A minimally invasive open surgical approach for piriformis syndrome. A case report and literature review
Piriformis syndrome is being increasingly recognized as a distinct clinical entity which is now thought to account for as many as 6–8% of cases of lumbar backache and sciatica. Gender distribution notes a strong female predominate with a female to male ratio of 6:1.4. The disease is noted to occur a...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-09-01
|
| Series: | Interdisciplinary Neurosurgery |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751920301419 |
| _version_ | 1819212165240848384 |
|---|---|
| author | Aftab Younus Adrian Kelly Patrick lekgwara |
| author_facet | Aftab Younus Adrian Kelly Patrick lekgwara |
| author_sort | Aftab Younus |
| collection | DOAJ |
| description | Piriformis syndrome is being increasingly recognized as a distinct clinical entity which is now thought to account for as many as 6–8% of cases of lumbar backache and sciatica. Gender distribution notes a strong female predominate with a female to male ratio of 6:1.4. The disease is noted to occur as a primary form as well as a secondary form with a wide differential diagnosis. Diagnosing the problem as the cause of a patient’s pain is difficult and the standard clinical tests have a low sensitivity. MRI evaluation is problematic due to thickness assessment alone being of limited value. Ultrasonography has shown promise and demonstrated superiority to MRI evaluation due to its ability to assess cross sectional area and inflammatory changes in the sciatic nerve. Management necessitates a conservative 6-week trial of non-steroidal anti-inflammatory medication, muscle relaxants, physical therapy and steroid injections. Most patients respond to this conservative regimen within 1–3 weeks however for enduring relief adherence to a stretching exercise program cannot be over-emphasised. Surgery is considered a last line resort and the standard approach utilizes a 12 cm incision placed posterior to the greater trochanter through which division of the piriformis tendon and a neurolysis of the sciatic nerve from the piriformis muscle belly is achieved. We report an adult female patient with piriformis syndrome who failed a 6-week trial of conservative measures. She was taken to the operating room and through a minimally invasive open surgical approach utilizing a 6 cm skin incision posterior to the greater trochanter the surgical objectives were achieved. There were no complications and at her 6-week follow-up appointment she was pain free. We recommend a minimally invasive open approach, through a 6 cm skin incision placed posterior to the greater trochanter, as adequate to achieve the surgical objectives in the surgical management of this disease. |
| first_indexed | 2024-12-23T06:38:38Z |
| format | Article |
| id | doaj.art-a144c46e941e4f429037cdb9be47062e |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-23T06:38:38Z |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-a144c46e941e4f429037cdb9be47062e2022-12-21T17:56:44ZengElsevierInterdisciplinary Neurosurgery2214-75192020-09-0121100720A minimally invasive open surgical approach for piriformis syndrome. A case report and literature reviewAftab Younus0Adrian Kelly1Patrick lekgwara2Department of Orthopedics, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Neurosurgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa; Corresponding author.Department of Neurosurgery, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South AfricaPiriformis syndrome is being increasingly recognized as a distinct clinical entity which is now thought to account for as many as 6–8% of cases of lumbar backache and sciatica. Gender distribution notes a strong female predominate with a female to male ratio of 6:1.4. The disease is noted to occur as a primary form as well as a secondary form with a wide differential diagnosis. Diagnosing the problem as the cause of a patient’s pain is difficult and the standard clinical tests have a low sensitivity. MRI evaluation is problematic due to thickness assessment alone being of limited value. Ultrasonography has shown promise and demonstrated superiority to MRI evaluation due to its ability to assess cross sectional area and inflammatory changes in the sciatic nerve. Management necessitates a conservative 6-week trial of non-steroidal anti-inflammatory medication, muscle relaxants, physical therapy and steroid injections. Most patients respond to this conservative regimen within 1–3 weeks however for enduring relief adherence to a stretching exercise program cannot be over-emphasised. Surgery is considered a last line resort and the standard approach utilizes a 12 cm incision placed posterior to the greater trochanter through which division of the piriformis tendon and a neurolysis of the sciatic nerve from the piriformis muscle belly is achieved. We report an adult female patient with piriformis syndrome who failed a 6-week trial of conservative measures. She was taken to the operating room and through a minimally invasive open surgical approach utilizing a 6 cm skin incision posterior to the greater trochanter the surgical objectives were achieved. There were no complications and at her 6-week follow-up appointment she was pain free. We recommend a minimally invasive open approach, through a 6 cm skin incision placed posterior to the greater trochanter, as adequate to achieve the surgical objectives in the surgical management of this disease.http://www.sciencedirect.com/science/article/pii/S2214751920301419 |
| spellingShingle | Aftab Younus Adrian Kelly Patrick lekgwara A minimally invasive open surgical approach for piriformis syndrome. A case report and literature review Interdisciplinary Neurosurgery |
| title | A minimally invasive open surgical approach for piriformis syndrome. A case report and literature review |
| title_full | A minimally invasive open surgical approach for piriformis syndrome. A case report and literature review |
| title_fullStr | A minimally invasive open surgical approach for piriformis syndrome. A case report and literature review |
| title_full_unstemmed | A minimally invasive open surgical approach for piriformis syndrome. A case report and literature review |
| title_short | A minimally invasive open surgical approach for piriformis syndrome. A case report and literature review |
| title_sort | minimally invasive open surgical approach for piriformis syndrome a case report and literature review |
| url | http://www.sciencedirect.com/science/article/pii/S2214751920301419 |
| work_keys_str_mv | AT aftabyounus aminimallyinvasiveopensurgicalapproachforpiriformissyndromeacasereportandliteraturereview AT adriankelly aminimallyinvasiveopensurgicalapproachforpiriformissyndromeacasereportandliteraturereview AT patricklekgwara aminimallyinvasiveopensurgicalapproachforpiriformissyndromeacasereportandliteraturereview AT aftabyounus minimallyinvasiveopensurgicalapproachforpiriformissyndromeacasereportandliteraturereview AT adriankelly minimallyinvasiveopensurgicalapproachforpiriformissyndromeacasereportandliteraturereview AT patricklekgwara minimallyinvasiveopensurgicalapproachforpiriformissyndromeacasereportandliteraturereview |