Skip to main content

Advertisement

Log in

Sciatic foramen anatomy and common pathologies: a pictorial review

  • Review
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

A Correction to this article was published on 30 April 2022

This article has been updated

Abstract

This article reviews the relevant anatomy, imaging features on computed tomography, magnetic resonance imaging, and management of common processes involving the sciatic foramen. The anatomy of the sciatic foramen is complex and provides an important conduit between the pelvis, gluteus, and lower extremity. This paper reviewed the anatomy, common pathologies, and imaging features of this region including trauma, infection, nerve entrapment, tumor spread, hernia, and vascular anomaly.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Fig. 26
Fig. 27
Fig. 28
Fig. 29
Fig. 30
Fig. 31
Fig. 32
Fig. 33
Fig. 34
Fig. 35
Fig. 36
Fig. 37

Similar content being viewed by others

Change history

Abbreviations

GSF:

Greater sciatic foramen

LSF:

Lesser sciatic foramen

SS:

Sacrospinous

ST:

Sacrotuberous

SI:

Sacroiliac

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PMS:

Piriformis muscle syndrome

PS:

Piriformis syndrome

PN:

Pudendal neuralgia

CTA:

CT angiography

MRA:

Magnetic resonance angiography

PSA:

Persistent sciatic artery

PNST:

Peripheral nerve sheath tumor

NF1:

Neurofibromatosis type 1

T1W:

T1-weighted

US:

Ultrasound

T2W:

T2-weighted

CECT:

Contrast-enhanced CT

MVA:

Motor vehicle accident

MM:

Multiple myeloma

ADPKD:

Autosomal dominant polycystic kidney disease

References

  1. Chaudhry, S.R., O. Imonugo, and K. Chaudhry, Anatomy, Abdomen and Pelvis, Ligaments, in StatPearls. Treasure Island (FL) (2021).

  2. 2.Iwanaga, J., Puffer, R. C., Watanabe, K., Spinner, R. J. & Tubbs, R. S. Division of Sacrospinous and Sacrotuberous Ligaments Expands Access Through Greater Sciatic Foramen: Anatomic Study with Application to Resection of Greater Sciatic Foramen Tumors. World Neurosurg. 128, e970–e974 (2019).

    Article  PubMed  Google Scholar 

  3. 3.Jankovic, D., Peng, P. & Van Zundert, A. Brief review: Piriformis syndrome: Etiology, diagnosis, and management. Can. J. Anesth. 60, 1003–1012 (2013).

    Article  PubMed  Google Scholar 

  4. 4.Cohen, B. A. et al. CT evaluation of the greater sciatic foramen in patients with sciatica. Am. J. Neuroradiol. 7, 337–342 (1986).

    CAS  PubMed  PubMed Central  Google Scholar 

  5. 5.Garwood, E. R., Duarte, A. & Bencardino, J. T. MR Imaging of Entrapment Neuropathies of the Lower Extremity. Radiol. Clin. North Am. 56, 997–1012 (2018).

    Article  PubMed  Google Scholar 

  6. 6.Obach, J., Aragones, J. M. & Ruano, D. The infrapiriformis foramen syndrome resulting from intragluteal injection. J. Neurol. Sci. 58, 135–142 (1983).

    Article  CAS  PubMed  Google Scholar 

  7. 7.Tan, C. H. et al. Pathways of extrapelvic spread of pelvic disease: Imaging findings. Radiographics 31, (2011).

    Article  PubMed  Google Scholar 

  8. 8.Schmal, H., Markmiller, M., Mehlhorn, A. T. & Sudkamp, N. P. Epidemiology and outcome of complex pelvic injury. Acta Orthop. Belg. 71, 41–47 (2005).

    PubMed  Google Scholar 

  9. 9.Ben-Menachem, Y., Coldwell, D. M., Young, J. W. R. & Burgess, A. R. Hemorrhage associated with pelvic fractures: Causes, diagnosis, and emergent management. Am. J. Roentgenol. 157, 1005–1014 (1991).

    Article  CAS  Google Scholar 

  10. 10.Scemama, U. et al. Pelvic trauma and vascular emergencies. Diagn. Interv. Imaging 96, 717–729 (2015).

    Article  CAS  PubMed  Google Scholar 

  11. 11.Young, J. W., Burgess, A. R., Brumback, R. J. & Poka, A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160, 445–451 (1986).

