The deep gluteal space is the anatomical region between the gluteal muscles and the posterior hip joint capsule, extending from the pelvis to the proximal femur. It contains the sciatic nerve, the inferior gluteal nerve and artery, the pudendal nerve, and the external rotator muscles (piriformis, obturator internus, gemelli, quadratus femoris). The space is bounded by the sacrotuberous ligament posteriorly and the proximal femur anterolaterally.
Deep gluteal syndrome (previously called non-discogenic sciatic nerve entrapment or piriformis syndrome) encompasses all causes of sciatic nerve compression within the deep gluteal space from any aetiology — piriformis hypertrophy, fibrovascular bands, hamstring origin scarring, obturator internus variants, and anatomical nerve-piriformis relationships. Endoscopic deep gluteal space surgery (hip arthroscopy extended to the deep gluteal space) allows visualisation and decompression of the sciatic nerve throughout this space.
Sciatic nerve entrapment within the deep gluteal space from fibrovascular bands, piriformis anomalies, or hamstring origin fibrosis produces sciatica unrelated to disc pathology; endoscopic deep gluteal surgery through hip arthroscopy portals identifies and releases compressive structures along the nerve from the greater sciatic notch to the posterior thigh.
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