Piriformis syndrome is characterized by symptoms of sciatica, most notably pain in your buttock area which spreads down your leg. In patients with piriformis syndrome, the sciatic nerve becomes irritated as the piriformis muscle spasms and squeezes your sciatic nerve against your pelvic bone. If injection treatments and physical therapy are unsuccessful in resolving your pain, surgery may be needed. There are three options: to cut the piriformis tendon, to cut through the piriformis muscle and a newer less invasive procedure.
Traditional Technique 1
The first traditional technique is generally completed under general anesthesia and is completed either as an outpatient or, in some cases; you may need to spend one night in the hospital. Your surgeon will make an incision approximately 3 inches in length in your buttock area. Your gluteus maximus fibers are split in order for the surgeon to view deep into your buttock to locate your piriformis muscle. Your surgeon will then cut your piriformis tendon where it meets the greater trochanter (located at the top of your hip).
Traditional Technique 2
The second technique is used if the first one will not be enough to fully relieve the pressure on your sciatic nerve. It is also usually completed under general anesthesia and is completed either as an outpatient or, in some cases; you may need to spend one night in the hospital. In some cases, your surgeon may use a similarly sized incision on your hip area (a similar incision as is used in hip replacement surgeries). Your surgeon will then cut through your piriformis muscle and remove a small area of the muscle.
Minimally Invasive Surgery
In contrast to traditional surgery, newer techniques can be completed using local anesthetics and on an outpatient basis. First, you will receive MRI-guided injections of Celestone (a steroid medication) and Marcaine (an anesthetic). According to NerveMed.com, this commonly resolves piriformis syndrome within a few treatments. If this is unsuccessful, the minimally invasive surgery developed by Dr. Aaron Filler at the Institute for Nerve Medicine may be indicated. It requires one small incision and does not affect the patients' gait (which traditional surgery can affect).
What to Expect After Surgery
After surgery, you will most likely be required to attend physical therapy for four to six weeks. Therapy will likely consist of ice or heat, massage, electrical stimulation or ultrasound, all of which help to ease muscle spasms and alleviate the associated pain and discomfort. Your therapist will also guide you on how to safely move to avoid straining the area which is healing. As you progress, you will receive exercises to increase your strength and eventually resume normal activity.
Symptoms of Piriformis Syndrome
Symptoms of piriformis syndrome include a pain which begins in your back and can run all the way down your leg to your foot. It may be felt on one or both sides of your body and is commonly accompanied by slight tingling sensation.
Non-surgical treatment options include pain relieving medications (like anti-inflammatories such as naproxen or ibuprofen). Physical therapy may help to alleviate muscle spasms and pain with exercises intended to alleviate the irritation to your sciatic nerve.