A systematic review of conservative and surgical treatments for deep gluteal syndrome.

Deep gluteal syndrome causes pain from irritation of the sciatic nerve as it passes through the buttock region, and clinicians can choose between conservative treatments (like injections) or surgery, but it has been unclear which works better. This systematic review searched multiple databases through July 2019 and identified 13 studies with 508 total patients: 8 randomized controlled trials (336 patients) testing conservative options such as steroid, botulinum toxin, thiocolchicoside, or colchicine injections into muscle, and 5 surgical case series (172 patients). Only 3 of the trials showed pain reduction reaching a minimum clinically important difference, while all 5 surgical case series showed improvement when comparing before and after surgery. Only one study showed a clinically meaningful reduction in disability.

The authors rated the overall quality of evidence as low, meaning no single conservative treatment could be recommended over another, and surgical evidence came only from uncontrolled case series without comparison groups.

This review looked at treatments for deep gluteal syndrome, a condition where irritation near the sciatic nerve in the buttock causes pain. Researchers combined findings from 13 studies covering 508 people: 8 trials (336 patients) tested injections such as steroids, botulinum toxin, thiocolchicoside, or colchicine, and 5 studies (172 patients) looked at surgery results without comparison to non-surgical care. The results were mixed.

Only 3 of the injection trials showed a meaningful improvement in pain, and just one study showed meaningful improvement in daily function or disability. The surgery studies showed improvement comparing patients before and after their operation, but since there was no comparison group, it's hard to know how much of that improvement was due to the surgery itself versus other factors like natural healing over time. Overall, the researchers found the quality of evidence across all these studies to be low.

This means it isn't clear which treatment works best, and more rigorous research is needed before firmer conclusions can be drawn.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review pooled 13 studies (508 patients total) on deep gluteal syndrome, split between 8 RCTs (336 patients) testing intramuscular injections (steroid, botulinum toxin, thiocolchicoside, colchicine) and 5 surgical case series (172 patients). Risk of bias was assessed using the Cochrane tool for RCTs and JBI checklists for case series, and outcomes were pain and disability reduction judged against a calculated minimum clinically important difference (MCID). Only 3 of the conservative trials reached the pain MCID, and only 1 study across the entire body of evidence showed an MCID improvement in disability.

The 5 surgical case series all showed before-after improvement, but as uncontrolled designs, these cannot establish efficacy relative to no treatment or natural history. The authors rated overall evidence quality as low, precluding recommendation of any single conservative modality over another. Given this uncertainty, the authors note that general back pain and sciatica management guidelines, with physiotherapy as first-line care, may be relevant, while surgery might have a role in chronic cases.

These statements reflect the low certainty of the underlying evidence base rather than confirmed treatment superiority.