American Society for Peripheral Nerve

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Piriformis Muscle Resection in Treatment of Sciatic Nerve Compression
Tim Tollestrup, MD; A. Lee Dellon, MD, PhD
Johns Hopkins University, Towson, MD

Introduction: Peripheral Nerve Surgeons should be knowledgeable about the treatment of sciatica by resection of the piriformis muscle. Unfortunately, very little information about this subject is available in the scientific literature. To remedy this situation, our experience with this procedure has been reviewed.

Methods & Materials: “Sciatica” was defined as symptoms including gluteal aching, pain in the posterior thigh, calf and foot with or without paresthesias, in a patient with MRI lumbosacral spine views showing the lumbar nerve roots to NOT be involved. Previous lumbar spinal surgery was not a cause for exclusion. Physical exam findings typically include tenderness of the sciatic nerve in the sciatic notch, as well as weakness with knee flexion but normal knee extension strength. Inclusion criteria were history and physical findings consistent with compression of the sciatic nerve at the level of the piriformis muscle/sciatic notch. Surgery was an open resection of the piriformis muscle with release of the deep gluteal space, and sciatic neurolysis if further scar tissue or tight vascular leashes were present around the sciatic nerve. Patients were included from November, 2011 through May, 2017, for whom there was at least a 6 month follow-up. Outcomes were graded as excellent if no symptoms remained, good if some symptoms remained, fair if there was just a slight improvement, and failure, when there was no change in symptoms.

Results: One hundred patients were enrolled who met the above criteria for sciatica. Of these 100 were followed for more than 6 months. Among these 100 patients, 80 (80%) had excellent results, 10 (10%) had good results, 2 (2%) had fair results, and 8 (8%) had failed to improve at all. There were no complications related to bleeding, wound healing or injury to the sciatic nerve.

Conclusion: Resection of the piriformis muscle as part of sciatic neurolysis can improve lower extremity function and relieve patient symptoms in approximately 90% of patients.

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