Anatomical variation in bifurcation and trifurcations of sciatic nerve and its clinical implications: in selected university in Ethiopia

BMC Research Notes

Yared Godefa Debeb¹  Birhane Alem Berihu² 

[1] Department of Physiology, Institute of Bio–Medical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia;Department of Anatomy and Histology, Institute of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia

关键词: Bifurcation of the sciatic nerve;    Trifurcation of the sciatic nerve;    Tibial and common peroneal nerves;    Sciatic nerve;   

Others  :  1232865
DOI  :  10.1186/s13104-015-1626-6

 received in 2015-06-20, accepted in 2015-10-26,  发布年份 2015

【 摘 要 】

Background

The Sciatic nerve is the widest nerve of the body. It consists of two components, namely: the tibia and the common peroneal components derived from the ventral rami of L4 to S3 spinal nerves of the lumbosacral plexus. It exits the pelvis through the greater sciatic foramen below the Piriformis muscle and descends between the greater trochanter of the femur and ischial tuberosity of the pelvis to the knee. The purpose of this study is to identify the course and variations in branching pattern of the sciatic nerve which may lead to various clinical manifestations.

Methods

Twenty-eight formalin fixed cadavers comprising of 56 lower limbs are used for this study, of which six specimens were female cadavers. Dissection of gluteal region and posterior compartment of the thigh was done to expose the sciatic nerve. Variations in the sciatic nerve anatomy; their relationship to Piriformis muscle and a point of bifurcation and trifurcation were noted and recorded.

Results

Forty-two lower limbs (75 %) showed normal anatomy of sciatic nerve. Fourteen regions (25 %) showed variations in the sciatic nerve, of which six regions (11 %) showed a variation of the sciatic nerve in relation to Piriformis muscle, three regions (5 %) showed trifurcation of the sciatic nerve and five regions (9 %) showed variation in the origin of the sural nerve.

Conclusion

The knowledge regarding the level of division and distribution of the sciatic nerve and its location is of great importance. The sciatic nerve is frequently involved in daily medical practice of neurology, orthopedics, rehabilitation and anesthesia. Its long course makes it vulnerable to nerve injury. Even in this era the cadaver is the best means to study anatomy. It emphasizes proper clinical implications, for the surgeons to practice efficient surgical recombination and avoid errors.

