gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Piriformis syndrome – Fata morgana or a neglected neurosurgical disease

Meeting Abstract

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  • U. Barcik - Neurochirurgische Klinik, Klinikum St. Marien, Amberg
  • R. Megele - Neurochirurgische Klinik, Klinikum St. Marien, Amberg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.08.11

DOI: 10.3205/12dgnc077, URN: urn:nbn:de:0183-12dgnc0772

Published: June 4, 2012

© 2012 Barcik et al.
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Outline

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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.