Piriformis Syndrome with Variant Sciatic Nerve Anatomy: A Case Report
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
A 68 year-old male long distance runner presented with low back and left buttock pain, which eventually progressed to severe and debilitating pain, intermittently radiating to the posterior thigh and foot. Comprehensive workup ruled out possible spine or hip etiologies of his symptoms. Pelvic MRI neurogram with complex oblique planes through the piriformis demonstrated variant anatomy of the left sciatic nerve consistent with the clinical diagnosis of piriformis syndrome. Patient ultimately underwent neurolysis with release of the sciatic nerve and partial resection of the piriformis muscle. Post-operatively, the patient reported significant pain reduction and resumed running three months later. Piriformis syndrome is uncommon but should be considered in the differential diagnosis for buttock pain. Advanced imaging was essential to guide management.
related content
- “Piriformis syndrome--a rare cause of extraspinal sciatica,” Arooj et al, J Pak Med Assoc, 2014.
- “Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome,” Natsis et al, Surg Radiol Anat, 2014.
- “Piriformis syndrome: a real pain in the buttock?,” Halpin et al, Neurosurgery, 2009.
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