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Diagnosis and Endoscopic Release of the Piriformis Muscle Under Local Anesthesia for Piriformis Syndrome

  • Tatsuo Kosugi
  • Akira Dezawa
  • Shinichi Kusano
  • Kiyoshi Yoshihara
  • Koh Katoh
Conference paper

Summary

We developed a minimally invasive technique for releasing the piriformis muscle under endoscopic control for entrapment neuropathy of the sciatic nerve due to tension and contraction of the piriformis muscle. This is a technical report on minimally invasive arthroscopic release of the piriformis muscle. This surgical technique was performed in patients who fulfilled at least five of nine diagnostic criteria (Fig. 1) that we established and who did not respond to conservative therapy for 6 months or more. While a cavity was maintained using a disposable syringe (10ml) with a cut tip, an arthroscope (4mm in diameter) was inserted at an oblique viewing angle of 30°, and the muscle was identified. The area from the musculotendinous junction to the muscle was gradually incised using a special scraper. Pain disappeared simultaneously with release of the piriformis muscle during operation. In this technique of releasing the piriformis muscle, an adequate cavity can be produced and maintained in a manner similar to that in the posterior endoscopic operation for intervertebral disc herniation. This technique is useful for reducing postoperative pain and allows an early return to society.

Key words

Piriformis syndrome Endoscopy Local anesthesia 

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References

  1. 1.
    Yoemans W (1928) The relation of arthritis of the sacroiliac joint to sciatica. Lancet 2:1119–1122Google Scholar
  2. 2.
    Freiburg AH (1937) Sciatica pain and its relief by operation on muscle and fascia. Arch Surg 34:337–350Google Scholar
  3. 3.
    Pace JB (1976) Piriformis syndrome. West J Med 124:435–439PubMedGoogle Scholar
  4. 4.
    Barton PM (1991) Piriformis syndrome: a rational approach to management. Pain 47:345–352CrossRefPubMedGoogle Scholar
  5. 5.
    Hanania M, Kitain E (1998) Perisciatic injection of steroid for the treatment of sciatica due to piriformis syndrome. Reg Anesth Pain Med 23:223–228PubMedGoogle Scholar
  6. 6.
    Beaton LE, Anson BJ (1938) The sciatic nerve and piriformis muscle. J Bone Joint Surg 20:686–689Google Scholar
  7. 7.
    Sayson SC, Ducey JP, Maybrey JB, et al (1994) Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain 59:149–152CrossRefPubMedGoogle Scholar
  8. 8.
    Robinson D (1947) Piriformis syndrome in relation to sciatic pain. Am J Surg 73:355–358CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Tatsuo Kosugi
    • 1
  • Akira Dezawa
    • 1
  • Shinichi Kusano
    • 1
  • Kiyoshi Yoshihara
    • 1
  • Koh Katoh
    • 1
  1. 1.Department of Orthopaedic SurgeryTeikyo University School of Medicine, Mizonokuchi HospitalKawasakiJapan

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