The Piriformis Syndrome. A sciatic nerve entrapment misdiagnosed as lumbar radiculopathy. A case report and literature review
Keywords:
Sciatica, Sciatic nerve, Piriformis Muscle
Abstract
The term Piriformis Syndrome describes an extrapelvic pressure of the whole or part of the Sciatic Nerve, at the level of the Piriformis muscle caused by various conditions and characterized Clinically by symptoms of sciatica. As early as 1928 Yeoman described extra pelvic entrapment of the sciatic nerve by the piriformis muscle as a cause of sciatica. After Mixter and Barr in 1934 described nerve root compression by disc prolapse as a cause of sciatica, this diagnosis dominated the Clinical thinking for nearly three decades and what had been previously described was nearly forgotten. The development of imaging techniques revealed other intraspinal compressing elements. On the other hand, cases of negative root exploration for Sciatica focused attention to extrapelvic sciatic nerve pathology. This report concerns the case of a patient, who after a negative root exploration for severe sciatica proved to have an extrapelvic cause for this problem at the level of the piriformis muscle due mainly to anatomic variation of the sciatic nerve in relation to the piriformis muscle.
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References
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2. Anson B.S. and Maddock G.W., Calendars Surgical Anatomy, 3d ed., 861-863, Philadelphia London, 1928
3. Benerjee T. Hall, CD Sciatic Entrapment neuropathy, case report, Journal of Neurosurgery, 45 (2), 216-217, 1976
4. Barton P. M., Piriformis syndrome. A rational approach to management. Pain 47 (3), 345-352, 1991
5. Beaton L.E. and Anson B.J., The sciatic nerve and the piriformis muscle. Their Interrelation a possible cause of coccycodynia. J. Bone Joint Surg. 20, 686-68, 1938
6. Brown J.A., Brawn Ma Namey, Piriformis syndrome in a 10-year-old boy as a Complication of operation with the patient in a sitting position, Neurosurgery 23 (1) 117-119, 1988
7. Durani Z., Winnie A.P., Piriformis muscle syndrome an underdiagnosed cause of sciatica, J of Pain and symptom management 6 (6) 374-379, 1991
8. Bower E.B., Smullens S.N. and Park W.E., Clinical aspects of persistent sciatic Artery. Report of two cases and review of the literature. Surgery 81, 588,595, 1977
9. Cameron H., V NudftAl F, The piriformis syndrome, Can J. Surg, 31, 210, 1988
10. Chen W.S., Sciatica due to piriformis pyomyositis. Report of case, J. Bone Joint Surg.,74-A,1546-1548, 1992
11. Fishman L.M., Zybert P.A.: Electrophysiologic evidence of Piriformis syndrome. Arche of Physical Med. and Rehabilitation
12. Freiberg A.H., Sciatic pain and its relief by operations on muscle and fascia. Arch. Surg.,34:337-350, 1937
13. Freiberg A.H. The fascial elements in associated low-back pain and sciatic pain., J. Bone and Joint Surg. 23:478-480, April 1941
14. Freiberg A.H. and Vinke T.H.: Sciatica and the sacro-iliac joint. J. Bone and Joint Surg. 16:126-136, Jan. 1934
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16. Hallin R.P.: Sciatic pain and the pyriformis muscle, Postgrad Med. m 74:69-72, Aug.1983
17. Hubert H.M.: (The pyriformis syndrome - possible cause of sciatica). Das piriformissyndrom-eine mogliche Ursache fur Ischialgien. Schweiz. Rundschan fur Medizin Praxis, 79 (9): 235-236, Feb. 1990
