Piriformis Syndrome Resulting From a Rare Anatomic Variation

Kosukegawa, Ima; Yoshimoto, Mitsunori; Isogai, Satoshi; Nonaka, Shinsuke; Yamashita, Toshihiko

doi:10.1097/01.brs.0000231877.34800.71

Cited by 38 publications

(24 citation statements)

References 13 publications

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“…In our two patients, MRI was not helpful, although one showed a slightly thickened piriformis muscle. In contrast to previous reports [1,12,18,21], the anatomic variation was not detected by MRI. Changes in the initial electromyography were either absent or not specific for compression of the sciatic nerve.…”

Section: Discussioncontrasting

confidence: 99%

Recurrent Piriformis Syndrome After Surgical Release

Kobbe

Zelle

Gruen

2008

Clinical Orthopaedics &Amp; Related Research

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Piriformis syndrome is an uncommon condition characterized by sciatic nerve entrapment at the greater sciatic notch. Nonoperative treatment such as physical therapy, nonsteroidal antiinflammatory drugs, and local injections often results in relief of symptoms. For patients who do not benefit from nonoperative therapy, surgical exploration and decompression of the sciatic nerve has been effective. However, the success of surgery may be diminished by scar formation or hematoma in the anatomically restricted sciatic notch. We report two patients with piriformis syndrome who responded primarily to surgical decompression and had recurrent symptoms resulting from scar tissue formation in the sciatic notch. On revision surgery, polytetrafluoroethylene pledgets were placed around the sciatic nerve to avoid compression and entrapment by scar tissue. Both patients had satisfactory outcomes at 3 years followup.

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Section: Discussioncontrasting

confidence: 99%

Recurrent Piriformis Syndrome After Surgical Release

Kobbe

Zelle

Gruen

2008

Clinical Orthopaedics &Amp; Related Research

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“…We suggest that this arrangement be termed as low formation of SN rather than a higher division of SN. We did not find Beaton and Anson type 4 variations as this variation is extremely rare and is reported only by Chen [5], and by Kosukegawa et al [9].…”

Section: Discussionmentioning

confidence: 54%

The sciatic nerve in human cadavers — high division or low formation?

2016

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“…Although it does not appear that piriformis syndrome is commonly caused by the anomalies mentioned here, there are a few cases reporting anomalies causing piriformis syndrome (Solheim et al, 1981;Chen and Wan, 1992;Ozaki et al, 1999;Kosukegawa et al, 2006). Because the symptoms and signs of intervertebral disc disease mimic those of piriformis syndrome, the diagnosis of intervertebral disc disease may serve as a red herring, causing unnecessary procedures to be performed on the lumbar spine.…”

Section: Discussionmentioning

confidence: 85%

“…Only a few case reports link the piriformis and sciatic nerve anomalies to piriformis syndrome (Solheim et al, 1981;Chen and Wan, 1992;Ozaki et al, 1999;Kosukegawa et al, 2006). If this anomaly was associated with piriformis syndrome, an increased prevalence of the anomaly would be expected among patients suffering from piriformis syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical features are similar to intervertebral disc herniations with patients suffering from low back, buttock, and post-thigh pain, with occasional neurological symptoms such as foot drop, and dysasthesia. In some cases, it can be due to congenital variations of the PM and the sciatic nerve (Solheim et al, 1981;Chen and Wan, 1992;Ozaki et al, 1999;Kosukegawa et al, 2006). The type of anatomical variation present may reflect the clinical presentation of piriformis syndrome such that a split nerve (anomaly ''B,'' ''C,'' or ''E'') may only involve the common peroneal nerve, whereas anomaly ''D'' or ''F'' may involve the entire sciatic nerve.…”

Section: Introductionmentioning

confidence: 99%

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Variations of the piriformis and sciatic nerve with clinical consequence: A review

2009

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The deep gluteal region is often encountered when performing injections, when performing surgery such as total hip replacements, or diagnosing problems of this region or lower limbs using clinical or imaging techniques. Previously, the prevalence figures of piriformis and sciatic nerve anomalies have ranged from 1.5 to 35.8% in dissected specimens. This study systematically reviews and meta-analyses the prevalence of piriformis and sciatic nerve anomalies in humans using previously published literature. A further review is conducted regarding the anatomical abnormalities present in surgical case series of procedures for patients suffering from piriformis syndrome. After pooling the results of 18 studies and 6,062 cadavers, the prevalence of the anomaly in cadavers was 16.9%; 95% confidence interval (CI) 16.0-17.9%. The prevalence of the piriformis and sciatic nerve anomaly in the surgical case series was 16.2%, 95% CI: 10.7-23.5%. The difference between the two groups was not found to be significant 0.74%; 95% CI: -5.66 to 7.13; P = 0.824. Because of the high likelihood of an anomaly being present in a patient, clinicians and surgeons should be aware of the potential complications this anomaly may have on medical or surgical interventions. Furthermore, because the prevalence of the anomaly in piriformis syndrome patients is not significantly different from what is thought to be a normal population, it indicates that this anomaly may not be as important in the pathogenesis of piriformis syndrome as previously thought.

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Piriformis Syndrome Resulting From a Rare Anatomic Variation

Abstract: This is a very rare case of surgically treated piriformis syndrome resulting from type d anatomic variation in Beaton's classification. Pelvic MRI and perineurography of the sciatic nerve were useful for diagnosis in this case.

Cited by 38 publications

References 13 publications

Recurrent Piriformis Syndrome After Surgical Release

Recurrent Piriformis Syndrome After Surgical Release

The sciatic nerve in human cadavers — high division or low formation?

Variations of the piriformis and sciatic nerve with clinical consequence: A review

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