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

Elizabeth Hogan, Darshan Vora, Jonathan H Sherman, Elizabeth Hogan, Darshan Vora, Jonathan H Sherman

Abstract

Background: Piriformis syndrome accounts for approximately 6% of patients who present with sciatic pain. There are many treatment options ranging from physical therapy, to trigger point injections, to surgical intervention. We discuss a surgical method that represents a minimally invasive technique for the treatment of piriformis syndrome.

Methods: We describe a novel operative approach and technique for release of the piriformis muscle in the treatment of piriformis syndrome. Described are the preoperative planning, incision and approach, and technique for identifying and releasing the piriformis muscle.

Results: Three patients were treated for piriformis syndrome using the described technique. Each patient displayed successful relief of their symptoms immediately following the surgical procedure and at delayed follow-up.

Conclusion: Early experience with our method of piriformis release suggests that it is well suited for the treatment of piriformis syndrome. The novel integration of pre-operative trigger point localization coupled with intraoperative neuromonitoring allows effective pain relief with minimal morbidity.

Keywords: Minimally invasive; Neuromonitoring; Piriformis syndrome; Sciatic nerve.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Illustration of displaying the incision line and initial dissection through the gluteus maximus. On the right side of the image, the incision line is displayed and center on the trigger point identified in the pre-op area. The line is drawn along the direction of the piriformis muscle extending from the sacrum to the greater trochanter of the femur. On the right side of the image, the initial blunt dissection is displayed through the gluteus maximus
Fig. 2
Fig. 2
Illustration of displaying stimulation and identification of the sciatic nerve using a nerve stimulator. The piriformis muscle is elevated with a hand-held retractor in this process
Fig. 3
Fig. 3
Illustration of displaying the release of the piriformis muscle. On the left side of the image, the sciatic nerve is displayed in its typical location below the piriformis muscle. On the right side of the image, the sciatic nerve is shown decompressed after cutting of the piriformis muscle

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