Skip to main content
SpringerLink
Log in

Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

To detect the variable relationship between sciatic nerve and piriformis muscle and make surgeons aware of certain anatomical features of each variation that may be useful for the surgical treatment of the piriformis syndrome.

Methods

The gluteal region of 147 Caucasian cadavers (294 limbs) was dissected. The anatomical relationship between the sciatic nerve and the piriformis muscle was recorded and classified according to the Beaton and Anson classification. The literature was reviewed to summarize the incidence of each variation.

Results

The sciatic nerve and piriformis muscle relationship followed the typical anatomical pattern in 275 limbs (93.6 %). In 12 limbs (4.1 %) the common peroneal nerve passed through and the tibial nerve below a double piriformis. In one limb (0.3 %) the common peroneal nerve coursed superior and the tibial nerve below the piriformis. In one limb (0.3 %) both nerves penetrated the piriformis. In one limb (0.3 %) both nerves passed above the piriformis. Four limbs (1.4 %) presented non-classified anatomical variations. When a double piriformis muscle was present, two different arrangements of the two heads were observed.

Conclusions

Anatomical variations of the sciatic nerve around the piriformis muscle were present in 6.4 % of the limbs examined. When dissection of the entire piriformis is necessary for adequate sciatic nerve decompression, the surgeon should explore for the possible existence of a second tendon, which may be found either inferior or deep to the first one. Some rare, unclassified variations of the sciatic nerve should be expected during surgical intervention of the region.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Agur AMR, Dalley AF II (2005) Grant’s Atlas of Anatomy, 10th edn. Lippincott Williams & Wilkins, Baltimore

  2. Anson BJ, McVay CB (1984) Surgical Anatomy, 6th edn. W.B. Saunders Company, Philadelphia

  3. Arifoglu Y, Sargon MF, Tanyeli E, Yazar F (1997) Double superior gemellus together with double piriformis and high division of the sciatic nerve. Surg Radiol Anat 19:407–408

    Article  CAS  PubMed  Google Scholar 

  4. Babinski MA, Machado FA, Costa WS (2003) A rare variation in the high division of the sciatic nerve surrounding the superior gemellus muscle. Eur J Morphol 41:41–42

    Article  CAS  PubMed  Google Scholar 

  5. Bardeen KV (1901) A statistical study of the variations in the formation and position of the lumbosacral plexus in man. Anat Anz 9:209–238

    Google Scholar 

  6. Barton PM (1991) Piriformis syndrome: a rational approach to management. Pain 47:345–352

    Article  CAS  PubMed  Google Scholar 

  7. Beaton LE, Anson BJ (1937) The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec 70:1–5

    Article  Google Scholar 

  8. Beaton LE, Anson BJ (1938) The sciatic nerve and the piriformis muscle: their interrelation a possible cause of coccygodynia. J Bone Jt Surg 20:686–688

    Google Scholar 

  9. Benzon HT, Katz JA, Benzon HA, Iqbal MS (2003) Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology 98:1442–1448

    Article  PubMed  Google Scholar 

  10. Brooks JBB, Silva CAC, Soares SA et al (2011) Anatomical variations of the sciatic nerve in a group of Brazilian cadavers. Rev Dor Sao Paulo 12:332–336

    Google Scholar 

  11. Cassidy L, Walters A, Bubb K et al (2012) Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat 34:479–486

    Article  PubMed  Google Scholar 

  12. Chen WS, Wan YL (1992) Sciatica caused by piriformis muscle syndrome: report of two cases. J Formos Med Assoc 91:647–650

    CAS  PubMed  Google Scholar 

  13. Chiba S, Ishibashi Y, Kasai T (1994) Perforation of dorsal branches of the sacral nerve plexus through the piriformis muscle and its relation to changes of segmental arrangements of the vertebral column and others. Kaibogaku Zasshi 69:281–305

    CAS  PubMed  Google Scholar 

  14. Chiba S (1992) Multiple positional relationships of nerves arising from the sacral plexus to the piriformis muscle in humans. Kaibogaku Zasshi 67:691–724

    CAS  PubMed  Google Scholar 

  15. Filler AG, Haynes J, Jordan SE et al (2005) Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg 2:99–115

    Google Scholar 

  16. Fishman LM, Dombi GW, Michaelsen C et al (2002) Piriformis syndrome: diagnosis, treatment, and outcome: a 10-year study. Arch Phys Med Rehabil 83:295–301

    Article  PubMed  Google Scholar 

  17. Fishman LM, Schaefer MP (2003) The PS is underdiagnosed. Muscle Nerve 28:626–629

    Article  Google Scholar 

  18. Fukumoto N (1935) Uber den M. piriformis und N. ischiadicus von Japanern. Fukuoka Acta Medica 28:39

    Google Scholar 

  19. Guvencer M, Akyer P, Iyem C et al (2008) Anatomic considerations and the relationship between the piriformis muscle and the sciatic nerve. Surg Radiol Anat 30:467–474

    Article  PubMed  Google Scholar 

  20. Guvencer M, Iyem C, Akyer P et al (2009) Variations in the high division of the sciatic nerve and relationship between the sciatic nerve and the piriformis. Turk Neurosurg 19:139–144

