Endoscopic vs Open Surgeries for Piriformis Syndrome: A Systematic Review and Meta-Analysis

Piriformis syndrome (PS) is a neuromuscular condition caused by compression or irritation of the sciatic nerve near the piriformis muscle, resulting in buttock pain that may radiate to the lower limb. Although most patients improve with conservative treatment, some develop refractory PS and require surgery. Endoscopic decompression has emerged as a minimally invasive alternative to open surgery. This study evaluated the available evidence on surgical outcomes for refractory PS.

This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Scopus, Medline, and ScienceDirect were searched without year restriction. Because no direct comparative studies between endoscopic and open surgeries were identified, both approaches were analyzed separately. Eligible studies reported pain outcomes using the visual analog scale (VAS) and functional outcomes using the modified Harris hip score (mHHS).

Twelve studies met the inclusion criteria, including nine endoscopic and three open-surgery studies. Nine studies were eligible for quantitative synthesis. Pooled analysis of six endoscopic studies showed a significant reduction in VAS (mean difference -4.7; 95% CI -5.2--4.2) and improvement in mHHS (mean difference +25.6; 95% CI +16.0-+35.3). Endoscopic complication rates ranged from 0% to 12% and were mostly minor. Open-surgery evidence was limited and synthesized narratively only.

Endoscopic decompression appears to provide favorable outcomes in carefully selected patients with refractory PS. However, definitive superiority over open surgery cannot be established from the current literature.