Comprehensive Management of Piriformis Syndrome with Endoscopic Release and Sciatic Neurolysis Provides Favorable Outcomes and Low Complication Rate
Authors
Quesada-Jimenez R, Walsh EG, Kahana-Rojkind AH, Schab AR, McCarroll TR, Domb BG
Background
Piriformis Syndrome (PS) is a neuromuscular condition caused by compression of the sciatic nerve by the piriformis muscle, leading to buttock pain and sciatica. Surgical treatment using endoscopic sciatic neurolysis and piriformis release has emerged as a minimally invasive alternative for patients who do not respond to conservative management.
Methods
This retrospective case series analyzed prospectively collected data from 18 patients treated with endoscopic piriformis release and sciatic neurolysis between 2010 and 2021. All patients were diagnosed using a standardized algorithm and completed preoperative and minimum 2-year follow-up assessments. Patient-reported outcome (PRO) measures included the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and overall satisfaction. Minimal clinically important difference (MCID) thresholds were also evaluated.
Key Findings
- All patients reported symptom relief following surgery.
- Significant improvements were found in:
- mHHS (p < 0.001)
- NAHS (p < 0.001)
- HOS-SSS (p = 0.019)
- VAS for pain (p < 0.001)
- Patient satisfaction was high (mean: 8.3 ± 1.7).
- The proportion of patients reaching the MCID was:
- mHHS: 83.3%
- NAHS: 77.8%
- HOS-SSS: 61.1%
- VAS: 94.4%
- Complication rates were low.
Conclusion
Endoscopic piriformis release combined with sciatic neurolysis offers a safe and effective treatment for piriformis syndrome, resulting in high satisfaction, substantial symptom relief, and clinically meaningful improvements in hip function and pain scores.
What Does This Mean For Patients
Patients with persistent piriformis syndrome symptoms despite conservative treatment may benefit from this minimally invasive surgical approach, which shows a high success rate, long-term symptom relief, and low risk of complications.