Surgical Decompression of Pudendal Neuralgia Due to Entrapment Beneath a Bifurcate Piriformis Muscle: A Case Report

A 33-year-old woman with a 1-year history of right gluteal and pelvic pain due to entrapment of the pudendal nerve by a bifurcate piriformis muscle underwent piriformis tenotomy, pudendal neurolysis, and sciatic neurolysis by an open posterolateral hip approach. At 32-week follow-up, the patient was free of deep gluteal pain and all pudendal neuralgia symptoms.

Pudendal nerve entrapment by the piriformis is an uncommon cause of pudendal neuralgia that can be effectively treated with surgical intervention. We demonstrate an open posterolateral hip approach may provide significant pain relief and satisfactory improvements in patient-reported outcomes in management of this pathology.