Surgical Treatment of Piriformis Syndrome

Abstract

BackgroundPiriformis syndrome (PS) is an uncommon disease characterized by symptoms resulting from compression/irritation of the sciatic nerve by the piriformis muscle. Uncertainty and controversy remain regarding the proper diagnosis and most effective form of treatment for PS. This study analyzes the diagnostic methods and efficacy of conservative and surgical treatments for PS.MethodsFrom March 2006 to February 2013, we retrospectively reviewed 239 patients who were diagnosed with PS and screened them for eligibility according to our inclusion/exclusion criteria. All patients underwent various conservative treatments initially including activity modification, medications, physical therapy, local steroid injections into the piriformis muscle, and extracorporeal shock wave therapy for at least 3 months. We resected the piriformis muscle with/without neurolysis of the sciatic nerve in 12 patients who had intractable sciatica despite conservative treatment at least for 3 months. The average age of the patients (4 males and 8 females) was 61 years (range, 45 to 71 years). The average duration of symptoms before surgery was 22.1 months (range, 4 to 72 months), and the mean follow-up period was 22.7 months (range, 12 to 43 months). We evaluated the degree of pain and recorded the responses using a visual analog scale (VAS) preoperatively and 3 days and 12 months postoperatively.ResultsButtock pain was more improved than sciatica with various conservative treatments. Compared with preoperatively, the VAS score was significantly decreased after the operation. Overall, satisfactory results were obtained in 10 patients (83%) after surgery.ConclusionsPS is thought to be an exclusively clinical diagnosis, and if the diagnosis is performed correctly, surgery can be a good treatment option in patients with refractory sciatica despite appropriate conservative treatments.

The majority of piriformis muscles are innervated by the superior gluteal nerve

“…Piriformis syndrome is an indefinite disease that refers to pain caused by impingement/irritation of the sciatic nerve by the piriformis muscle, causing sciatica, buttock pain, or both as it exits the pelvis through the greater sciatic foramen (Pecina et al, ; Cassidy et al, ; Han et al, ; Siddiq et al, ). To describe the piriformis syndrome, the synonyms “psudosciatica,” “sciatic notch syndrome,” “gluteal nerve syndrome,” “pelvic outlet syndrome,” and “wallet neuritis” have been used (Boyajian‐O'Neill et al, ; Filler, ; Hopayian et al, ; Jankovic et al, ; Iwanaga et al, ; Tubbs et al, ).…”

A rare muscle variation – accessory piriformis muscle

“…Piriformis syndrome includes hip pain, buttock pain, sciatica and intolerance to sitting. [3,12,13] In up to 16.2% of surgical case series, piriformis syndrome is caused by anatomical variations. [14] The accessory piriformis, piercing the sciatic nerve, might be one of the rare causes of nerve compression.…”

A minimally invasive surgical approach for the treatment of piriformis syndrome: a case series

“…Piriformis syndrome (PS) is a controversial and uncommon condition that is characterized by symptoms caused by irritation or compression of the sciatic nerve as it travels underneath the piriformis muscle just distal to the sciatic notch [1]. It is speculated that about 6-8% of sciatic nerve pain is due to PS [2,3].…”

“…PS is characterized by buttock pain that radiates down the posterior aspect of the leg that is aggravated by sitting. Patients also report external tenderness near the greater sciatic notch [1].…”

“…The treatment of PS has traditionally been conservative in nature with noninvasive treatment including activity modifications, physical therapy, and use of antiinflammatory medications, muscle relaxants, and/or neuropathic pain medications [1,5]. When patients fail conservative management, the next step in treatment is typically localized injections of either corticosteroids or botulinum neurotoxin into the piriformis muscle [5].…”