Endoscopic Treatment of Piriformis Syndrome Results in a Significant Improvement in Pain Visual Analog Scale Scores

To survey the clinical satisfaction of patients who have had an endoscopic piriformis release with a sciatic nerve neurolysis.

Patients with piriformis syndrome (PS) who were treated with an endoscopic piriformis release combined with a sciatic neurolysis between 2013 and 2018 were identified. All patients had a minimum follow-up of 1 year. Patients were contacted by telephone in 201,9 whereby the rate of satisfaction and pain were evaluated with the Benson surgery scale and the visual analog scale (VAS).

The average duration of symptoms at first presentation was 34 months (range 16-54 months). Thirty-seven cases (82,2%) had an EMG that showed sciatic compression around the piriformis muscle. The average preoperative VAS pain score was 7.4 (± 0.8). The mean VAS score at the time of the survey was 1.9 (± 2.4). The difference in median preoperative and postoperative VAS was 6. Using the Wilcoxon signed-rank test, we found there was a significant improvement of VAS score (with P < .001). Using the Benson operative scale, we found that outcomes at the time of the survey were excellent in 23 patients (24 cases, 53.4%), good in 10 (22.2%), fair in 3 (6.7%), and poor in 8 (17.7%). Three patients with a poor result had a wrong diagnosis of PS and ended up needing treatment for a different diagnosis. In total, 33 patients answered affirmative on the question if they would undergo the procedure again. Apart from 3 local wound infections, no major complications were observed.

Once a diagnosis is made, the endoscopic release of the piriformis tendon results in significant improvement in Pain VAS scores for patients with refractory symptoms despite conservative treatment.

Level IV, therapeutic case series.