    Article  CAS  PubMed  Google Scholar 

  12. 12.Khurana, B., Sheehan, S. E., Sodickson, A. D. & Weaver, M. J. Pelvic ring fractures: What the orthopedic surgeon wants to know. Radiographics 34, 1317–1333 (2014).

    Article  PubMed  Google Scholar 

  13. 13.Boyanova, L., Kolarov, R., Mateva, L., Markovska, R. & Mitov, I. Actinomycosis: a frequently forgotten disease. Future Microbiol. 10, 613–628 (2015).

    Article  CAS  PubMed  Google Scholar 

  14. 14.Purola, E. & Paavonen, J. Actinomycosis and IUD’s. Duodecim. 97, 231–234 (1981).

    CAS  PubMed  Google Scholar 

  15. 15.Kelly, J. & Aaron, J. Pelvic actinomycosis and usage of intrauterine contraceptive devices. Yale J. Biol. Med. 55, 453–461 (1982).

    CAS  PubMed  PubMed Central  Google Scholar 

  16. 16.Harisinghani, M. G. et al. CT-guided transgluteal drainage of deep pelvic abscesses: Indications, technique, procedure-related complications, and clinical outcome. Radiographics 22, 1353–1367 (2002).

    Article  PubMed  Google Scholar 

  17. Harisinghani, M. G. et al. Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 228(3), 701–5 (2003).

    Article  PubMed  Google Scholar 

  18. 18.Sugawara, S., Ehara, S., Hitachi, S. & Okada, K. Patterns of soft-tissue tumor extension in and out of the pelvis. Am. J. Roentgenol. 194, 746–753 (2010).

    Article  Google Scholar 

  19. 19.Spinner, R. J. et al. Resection of benign sciatic notch dumbbell-shaped tumors. J. Neurosurg. 105, 873–880 (2006).

    Article  PubMed  Google Scholar 

  20. 20.Matsumoto, Y. et al. Bone and soft tissue tumors presenting as sciatic notch dumbbell masses: A critical differential diagnosis of sciatica. World J. Clin. Oncol. 7, 414–419 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.Lazaridis, N., Anastasopoulos, N., Zevgaridis, A., Piagkou, M. & Natsis, K. Accidental Ultrasound Finding of a Giant Intermuscular Gluteal Lipoma with Intrapelvic Extension: A Case Report. Cureus 12, 1–5 (2020).

    Google Scholar 

  22. 22.Fernández, E. M. L. T., Hernández, J. R. H., Esparragon, J. C., García, A. T. & Jorge, V. N. Intermuscular lipoma of the gluteus muscles compressing the sciatic nerve: An inverted sciatic hernia. J. Neurosurg. 117, 795–799 (2012).

    Article  Google Scholar 

  23. 23.Pilavaki, M. et al. Imaging of peripheral nerve sheath tumors with pathologic correlation: Pictorial review. Eur. J. Radiol. 52, 229–239 (2004).

    Article  CAS  PubMed  Google Scholar 

  24. 24.Stull, M. A., Moser, R. P., Kransdorf, M. J., Bogumill, G. P. & Nelson, M. C. Magnetic resonance appearance of peripheral nerve sheath tumors. Skeletal Radiol. 20, 9–14 (1991).

    Article  CAS  PubMed  Google Scholar 

  25. 25.Lin, J., Jacobson, J. A. & Hayes, C. W. Sonographic target sign in neurofibromas. J. Ultrasound Med. 18, 513–517 (1999).

    Article  CAS  PubMed  Google Scholar 

  26. 26.Strike, S. A. & Puhaindran, M. E. Nerve Tumors of the Upper Extremity. Clin. Plast. Surg. 46, 347–350 (2019).

    Article  PubMed  Google Scholar 

  27. 27.Martinez, A. P. & Fritchie, K. J. Update on Peripheral Nerve Sheath Tumors. Surg. Pathol. Clin. 12, 1–19 (2019).

    Article  PubMed  Google Scholar 

  28. 28.Perrin, R. G. & Guha, A. Malignant peripheral nerve sheath tumors. Neurosurg. Clin. 15, 203–216 (2004).

    Article  Google Scholar 

  29. 29.Barbara S. Ducatman, MD, Bernd W. Scheothauer, MD, David G. Piepgras, MD, Herbert M. Reiman, MD, and Duane M. Ilstrup, M. Malignant Peripheral Nerve Sheath Tumors: A Clinicopathologic Study of 120 Cases. Cancer 57 94, 2006–2021 (1986).

    Article  CAS  PubMed  Google Scholar 

  30. 30.Hrehorovich, P. A., Franke, H. R., Maximin, S. & Caracta, P. Malignant peripheral nerve sheath tumor. Radiographics 23, 790–794 (2003).

