2012;3(2):46-8.

Lewis S, Jurak J, Lee C, Lewis R, Gest T. Anatomical variations of the sciatic nerve, in relation to the piriformis muscle. Trans Res Anat. 2016;5:15-9.

Shwetha K, Dakshayani KR. Bilateral high division of sciatic nerve. Int J Res Med Sci. 2014;2(4):1785-7.

Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M and Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat. 2014;36:273-80.