Diagnosis and Management of Sciatic Endometriosis at the Greater sciatic Foramen: a Case Report

Sciatic endometriosis is a rare condition in which endometrial tissue invades or compresses the lumbosacral plexus and/or sciatic nerve and causes sciatic pain, which is often cyclical. Its diagnosis depends on the recognition of signs and symptoms atypical to common degenerative lumbar disorders and its treatment requires timely and coordinated care. A 26-year-old woman presented to a chiropractor at a hospital-based outpatient clinic with a 6-month exacerbation of radiating pain and paresthesia from the right gluteal region into the leg and foot. She was previously treated for over 3 months for suspected lumbosacral radiculopathy with physical therapy. Multisegmental neurologic deficits inconsistent with her prior lumbar imaging prompted further investigation. Pelvis and hip MRI identified a 7×5 cm mass extending through the greater sciatic foramen which compressed and infiltrated the lumbosacral plexus, sciatic nerve, and superior gluteal nerve, and was confirmed via biopsy to be endometriosis. Referral and co-management with a neurologist and obstetrician resulted in a conservative strategy of hormone therapy with the option of having surgical excision if needed. Sciatic endometriosis is a rare disorder that may be misdiagnosed due to its tendency to mimic common lumbar disorders. This case highlights the role of a chiropractor coordinating care for a complex disorder that benefits from early diagnosis for optimal management. It also illustrates how integration of chiropractors into a hospital system can facilitate their ability to manage neuro-musculoskeletal disorders as they can easily refer to and communicate with other medical specialties within the network.