18. Hughes S.S., Goldstein M.N., Hicks D.G., Pellegrini V.D. Jr.: Extrapelvic compression of the sciatic nerve. An unusual cause of pain about the hip: report of five cased, J. Bone and Joint Surg. 74-A (10) 1553-1559, 1992
19. Jankiewicz J.J., Hennrikus W.L., Honkom J.A.: The appearance of the pyriformis muscle syndrome in computed tomography and MRI. A case report and review of the literature (Review). Clinical Orthop & Related Research (262):205-209, 1991
20. Julsrud M.E., Piriformis syndrome, J. American Podiatric Med Assoc 79 (3):128-131, 1989
21. Karl R.D. Jr., Yedinak M.A., Hartshorne M.F., Cawtown M.A., Bauman J.M., Howard W.H. and Bunker S.R.: Scintigraphic appearance of the piriformis muscle syndrome. Clin. Nucl. Med., 10:361-363, 1985
22. Lee C.S. and Tsai T.L.: The relation of the sciatic nerve to the piriformis muscle, J Formosan Med Assn, 73: 75-80, 1974
23. Mc Lellan G.L., Morettin L.B.: Persistent Sciatic Artery. Arch. Surg, 117, 817-822, 1982
24. Merrild V., Søgaard, Ib.: Sciatica caused by perifibrosis of the sciatic nerve (Brief Report), J. Bone and Joint Surg., 68-B, 5,706, 1986
25. Miao H.: Eirological exploration of piriformis syndrome. Chung-Hua Wai Kotsa Chik Ckinese J. of Surgery 21 (3): 163-164, 1983
26. Mixter W.J. and Barr J.S.: Rupture of the intervertebral disc with involvement of the spinal canal. New England J. Med. 211:210-214, 1934
27. Mizuguchi T.: Division of the Pyriformis muscle for the Treatment of Sciatica Postlaminectomy syndrome and osteoarthritis of the Spine. Arch. Surg. 111, 719-722, 1972
28. Nakano K.K.: Unraveling the mysteries of piriformis syndrome: J. Musculoskel Med 3: 8-10, 1986
29. Nicholson R.L., Postershank S.P., Balkunth B.B.: Persistent Primitive Sciatic Artery. Radiology 122: 687-689, 1977
30. Noftal F.: The piriformis syndrome. Canadian J. Surg., 31: 210, 1988
31. Pace J.B. and Nagle D.: Piriformis syndrome. Western J. Med. 124: 435-439, 1976
32. Palliath S. and Buday J.: Sciatic nerve compression: Diagnostic value of electromyography and computerized tomography. Electromyog. And Clin. Neurophysiol. 29: 9-11, 1986
33. Papadopoulos S.M., Mc Gillicuddy J.E. and Messina I.M.: Pseudoaneurysm of the inferior gluteal artery, presenting as sciatic nerve compression. Neurosurgery, 24: 926-928, 1989
34. Park H.W., Jahng J.S., Lee W.H.: Piriformis syndrome – a case report. Yonsei Medical Journal 32 (1): 68-68, 1991
35. Paterson A.M.: The morphology of the sacral plexus in men. J. Anat. And Physiol. 21: 407-412, 1987
36. Pecina M. Contribution to the aetiological explanation of the piriformis syndrome. Acta Anatomica 105 (2): 181-187, 1979
37. Prokhorchik N.M.: The use of novocaine blocks in the combined treatment of the piriform muscle syndrome (Russian). Voenuo-Meditsinskii Zhurnal (10): 53-54, 1989
38. Robinson D.R.: Pyriformis syndrome in relation to sciatic pain. Am. J. Surg. 73: 355-358, 1974
39. Rombough G.: Extrapelvic compression of sciatic nerve. An usual cause of pain about the hip. J. Bone and Joint Surg. 75-A: 1576, 1993
40. Saal J.A., Dillingham M.P., Gamburd R.S. and Fanton G.S.: The pseudoradicular syndrome. Lower extremity peripheral nerve entrapment mis-regarding as lumbar radiculopathy. Spine (13), 8,926-930, 1988
41. Solheim L.F., Siewers P and Paus B.: The piriformis muscle syndrome. Sciatic nerve entrapment treated with section of the piriformis muscle. Acta Ortop. Scandinavica 52: 75-75, 1981
