Superior gluteal vein syndrome: an intrapelvic cause of sciatica

Nucelio Lemos; Laura Cancelliere; Adrienne L K Li; Renato Moretti Marques; Gustavo L Fernandes; Corey Sermer; Kinshuk Kumar; Jose Sebastião Afonso; Manoel J B C Girão

doi:10.1093/jhps/hnz012

Superior gluteal vein syndrome: an intrapelvic cause of sciatica

J Hip Preserv Surg. 2019 Mar 25;6(2):104-108. doi: 10.1093/jhps/hnz012. eCollection 2019 Jul.

Authors

Nucelio Lemos^{1

2}, Laura Cancelliere¹, Adrienne L K Li¹, Renato Moretti Marques², Gustavo L Fernandes², Corey Sermer¹, Kinshuk Kumar¹, Jose Sebastião Afonso³, Manoel J B C Girão²

Affiliations

¹ Pelvic Functional Surgery and Neuropelveology Clinic, Neuropelveology and Pelvic Functional Surgery Special Interest Group (NPFSSIG), Department of Obstetrics and Gynecology of Women's College and Mount Sinai Hospitals, University of Toronto, 700 University Avenue, Room 8-917, Toronto, ON, Canada.
² Pelvic Neurodysfunction Clinic, Department of Obstetrics and Gynecology, Federal University of São Paulo, São Paulo, Brazil.
³ Department of Obstetrics and Gynecology, Amazonas State University, Manaus, AM, Brazil.

Abstract

The role of malformed or dilated branches of iliac vessels in causing pelvic pain is not well understood. Such vessels may entrap nerves of the lumbosacral (LS) plexus against the pelvic sidewalls, producing symptoms not typically encountered in gynecological practice, including sciatica and refractory urinary and/or anorectal dysfunction. We describe cases of sciatica in which laparoscopy revealed compression of the LS plexus by variant superior gluteal veins (SGVs). In demonstrating an improvement in patient symptoms after decompression, we identify this neurovascular conflict as a potential intrapelvic cause of sciatica. This study is a retrospective case series (Canadian Task Force Classification II-3). Nerve decompression laparoscopies were performed in São Paulo, Brazil. Thirteen female patients undergoing laparoscopy for sciatica with no clear spinal or musculoskeletal causes were included in this study. In all cases, we identified LS entrapment by aberrant SGVs, and performed decompression by vessel ligation. The average preoperative visual analog scale score of 9.62 ± 0.77 decreased significantly to 2.54 ± 2.88 post-operatively (P < 0.001). The success rate (defined as ≥ 50% improvement in visual analog scale score) was 92.3%, over a follow-up of 13.2 ± 10.6 months. Our case series demonstrates a high success rate and significant decrease in pain scores after laparoscopic intrapelvic decompression, thereby identifying pelvic nerve entrapment by aberrant SGVs as a potential yet previously unrecognized cause of sciatica. This intrapelvic neurovascular conflict-the SGV syndrome-should be considered in cases of sciatica with no identifiable spinal or musculoskeletal etiology.