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Endoscopic vs Open Surgeries for Piriformis Syndrome: A Systematic Review and Meta-Analysis
Fanny Indra Warman1, Jifaldi Afrian Maharaja Dinda Sedar2,3, Muhammad Hanun Mahyuddin2
1Department of Orthopaedic and Traumatology, Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia.
Advances in Orthopedics
|July 31, 2026
Summary
Endoscopic decompression offers promising results for refractory piriformis syndrome (PS), significantly reducing pain and improving function. However, direct comparison with open surgery is lacking to establish definitive superiority.
Area of Science:
- Orthopedics
- Neurosurgery
- Pain Management
Background:
- Piriformis syndrome (PS) is a neuromuscular disorder causing buttock pain due to sciatic nerve irritation.
- Conservative treatments fail in some patients, leading to refractory PS requiring surgical intervention.
- Endoscopic decompression presents a minimally invasive surgical option for refractory PS.
Purpose of the Study:
- To evaluate surgical outcomes for refractory piriformis syndrome.
- To assess the efficacy of endoscopic decompression compared to open surgery.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched major databases (PubMed, Scopus, Medline, ScienceDirect) without date restrictions.
- Analyzed pain (VAS) and functional (mHHS) outcomes separately for endoscopic and open surgery due to lack of direct comparative studies.
Main Results:
- Twelve studies (9 endoscopic, 3 open) were included; 9 were synthesized quantitatively.
- Endoscopic decompression showed significant pain reduction (VAS: -4.7) and functional improvement (mHHS: +25.6).
- Endoscopic complication rates were low (0-12%) and minor; open surgery data was limited.
Conclusions:
- Endoscopic decompression demonstrates favorable outcomes in selected refractory PS patients.
- Current literature does not definitively establish endoscopic superiority over open surgery.
- Further comparative research is needed to confirm the advantages of endoscopic techniques.