42. Smart J.D., Morgan R.F., Persing J.A.: Nerve compression syndromes of the lower extremity. Amer. Family Physician 40(4) 101-112, 1989
43. Synek V.M: The piriformis syndrome. Review and case presentation. Neurol. 23, 31-37, 1987
44. Vantertop W.P, Bosmam N.J.Q The piriformis syndrome. A case report. J.Bone J. Surg. 73a,1095-1097, 1991
45. Willbourne A.: The value and limitations of EMG in the Diagnosis of lumbar disc disease. N.York Raven Press, Pp651109, 1982
46. Hopaian K, Song F, Riera R and Sambandan S. The clinical features of piriformis syndrome. A systematic review. Eur Spine 2010 Dec 19(2095-2019)
2. Anson B.S. and Maddock G.W., Calendars Surgical Anatomy, 3d ed., 861-863, Philadelphia London, 1928
3. Benerjee T. Hall, CD Sciatic Entrapment neuropathy, case report, Journal of Neurosurgery, 45 (2), 216-217, 1976
4. Barton P. M., Piriformis syndrome. A rational approach to management. Pain 47 (3), 345-352, 1991
5. Beaton L.E. and Anson B.J., The sciatic nerve and the piriformis muscle. Their Interrelation a possible cause of coccycodynia. J. Bone Joint Surg. 20, 686-68, 1938
6. Brown J.A., Brawn Ma Namey, Piriformis syndrome in a 10-year-old boy as a Complication of operation with the patient in a sitting position, Neurosurgery 23 (1) 117-119, 1988
7. Durani Z., Winnie A.P., Piriformis muscle syndrome an underdiagnosed cause of sciatica, J of Pain and symptom management 6 (6) 374-379, 1991
8. Bower E.B., Smullens S.N. and Park W.E., Clinical aspects of persistent sciatic Artery. Report of two cases and review of the literature. Surgery 81, 588,595, 1977
9. Cameron H., V NudftAl F, The piriformis syndrome, Can J. Surg, 31, 210, 1988
10. Chen W.S., Sciatica due to piriformis pyomyositis. Report of case, J. Bone Joint Surg.,74-A,1546-1548, 1992
11. Fishman L.M., Zybert P.A.: Electrophysiologic evidence of Piriformis syndrome. Arche of Physical Med. and Rehabilitation
12. Freiberg A.H., Sciatic pain and its relief by operations on muscle and fascia. Arch. Surg.,34:337-350, 1937
13. Freiberg A.H. The fascial elements in associated low-back pain and sciatic pain., J. Bone and Joint Surg. 23:478-480, April 1941
14. Freiberg A.H. and Vinke T.H.: Sciatica and the sacro-iliac joint. J. Bone and Joint Surg. 16:126-136, Jan. 1934
15. Gauthier C., Walter C., Chantraine H.: Une entite nosological meconnue: Le syndrome du muscle pyramidal. Rev. Med de la Suisse Romande 110 (4):351-354, 1990
16. Hallin R.P.: Sciatic pain and the pyriformis muscle, Postgrad Med. m 74:69-72, Aug.1983
17. Hubert H.M.: (The pyriformis syndrome - possible cause of sciatica). Das piriformissyndrom-eine mogliche Ursache fur Ischialgien. Schweiz. Rundschan fur Medizin Praxis, 79 (9): 235-236, Feb. 1990
18. Hughes S.S., Goldstein M.N., Hicks D.G., Pellegrini V.D. Jr.: Extrapelvic compression of the sciatic nerve. An unusual cause of pain about the hip: report of five cased, J. Bone and Joint Surg. 74-A (10) 1553-1559, 1992
19. Jankiewicz J.J., Hennrikus W.L., Honkom J.A.: The appearance of the pyriformis muscle syndrome in computed tomography and MRI. A case report and review of the literature (Review). Clinical Orthop & Related Research (262):205-209, 1991
20. Julsrud M.E., Piriformis syndrome, J. American Podiatric Med Assoc 79 (3):128-131, 1989
21. Karl R.D. Jr., Yedinak M.A., Hartshorne M.F., Cawtown M.A., Bauman J.M., Howard W.H. and Bunker S.R.: Scintigraphic appearance of the piriformis muscle syndrome. Clin. Nucl. Med., 10:361-363, 1985