    Article  PubMed  Google Scholar 

  31. 31.Doorn, P. F., Molenaar, W. M., Buter, J. & Hoekstra, H. J. Malignant peripheral nerve sheath tumors in patients with and without neurofibromatosis. Eur. J. Surg. Oncol. 21, 78–82 (1995).

    Article  CAS  PubMed  Google Scholar 

  32. 32.Wasa, J. et al. MRI features in the differentiation of malignant peripheral nerve sheath tumors and neurofibromas. Am. J. Roentgenol. 194, 1568–1574 (2010).

    Article  Google Scholar 

  33. 33.Toms, A. P., Anastakis, D., Bleakney, R. R. & Marshall, T. J. Lipofibromatous hamartoma of the upper extremity: A review of the radiologic findings for 15 patients. Am. J. Roentgenol. 186, 805–811 (2006).

    Article  Google Scholar 

  34. 34.Cavallaro, M. C., Taylor, J. A. M., Gorman, J. D., Haghighi, P. & Resnick, D. Imaging findings in a patient with fibrolipomatous hamartoma of the median nerve. Am. J. Roentgenol. 161, 837–838 (1993).

    Article  CAS  Google Scholar 

  35. 35.Rabbiosi, G., Borroni, G. & Scuderi, N. Familial multiple lipomatosis. Acta Derm. Venereol. 57, 265–267 (1977).

    CAS  PubMed  Google Scholar 

  36. 36.Fandridis, E. M. et al. Lipomatosis of the sciatic nerve: report of a case and review of the literature. Microsurg. Off. J. Int. Microsurg. Soc. Eur. Fed. Soc. Microsurg. 29, 66–71 (2009).

    Google Scholar 

  37. 37.Dovey, S. & Sanfilippo, J. Endometriosis and the adolescent. Clin. Obstet. Gynecol. 53, 420–428 (2010).

    Article  PubMed  Google Scholar 

  38. 38.Bulun, S. E. Mechanisms of disease. Endometriosis. N Engl J Med 360, 268–279 (2009).

    Article  CAS  PubMed  Google Scholar 

  39. 39.Vercellini, P. et al. Evidence for asymmetric distribution of sciatic nerve endometriosis. Obstet. Gynecol. 102, 383–387 (2003).

    Article  PubMed  Google Scholar 

  40. 40.Siquara De Sousa, A. C., Capek, S., Amrami, K. K. & Spinner, R. J. Neural involvement in endometriosis: Review of anatomic distribution and mechanisms. Clin. Anat. 28, 1029–1038 (2015).

    Article  PubMed  Google Scholar 

  41. 41.Saar, T. et al. Endometriosis involving the sciatic nerve: A case report of isolated endometriosis of the sciatic nerve and review of the literature. Gynecol. Minim. Invasive Ther. 7, 81–85 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.Howe, B. M., Amrami, K. K., Nathan, M. A., Garcia, J. J. & Spinner, R. J. Perineural spread of cervical cancer to the sciatic nerve. Skeletal Radiol. 42, 1627–1631 (2013).

    Article  PubMed  Google Scholar 

  43. 43.Puffer, R. C. et al. Extensive perineural spread of an intrapelvic sciatic malignant peripheral nerve sheath tumor: a case report. Acta Neurochir. (Wien). 160, 1833–1836 (2018).

    Article  Google Scholar 

  44. 44.Ji, Y. H., Sun, W. L. & Jong, O. K. MR imaging features of obturator internus bursa of the hip. Korean J. Radiol. 9, 375–378 (2008).

    Article  Google Scholar 

  45. 45.Vassalou, E. E., Fotiadou, A., Ziaka, D., Natsiopoulos, K. & Karantanas, A. H. Piriformis muscle syndrome: MR imaging findings and treatment outcome in 23 patients. Hell. J. οf Radiol. 2, (2017).

    Google Scholar 

  46. 46.Rossi, P. et al. Magnetic resonance imaging findings in Piriformis syndrome: A case report. Arch. Phys. Med. Rehabil. 82, 519–521 (2001).

    Article  CAS  PubMed  Google Scholar 

  47. 47.Sayson, S. C., Ducey, J. P., Maybrey, J. B., Wesley, R. L. & Vermilion, D. Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain 59, 149–152 (1994).

