Deep gluteal space problems: piriformis syndrome, ischiofemoral impingement and sciatic nerve release

Piriformis syndrome is a neuromuscular pain syndrome occurring as a result of compression on the underlying sciatic nerve due to various causes including the hypertrophy, inflammation, mass lesions or anatomical variations occuring in the deep gluteal space. Patients with piriformis syndrome often experience pain and numbness in the hip, thigh and leg, similar to those of sciatica. In addition to clinical findings, electrophysiological examinations and magnetic resonance imaging (MRI) is useful for diagnosis. Once diagnosed, the treatment approach is stepwise and conservative treatment is successful in majority of cases. Surgical treatment should be performed for the cases in whom conservative treatment methods fail and when the sciatic nerve should be decompressed. Surgery is an important treatment option for unresolved piriformis syndrome with its simplicity and low morbidity. Several surgical procedures have been described for the decompression of affected sciatic nerve. Due to excessive fibrosis tissue that may be developed around the sciatic nerve in classical surgical procedures, person's return to social and work life may be delayed. In the present study, we will evaluate the surgical indication criteria of our cases who underwent minimally invasive surgical treatment due to piriformis syndrome, the definition of the surgical procedure and the outcomes.

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Laparoscopic surgical approach for the treatment of piriformis syndrome: Intrapelvic decompression technique

Journal of Endometriosis and Pelvic Pain Disorders ◽

10.1177/22840265211045610 ◽

2021 ◽

pp. 228402652110456

Author(s):

Ahmet Kale ◽

Gülfem Başol ◽

Elif Cansu Gündoğdu ◽

Emre Mat ◽

Gazi Yıldız ◽

...

Keyword(s):

Sciatic Nerve ◽

Decompression Surgery ◽

Piriformis Syndrome ◽

First Case ◽

Cutaneous Allodynia ◽

Pelvic Nerves ◽

Uncommon Disease ◽

History Of ◽

Vas Scores ◽

The Right

Introduction: Piriformis syndrome is an uncommon disease resulting from the piriformis muscle’s compression of the sciatic nerve. Pain and numbness in the buttocks and down the leg are the most common symptoms. This study analyzes the laparoscopic surgical treatment of piriformis syndrome. Methods: We report three cases of piriformis syndrome diagnosed in our hospital. The first case was a 40 years old woman with a 7-year history of intermittent low back pain and sciatica on her right side. Hyperesthesia and cutaneous allodynia were observed in the right sciatic nerve dermatome. The second case was a 30 years old woman with a 2-year history of sciatica on her left side. The third case was a 30 years old woman with a 2-year history of sciatica on her right side. All the patients underwent laparoscopic decompression surgery, which was performed to release the sciatic nerve or sacral nerve roots. Results: The patients were reexamined at the postoperative 3rd and 6th months. Their visual analog scale (VAS) scores were found to be decreased from 10/10, 9/10, and 7/10 to 0/10, 1/10, and 0/10, respectively. Conclusion: Due to the very few cases in the literature, pelvic piriformis syndrome is an exclusively clinical diagnosis. If the sciatica is refractory to conservative treatments, laparoscopic exploration and decompression surgery of the pelvic nerves and piriformis muscle could be an option.

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Arthroscopic Treatment of Secondary Piriformis Syndrome by Perineural Cyst on the Sciatic Nerve: A Case Report

The Journal of the Korean Hip Society ◽

10.5371/jkhs.2008.20.4.326 ◽

2008 ◽

Vol 20 (4) ◽

pp. 326

Author(s):

Chan Kang ◽

Deuk Soo Hwang ◽

Soo Min Cha

Keyword(s):

Case Report ◽

Sciatic Nerve ◽

Arthroscopic Treatment ◽

Piriformis Syndrome ◽

Perineural Cyst

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Case 3

10.1093/med/9780190603434.003.0007 ◽

2018 ◽

Author(s):

Bashar Katirji

Keyword(s):

Sciatic Nerve ◽

Nerve Injury ◽

Clinical Manifestations ◽

Sciatic Nerve Injury ◽

Foot Drop ◽

Motor Deficits ◽

Nerve Lesion ◽

Piriformis Syndrome ◽

Sciatic Nerve Lesion ◽

Painful Syndrome

Sciatic nerve injury is a relatively uncommon lower extremity mononeuropathy. The various etiologies of sciatic neuropathies are highlighted in this case. The clinical manifestations and diagnosis include distinguishing foot drop due to sciatic neuropathy from peroneal (fibular) neuropathy across the fibular neck, L5 radiculopathy, and lumbosacral plexopathy. The electrodiagnostic features of sciatic nerve lesion are separated from those of foot drop due to other peripheral nerve causes. In contrast to sciatic nerve injury, the piriformis syndrome is mostly a painful syndrome with no or minimal sensory or motor deficits. The clinical manifestations of piriformis syndrome and controversies surrounding this syndrome completes the discussion in this case.

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Arthroscopic treatment of piriformis syndrome by perineural cyst on the sciatic nerve: a case report

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-009-1013-8 ◽

2010 ◽

Vol 18 (5) ◽

pp. 681-684 ◽

Cited By ~ 21

Author(s):

Deuk-Soo Hwang ◽

Chan Kang ◽

Jung-Bum Lee ◽

Soo-Min Cha ◽

Kyu-Woong Yeon

Keyword(s):

Case Report ◽

Sciatic Nerve ◽

Arthroscopic Treatment ◽

Piriformis Syndrome ◽

Perineural Cyst

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Swelling of the Leg, Deep Venous Thrombosis and the Piriformis Syndrome

Pain Research and Management ◽

10.1155/2001/104091 ◽

2001 ◽

Vol 6 (4) ◽

pp. 200-203 ◽

Cited By ~ 2

Author(s):

Sara Bustamante ◽

Peter G Houlton

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Sciatic Nerve ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Lower Limb ◽

Leg Pain ◽

Low Back ◽

Piriformis Syndrome ◽

Possible Cause

BACKGROUND: The piriformis syndrome, which was first described 60 years ago, is a well recognized cause of sciatica, leg pain and low back pain, due to the entrapment of the sciatic nerve in the piriformis and other rotator muscles. Very few complications relating to this syndrome have been described.AIMS: To discuss how the piriformis syndrome may cause venous engorgement in the lower limb, and how the piriformis syndrome should be included as a possible cause of acute deep venous thrombosis in a not initially swollen leg. Both complications can occur independently.METHODS: Two cases of swelling of the leg and acute deep venous thrombosis independently associated with the piriformis syndrome are presented.CONCLUSIONS: Swelling of the leg and deep venous thrombosis are possible complications of the piriformis syndrome that occur due to entrapment of nerves and vessels within the leg, secondary to a severe spasm and hypertrophy of the piriformis and other rotator muscles.

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