The Modified Surgical Technique in Treatment of Injection Related-Sciatic Nerve Injury in Children

Abstract

Introduction: Injection induced sciatic nerve injury, either by inter-intrafascicular injection or inflammation of the surrounding soft tissue, may result in a broad spectrum of functional loss. Surgery as a part of the treatment, may be indicated in cases those had not enough spontaneous recovery. Case reports: On the basis of preoperative clinical and electrophysiological assessments, eight patients with injection induced sciatic nerve injury underwent surgery. There were 7 boys and one girl. The mean age was 6,5 years (3-12) and left sided involvement was observed in all except one. The interval from injury to operation was 60 to145 days. In all patients sciatic nerve was found to be adhered to soft tissue without any structural deformity. During the operation, gluteal muscle mass was not cut but was lifted from nerve in order to avoid postoperative pain and scar tissue. After external neurolysis of nerve was performed under magnification, at the most adhered level a few milliliters of serum physiologic injected intrafascicullary. Neurolysis versus nerve grafting was decided on the basis of morphologic appearance of sciatic nerve. In six of the eight patients postoperative Sunderland recovery scales were good or excellent. Conclusion: In case of childhood injection neuropathy of sciatic nerve, when the spontaneous recovery does not take place within three to four months, surgical exploration should be performed. During the surgery, external neurolysis without cutting the gluteus muscle is possible in childhood and may be tried in any case without neuroma.