    Article  PubMed  Google Scholar 

  48. 48.Ro, T. H. & Edmonds, L. Diagnosis and management of piriformis syndrome: a rare anatomic variant analyzed by magnetic resonance imaging. J. Clin. Imaging Sci. 8, (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.Bäumer, P., Weiler, M., Bendszus, M. & Pham, M. Somatotopic fascicular organization of the human sciatic nerve demonstrated by MR neurography. Neurology 84, 1782–1787 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  50. 50.Capek, S., Howe, B. M., Amrami, K. K. & Spinner, R. J. Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: Clinical and imaging patterns. Neurosurg. Focus 39, (2015).

    Article  PubMed  Google Scholar 

  51. 51.Russell, J. M. et al. Magnetic resonance imaging of the sacral plexus and piriformis muscles. Skeletal Radiol. 37, 709–713 (2008).

    Article  PubMed  Google Scholar 

  52. 52.Filler, A. G. et al. 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. Spine 2, 99–115 (2005).

    Article  PubMed  Google Scholar 

  53. 53.Fannucci, E. et al. CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process. Eur. Radiol. 11, 2543–2548 (2001).

    Article  Google Scholar 

  54. Kaur, J. and P. Singh, Pudendal Nerve Entrapment Syndrome, in StatPearls. Treasure Island (FL) (2021).

  55. 55.Solomon, L. B., Lee, Y. C., Callary, S. A., Beck, M. & Howie, D. W. Anatomy of piriformis, obturator internus and obturator externus: Implications for the posterior surgical approach to the hip. J. Bone Jt. Surg. - Ser. B 92, 1317–1324 (2010).

    Article  CAS  Google Scholar 

  56. 56.Pailhé, R. et al. Pudendal nerve neuralgia after hip arthroscopy: Retrospective study and literature review. Orthop. Traumatol. Surg. Res. 99, 785–790 (2013).

    Article  PubMed  Google Scholar 

  57. Soon-Sutton, T. L., Feloney, M. P. & Antolak, S. Pudendal Neuralgia. StatPearls [Internet] (2020).

  58. 58.Arora, J., Mehta, V., Suri, R. K. & Rath, G. Unilateral partial ossification of sacrotuberous ligament: Anatomico-radiological evaluation and clinical implications. Rom. J. Morphol. Embryol. 50, 505–508 (2008).

    Google Scholar 

  59. 59.Uruc, V., Ozden, R., Kalaci, A., Dogramaci, Y. & Başarslan, S. K. Unilateral Complete Ossification of Sacrotuberous Ligament: An Unusual Cause of Pudendal Nerve Entrapment Syndrome. Neurosurgery Quarterly vol. 26 185–187.

    Article  Google Scholar 

  60. Stav, K., Dwyer, P. L., Franzcog & Roberts, L. Pudendal neuralgia: Fact or fiction? Obstet. Gynecol. Surv. 64, 190–199 (2009)

  61. 61.Filler, A. G. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: Imaging, injections, and minimal access surgery. Neurosurg. Focus 26, 1–14 (2009).

    Article  Google Scholar 

  62. 62.Tazawa, K. I. et al. Spinal nerve root hypertrophy on MRI: Clinical significance in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy. Intern. Med. 47, 2019–2024 (2008).

    Article  PubMed  Google Scholar 

  63. 63.Oguz, B., Oguz, K. K., Cila, A. & Tan, E. Diffuse spinal and intercostal nerve involvement in chronic inflammatory demyelinating polyradiculoneuropathy: MRI findings. Eur. Radiol. 13, 230–234 (2003).

    Article  Google Scholar 

  64. 64.Duff, S. E. & Wilson, N. M. True aneurysm of the inferior gluteal artery: Case report and review of the literature. Eur. J. Vasc. Endovasc. Surg. 22, 379–380 (2001).

    Article  CAS  PubMed  Google Scholar 

  65. 65.Deshmukh, H., Prasad, S. & Pantankar, T. Re: endovascular management of an inferior gluteal artery pseudoaneurysm secondary to tuberculous cold abscess. Cardiovasc. Intervent. Radiol. 23, 80–82 (2000).

    Article  CAS  PubMed  Google Scholar 

  66. 66.Schindera & Triller. Coil embolization of an infected superior gluteal artery pseudoaneurysm caused by methicillin-resistant Staphylococcus aureus. Vasa 34, 62–65 (2005).

    Article  PubMed  Google Scholar 

  67. 67.Unno, N., Yamamoto, N., Nishiyama, M. & Fujimoto, H. Inferior gluteal artery aneurysm with arteriovenous fistula. J. Vasc. Surg. 45, 1262 (2007).