【 授权许可】

   
2015 Berihu and Debeb.

【 图 表 】

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【 参考文献 】

• [1]Standring S: Gray’s anatomy: the anatomical basis of clinical practice. 39th edition. Churchill Livingstone, London; 2005.
• [2]Nayak S: An unusual case of trifurcation of the sciatic nerve. Neuroanatomy 2008, 5:6-7.
• [3]Yuen EC, So YT: Sciatic neuropathy. Neurol Clin 1999, 17:617-631.
• [4]Ndiaye A, Sakho Y, Fall F, Dia A, Sow ML: Sciatic nerve in gluteal portion: application of sciatic nerve post injection lesion. Morphologie 2004, 88:135-138.
• [5]Babinski MA, Machado FA, Costa WS: A rare variation in the high division of the sciatic nerve surrounding the superior gemellus muscle. Eur J Morphol 2003, 41:41-42.
• [6]Rosse C, Gaddum-Rosse P, Hollinshead WH: Hollinshead’s textbook of anatomy. 5th edition. Lippincott-Raven Publishers, Philadelphia; 1997.
• [7]Moore KL, Dalley AF: Clinically oriented anatomy. 4th edition. Lippincott Williams & Wilkins, Philadelphia; 1999.
• [8]Arifoglu Y, Sürücü HS, Sargon MF, Tanyeli E, Yazar F: Double superior gemellus together with double piriformis and high division of the sciatic nerve. Surg Radiol Anat 1997, 19:407-408.
• [9]Valade N, Ripart J, Nouvellon E, et al.: Does sciatic parasacral injection spread to the obturator nerve? An anatomic study. Anesth Analg 2008, 106:664-667.
• [10]Benzon HT, Katz JA, Benzon HA, Iqbal MS: Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology 2003, 98:1442-1448.
• [11]Sharadkumar Pralhad Sawant: A case report on the bilateral trifurcation of the sciatic nerve and its clinical significance Int J Anal Pharm Biomed Sci 2013, 2:1.
• [12]Mahajan T, Anup B, Mulimani NG: Variation in the formation of sural nerve—a case report. Int J Ayurvedic Med 2014, 1(1):7-10.
• [13]Sawant SP: A case report on the bilateral trifurcation of the sciatic nerve and its clinical significance. World Res J Orthop 2013, 1(1):7-10.
• [14]Beaton LE: The sciatic nerve and piriform muscle: their interrelations possible cause of coccgodynia. J Bone Joint Surg Am 1938, 20:686-688.
• [15]Sabnis AS: Anatomical Variations of Sciatic Nerve Bifurcation in Human Cadavers. J Clin Res Lett 2012, 3(2):46-48.
• [16]Muthu Kumar T, Srimathi , Ananda Rani , Sumathi Latha : A cadaveric study of sciatic nerve and its level of bifurcation. J Clin Diagn Res. 2011, 5(8):1502-1504.
• [17]Shewale AD, Karambelkar RR, Umarji BN: Study of variations in the divisions, course and termination of the sciatic nerve. J Krishna Inst Med Sci Univ 2013, 2(1):62-68.
• [18]Brooks JBB, Silva CAC, Soares SA, Kai MR, Cabral RH, Fragoso YD: Anatomical variations of the sciatic nerve in a group of Brazilian cadavers. J Hum Anat 2011, 12(4):332-336.
• [19]Güvençer M, Iyem C, Akyer P, Tetik S, Naderi S: Variations in the higher division of the sciatic nerve and relationship between the sciatic nerve and the Piriformis. Turk Neurosurg 2009, 19:139-144.
• [20]Ogeng’o JA, El Busaidy H, Mwika PM, Khanbhai MM: Variant anatomy of Sciatic nerve in a black Kenyan population. Folia Morphol. 2011, 70(3):175-179.
• [21]Brooks D: The place of nerve grafting in orthopedic surgery. J Bone Joint Surg 1955, 37:299-304.
• [22]Prakash , Bhardwaj AK, Devi MN, Sridevi NS, Rao PK, Singh G: Variations in the higher division of the sciatic nerve and relationship between the sciatic nerve and the Piriformis. Singapore MED J 2010, 51(9):721.
• [23]Moore KL, Dalley AF: Clinically oriented anatomy. 4th edition. Lippincott Williams and Wilkins, Baltimore; 1999.
• [24]Chiba S: Multiple positional relationships of nerves arising from the sacral plexus to the Piriformis muscle in humans. Kaibogaku Zasshi 1992, 67(6):691-724.
• [25]Pokorny D, Jahoda D, Veigl D, Pinskerova V, Sonsa A: 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 2006, 28(1):88-91.
• [26]Beaton LE, Anson BJ: The relation of the sciatic nerve and its subdivisions to the Piriformis muscle. Anat Rec 1937, 70(1):1-5.
• [27]Sharvari AM, Sharadkumar PS, Rakhi M: More, Shaguphta TS, Shaheen R, Uma R. A case report on the sciatic nerve terminated into the tibial, common peroneal and sural nerves. Int J Adv Case Rep 2015, 2(5):329-332.
• [28]Adibatti M, Sangeetha V: Study on variant anatomy of sciatic nerve. J Clin Diagn Res 2014, 8(8):AC07-AC09.
• [29]Anbumani TL, Thamarai Selvi A, Anthony Ammal S: Sciatic nerve and its variations: an anatomical study. Int J Anat Res 2015, 3(2):1121-1127.
• [30]Shastrakar R, Nakhate M, Sawant VG: Study of variation in the high division of sciatic nerve and its relationship with the Piriformis muscle. Med Res Chron 2015, 2(3):359-365.