    PubMed  Google Scholar 

  21. Hallin RP (1983) Sciatic pain and the piriformis muscle. Postgrad Med 74:69–72

    CAS  PubMed  Google Scholar 

  22. Hopayian K (2012) The clinical features of the piriformis syndrome. Surg Radiol Anat 34:671

    Article  PubMed  Google Scholar 

  23. Hopayian K, Song F, Riera R, Sambandan S (2010) The clinical features of the piriformis syndrome: a systematic review. Eur Spine J 19:2095–2109

    Article  PubMed Central  PubMed  Google Scholar 

  24. Jawish RM, Assoum HA, Khamis CF (2010) Anatomical, clinical and electrical observations in piriformis syndrome. J Orthop Surg Res 5:3

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kosukegawa I, Yoshimoto M, Isogai S et al (2006) Piriformis syndrome resulting from a rare anatomic variation. Spine (Phila Pa 1976) 31:664–666

    Article  Google Scholar 

  26. Kouvalchouk J, Bonnet JM, de Mondenard JP (1996) Piriformis syndrome. Apropos of 4 cases treated by surgery and review of the literature. Rev Chir Orthop Reparatrice Appar Mot 82:647–657

    CAS  PubMed  Google Scholar 

  27. Lee CS, Tsai TL (1974) The relation of the sciatic nerve to the piriformis muscle. Taiwan Yi Xue Hui Za Zhi 73:75–80

    CAS  PubMed  Google Scholar 

  28. Ming-Tzu P (1941) The relation of the sciatic nerve to the piriformis muscle in the Chinese. Am J Phys Anthropol 28:375

    Article  Google Scholar 

  29. Misra BD (1954) The relations of the sciatic nerve to the piriformis in Indian cadavers. J Anat Soc India 3:28–33

    Google Scholar 

  30. Nizankowski C, Slociak J, Szybejko J (1972) Variations in the anatomy of the sciatic nerve in man. Folia Morphol (Warsz) 31:507–513

    CAS  Google Scholar 

  31. Pace JB, Nagle D (1976) Piriformis syndrome. West J Med 124:435–439

    CAS  PubMed Central  PubMed  Google Scholar 

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

    Article  Google Scholar 

  33. Parsons FG, Keith A (1896) Sixth annual report of the committee of collective investigation of the anatomical society of Great Britain and Ireland, 1895–96. J Anat Physiol 31:31–44

    CAS  PubMed Central  PubMed  Google Scholar 

  34. Patel S, Shah M, Vora R et al (2011) A variation in the high division of the sciatic nerve and its relation with piriformis muscle. Natl J Res 1:27–30

    Google Scholar 

  35. Pecina M (1979) Contribution to the etiological explanation of the piriformis syndrome. Acta Anat (Basel) 105:181–187

    Article  CAS  Google Scholar 

  36. Pokorny D, Jahoda D, Veigl D et al (2006) Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat 28:88–91

    Article  PubMed  Google Scholar 

  37. Pokorny D, Sosna A, Veigl D, Jahoda D (1998) Anatomical variability of the relation of pelvitrochanteric muscles and sciatic nerve. Acta Chir Orthop Traumatol Cech 65:336–339

    CAS  PubMed  Google Scholar 

  38. Skandalakis JE (2004) Surgical anatomy: the embryologic and anatomic basis of modern surgery. Paschalidis Medical Publications, Athens, p 1605

    Google Scholar 

  39. Smoll NR (2010) Variations of the piriformis and sciatic nerve with clinical consequence: a review. Clin Anat 23:8–17

    Article  PubMed  Google Scholar 

  40. Trotter M (1932) The relation of the sciatic nerve to the piriformis muscle in American Whites and Negroes. Anat Rec 52:321–323

    Article  Google Scholar 

  41. Ugrenovic S, Jovanovic I, Krstic V et al (2005) The level of the sciatic nerve division and its relations to the piriform muscle. Vojnosanit Pregl 62:45–49

    Article  PubMed  Google Scholar 

  42. Uluutku MH, Kurtoglu Z (1999) Variations of nerves located in deep gluteal region. Okajimas Folia Anat Jpn 76:273–276

    Article  CAS  PubMed  Google Scholar 

  43. Windisch G, Braun EM, Anderhuber F (2007) Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome. Surg Radiol Anat 29:37–45

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Laboratory of Anatomy, Medical School, Aristotle University of Thessaloniki, P.O. Box: 300, Postal Code: 54124, Thessaloniki, Macedonia, Greece

    Konstantinos Natsis, Trifon Totlis, George A. Konstantinidis & George Paraskevas

  2. Laboratory of Anatomy, Medical School, University of Athens, Athens, Greece

    Maria Piagkou

  3. Center of Anatomy, Medical School, University of Cologne, Cologne, Germany

    Juergen Koebke

Authors
  1. Konstantinos Natsis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trifon Totlis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George A. Konstantinidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George Paraskevas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Piagkou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Juergen Koebke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Konstantinos Natsis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Natsis, K., Totlis, T., Konstantinidis, G.A. et al. Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat 36, 273–280 (2014). https://doi.org/10.1007/s00276-013-1180-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-013-1180-7

Keywords

Search

Navigation