International Journal of Anatomy and Research



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Type of Article: Original Research

Year: 2016 | Volume 4 | Issue 3 | Page No. 2743-2749

Date of Publication: 31-08-2016

DOI: http://dx.doi.org/10.16965/ijar.2016.323


DIFFERENT LEVELS OF BIFURCATION OF SCIATIC NERVE: A NOVEL CLASSIFICATION BASED ON A CADAVERIC STUDY IN INDIAN POPULATION

Harsimran Grewal *1, Rajan Kumar Singla 2, Rupinder Singh 3, Mannat Singla 4.

*1 Senior Resident, Department Of Anatomy, Government Medical College, Patiala,Punjab, India.

2 Professor & Head Of Department, Department Of Anatomy, Government Medical College,Patiala, Punjab, India.

3 M.Sc. Student, Department Of Anatomy, Government Medical College, Patiala, Punjab India.

4 M.B.B.S Student, Department Of Anatomy, Government Medical College, Patiala, Punjab India.

Address: Dr. Harsimran Grewal, 16, The Mall, Opposite Polo Ground, Patiala-147001, Punjab, India.
E-Mail:
grewalkim@gmail.com

ABSTRACT

Introduction: The Sciatic Nerve (SN) is the largest and thickest nerve in the body. It is composed of two nerves, the common peroneal (CPN) and the tibial (TN) which are bound together by a common sheath of connective tissue from their origin till the bifurcation at the superior angle of popliteal fossa. But this division may occur at any level above this point and rarely below it. These anatomical variations may contribute to clinical conditions such as piriformis syndrome, sciatica, coccygodynia and muscle atrophy.
Material and Methods: 30 Lower limbs of 15 cadavers (Male:Female -14:1) were dissected and examined to study the mode and level of bifurcation of SN.
Results: The highest incidence of SN bifurcation (63.3%) was observed at superior angle of popliteal fossa followed by division at junction of upper and middle 1/3rd of thigh in 20%, in the pelvis in 10% and in middle 1/3rd of thigh in 6.7%.
Conclusion: SN bifurcates terminally at different levels for which many classifications have been given. However  there are certain over lapping and thus confusions amongst them. Therefore, a new classification termed as Grewal et al classification has been designed and advocated for future studies. It may prove more helpful for anatomists to categorise different levels of bifurcation of SN and for surgeons, orthopaedicians and anaesthetists performing surgeries in the region and giving SN blocks at different levels.
KEY WORDS: Bifurcation Of Sciatic Nerve, Variations, Tibial Nerve, Common Peroneal Nerve, Piriformis Muscle.

REFERENCES

  1. Janes JM. General survey of the lower limb. In:Holllinshed WH, editor. Anatomy for surgeons: Volume 3, The back and limbs. 2nd ed.New York: Harper &   Row;.1969.p.575-634.
  2. Mahadevan V. Pelvic girdle, gluteal region and thigh. In: Standring S, editor. Gray’s Anatomy: The anatomical basis of clinical practice.40th ed. Philadelphia: Churchill Livingstone Elsevier: 2008.p.1349-1385.
  3. Agur AM, Dalley AF. Lower limb. In:Moore KL, Dalley AF, editors. Clinically oriented Anatomy. 5th ed. Philadelphia: Lippincott Williams & Wilkins.2006.p.555-724.
  4. Sangram S, Samanta C, Paul M, Biswas S, Ghosh R, Sarkar A et al. A study on the bifurcation of sciatic nerve with its clinical significance. Indian Journal of Basic and applied Medical Research, 2015 June;4(3):34-44.
  5. Brooks JBB, Silva CAC, Soares SA, Kai MR, Cabral RH, Fragosa YD. Anatomical variations of the sciatic nerve in a group of Brazilian cadavers. Rev Dor Sao Paulo,2011 Oct-Dec;12(4):332-6
  6. Muthu Kumar T, Srimathi, Rani A, Latha S. A cadaveric study of sciatic nerve and it’s level of bifurcation. J Clin Diagn Res,2011 Dec; 5(8):1502-4.
  7. Beaton LE, Anson BJ. The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Rec.1937;70:1-5
  8. Garg K. Back of thigh.In:Garg K,editor.BD Chaurassia’s:Human Anatomy Regional and applied dissection and clinical:Volume 2 Lower limb Abdomen and pelvis.5th ed.New Delhi:CBS publishers;2010.p.91-7.
  9. Prakash, Bhardwaj AK, Devi MN, Sridevi NS, Rao PK, Singh G. Sciatic nerve division: a cadaver study in the Indian population and review of the literature. Singapore Med J,2010;51(9):721-2
  10. Ogeng’O JA, El-Busaidy H, Mwika PM, Khanbhai MM, Munguti J.Variant anatomy of sciatic nerve in a black Kenyan population. Folia Morphol,2011;70(3):175-9.
  11. Kiros MD, Woldeyes DH. Anatomical variations in the level of bifurcation of the sciatic nerve in Ethiopia. J Exp Clin Anat,2015;14(1):1-4
  12. Saritha S, Praveen Kumar M, Supriya G. Anatomical variations in the bifurcation of the sciatic nerve, A cadaveric study and its clinical implications. Anat Physiol 2012;2:111.doi:10.4172/2161-0940.1000111.
  13. Desalegn M and Tesfay A. Variations of sciatic nerve its exit in relation to piriformis muscle in the Northern Ethiopia. International Journal of Pharma Sciences and Research,2014;Dec 5(12):953-6.
  14. Berihu BA and Debeb YG. Anatomical variation in bifurcation and trifurcations of sciatic nerve and its clinical implications: in selected university in Ethiopia. BMC Res Notes,2015;8:633
  15. Leishiwon PS, Matum M, Devi AJ, Deven I, Devi HR, Debbarma P. Level of division of sciatic nerve in fetuses. J Med Soc,2015;29(3):169-171.
  16. Collins P. Pre – and postnatal development. In: Standring S, editor. Gray’s Anatomy :The anatomical basis of clinical practice.40th ed. Philadelphia: Churchill Livingstone Elsevier : 2008.p.212.
  17. Gunnal SA and Wabale RN. An unusual bilateral sciatic nerve variation: Case report. Pravara Med Rev, 2011;3(4):12-14.
  18. Rejeena PR, Kunjumon PC, More Anju B. Bilateral variant of sciatic nerve exhibiting intra-pelvic division. Int J Med Res Health Sci,2014;3(2):451-3.
  19. Boyajian- O’ Neill LA, Mc Clain RL, Coleman MK, Thomas PP. Diagnosis and management of piriformis syndrome: An osteopathic approach. J Am Osteopath Assoc,2008 Nov; 108(11):657-64
  20. Ekanem PE, Abba S, Mariam K, Assefah H. Variations of sciatic nerve bifurcation in dissected cadavers from Ethiopia and their clinical implications: A case report. Int J Anat Res,2015;3(3):1341-4.
  21. Shwetha K, Dakshayani KR. Bilateral high division of sciatic nerve. Int J Res Med Sci, 2014;Nov 2(4):1785-7.

 

Harsimran Grewal, Rajan Kumar Singla, Rupinder Singh, Mannat Singla. DIFFERENT LEVELS OF BIFURCATION OF SCIATIC NERVE: A NOVEL CLASSIFICATION BASED ON A CADAVERIC STUDY IN INDIAN POPULATION. Int J Anat Res 2016;4(3):2742-2749. DOI: 10.16965/ijar.2016.323

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