    Article  PubMed  Google Scholar 

  68. 68.Shutze, W. P., Garrett, W. V. & Smith, B. L. Persistent Sciatic Artery: Collective Review and Management. Ann. Vasc. Surg. 7, 303–310 (1993).

    Article  CAS  PubMed  Google Scholar 

  69. 69.Thomas, M. L., Blakeney, C. G. & Browse, N. L. Arteriomegaly of persistent sciatic arteries. Radiology 128, 55–56 (1978).

    Article  CAS  PubMed  Google Scholar 

  70. 70.Mandell, V. S., Jaques, P. F., Delany, D. J. & Oberheu, V. Persistent sciatic artery: clinical, embryologic, and angiographic features. Am. J. Roentgenol. 144, 245–249 (1985).

    Article  CAS  Google Scholar 

  71. 71.van Hooft, I. M., Zeebregts, C. J., van Sterkenburg, S. M. M., de Vries, W. R. & Reijnen, M. M. P. J. The Persistent Sciatic Artery. Eur. J. Vasc. Endovasc. Surg. 37, 585–591 (2009).

    Article  PubMed  Google Scholar 

  72. 72.Belmir, H., Hartung, O., Azghari, A., S Alimi, Y. & Lekehel, B. The persistent sciatic artery: Report of ten cases. JMV-Journal Med. Vasc. 45, 241–247 (2020).

    Google Scholar 

  73. 73.Brantley, S. K., Rigdon, E. E. & Raju, S. Persistent sciatic artery: Embryology, pathology, and treatment. J. Vasc. Surg. 18, 242–248 (1993).

    Article  CAS  PubMed  Google Scholar 

  74. Jose Miguel Escudero-Fernandez, Matias De Albert De Delas Vigo, Lourdes Casas Gomila, Carme Torrents Odin, Alfredo Gimeno Cajal, Maite Veintemillas Araiz, R. D. O. Intraneural ganglion cyst of the tibial nerve in a subactue stage with muscular oedema and fatty infiltration. (2020). doi:https://doi.org/10.35100/eurorad/case.16937.

  75. 75.Desy, N. M. et al. Intraneural ganglion cysts: A systematic review and reinterpretation of the world’s literature. J. Neurosurg. 125, 615–630 (2016).

    Article  PubMed  Google Scholar 

  76. 76.Pendleton, C., Broski, S. M. & Spinner, R. J. Concurrent Schwannoma and Intraneural Ganglion Cyst Involving Branches of the Common Peroneal Nerve. World Neurosurg. 135, 171–172 (2020).

    Article  PubMed  Google Scholar 

  77. 77.Lisovski, V. & Minderis, M. Intraneural ganglion cyst: a case report and a review of the literature. Acta medica Litu. 26, 147–151 (2019).

    Article  Google Scholar 

  78. 78.Panwar, J., Mathew, A. & Thomas, B. P. Cystic lesions of peripheral nerves: Are we missing the diagnosis of the intraneural ganglion cyst? World J. Radiol. 9, 230 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  79. Chitranjan, Kandpal, H. & Madhusudhan, K. S. Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve. Br. J. Radiol. 83, 65–66 (2010).

  80. 80.Losanoff, J. E., Basson, M. D., Gruber, S. A. & Weaver, D. W. Sciatic hernia: a comprehensive review of the world literature (1900-2008). Am. J. Surg. 199, 52–59 (2010).

    Article  PubMed  Google Scholar 

  81. 81.Servant, C. T. J. An unusual cause of sciatica: a case report. Spine (Phila. Pa. 1976). 23, 2134–2136 (1998).

    Article  CAS  Google Scholar 

  82. 82.Spring, D. B., Vandeman, F. & Watson, R. A. Computed tomographic demonstration of ureterosciatic hernia. Am. J. Roentgenol. 141, 579–580 (1983).

    Article  CAS  Google Scholar 

  83. 83.Aguirre, D. A., Santosa, A. C., Casola, G. & Sirlin, C. B. Abdominal wall hernias: Imaging features, complications, and diagnostic pitfalls at multi-detector row CT. Radiographics 25, 1501–1520 (2005).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Khaled M. Elsayes.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cai, Z.J., Salem, A.E., Wagner-Bartak, N.A. et al. Sciatic foramen anatomy and common pathologies: a pictorial review. Abdom Radiol 47, 378–398 (2022). https://doi.org/10.1007/s00261-021-03265-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-021-03265-8

Keywords

Navigation