22. Lee C.S. and Tsai T.L.: The relation of the sciatic nerve to the piriformis muscle, J Formosan Med Assn, 73: 75-80, 1974
23. Mc Lellan G.L., Morettin L.B.: Persistent Sciatic Artery. Arch. Surg, 117, 817-822, 1982
24. Merrild V., Søgaard, Ib.: Sciatica caused by perifibrosis of the sciatic nerve (Brief Report), J. Bone and Joint Surg., 68-B, 5,706, 1986
25. Miao H.: Eirological exploration of piriformis syndrome. Chung-Hua Wai Kotsa Chik Ckinese J. of Surgery 21 (3): 163-164, 1983
26. Mixter W.J. and Barr J.S.: Rupture of the intervertebral disc with involvement of the spinal canal. New England J. Med. 211:210-214, 1934
27. Mizuguchi T.: Division of the Pyriformis muscle for the Treatment of Sciatica Postlaminectomy syndrome and osteoarthritis of the Spine. Arch. Surg. 111, 719-722, 1972
28. Nakano K.K.: Unraveling the mysteries of piriformis syndrome: J. Musculoskel Med 3: 8-10, 1986
29. Nicholson R.L., Postershank S.P., Balkunth B.B.: Persistent Primitive Sciatic Artery. Radiology 122: 687-689, 1977
30. Noftal F.: The piriformis syndrome. Canadian J. Surg., 31: 210, 1988
31. Pace J.B. and Nagle D.: Piriformis syndrome. Western J. Med. 124: 435-439, 1976
32. Palliath S. and Buday J.: Sciatic nerve compression: Diagnostic value of electromyography and computerized tomography. Electromyog. And Clin. Neurophysiol. 29: 9-11, 1986
33. Papadopoulos S.M., Mc Gillicuddy J.E. and Messina I.M.: Pseudoaneurysm of the inferior gluteal artery, presenting as sciatic nerve compression. Neurosurgery, 24: 926-928, 1989
34. Park H.W., Jahng J.S., Lee W.H.: Piriformis syndrome – a case report. Yonsei Medical Journal 32 (1): 68-68, 1991
35. Paterson A.M.: The morphology of the sacral plexus in men. J. Anat. And Physiol. 21: 407-412, 1987
36. Pecina M. Contribution to the aetiological explanation of the piriformis syndrome. Acta Anatomica 105 (2): 181-187, 1979
37. Prokhorchik N.M.: The use of novocaine blocks in the combined treatment of the piriform muscle syndrome (Russian). Voenuo-Meditsinskii Zhurnal (10): 53-54, 1989
38. Robinson D.R.: Pyriformis syndrome in relation to sciatic pain. Am. J. Surg. 73: 355-358, 1974
39. Rombough G.: Extrapelvic compression of sciatic nerve. An usual cause of pain about the hip. J. Bone and Joint Surg. 75-A: 1576, 1993
40. Saal J.A., Dillingham M.P., Gamburd R.S. and Fanton G.S.: The pseudoradicular syndrome. Lower extremity peripheral nerve entrapment mis-regarding as lumbar radiculopathy. Spine (13), 8,926-930, 1988
41. Solheim L.F., Siewers P and Paus B.: The piriformis muscle syndrome. Sciatic nerve entrapment treated with section of the piriformis muscle. Acta Ortop. Scandinavica 52: 75-75, 1981
42. Smart J.D., Morgan R.F., Persing J.A.: Nerve compression syndromes of the lower extremity. Amer. Family Physician 40(4) 101-112, 1989
43. Synek V.M: The piriformis syndrome. Review and case presentation. Neurol. 23, 31-37, 1987
44. Vantertop W.P, Bosmam N.J.Q The piriformis syndrome. A case report. J.Bone J. Surg. 73a,1095-1097, 1991
45. Willbourne A.: The value and limitations of EMG in the Diagnosis of lumbar disc disease. N.York Raven Press, Pp651109, 1982
46. Hopaian K, Song F, Riera R and Sambandan S. The clinical features of piriformis syndrome. A systematic review. Eur Spine 2010 Dec 19(2095-2019)
Published
2021-08-20
Section
Case Report
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