Piriformis Tenotomy and Sciatic Neurolysis via a Mini-open Approach: A Technique Guide

Piriformis syndrome is a common, treatable cause of deep gluteal pain. Treatment often starts with conservative measures such as nonsteroidal anti-inflammatories, muscle relaxants, physical therapy, and injections, but some patients progress to needing surgical intervention. Several surgical techniques are currently used to treat piriformis syndrome, with an endoscopic approach gaining popularity because of its less invasive nature and, therefore, esthetic and symptomatic benefits. However, an open approach remains more effective in releasing severely adherent sciatic nerves, in addition to being less technically demanding. This article aims to describe a reproducible mini-open surgical technique for piriformis tenotomy with sciatic neurolysis, thereby providing patients with the esthetic and symptomatic benefits of a traditional endoscopic approach while maintaining the efficiency of a traditional open approach.