gms | German Medical Science

Objective: The correct diagnosis of Piriformis Syndrome can be delayed by unspecific clinical symptoms and unawareness in the neurosurgical community. However, effective treatment can be offered by decompression of the sciatic nerve when passing through the infrapiriform foramen.

Methods: We describe a 69-year-old man who suffered during almost 6 years from severe pain in both buttocks radiating to both heels. When in the sitting position the pain was increasing. On the VAS he noted 8/10. There was no paresis and no hypoesthesia. Gower-Bonnet-Test was positive on both sides. Hofmann-Tinel sign was positive bilaterally over the Foramen infrapiriformis. We excluded common spinal disorders. Conservative treatment was ineffective. Although he got the opinions of various colleagues no surgery was offered. Interestingly, he self-diagnosed his disease with the help of Internet forums.

Results: Within 4 months the patient was operated 4 times. In the first session the left piriformis muscle (p.m.) was nicked by ¼ via a transgluteal approach but there was little effect. One month later the right piriformis muscle was dissected by ½. Since the pain relief was greater the patient demanded a revision of the left side, where the muscle was totally cut. Finally, the right p.m. was dissected totally. The latest follow-up at 3 months after the last surgery showed a very good result in respect to pain release.

Conclusions: Piriformis Syndrome exists. The best treatment is the total dissection of the p.m. Incomplete dissection is perhaps responsible for unsatisfactory results. Neurosurgeons should take care of such patients.