Published 4 issues per year
ISSN Print: 1050-6934
ISSN Online: 1940-4379
Indexed in
Computed Tomography-Guided Percutaneous Infiltrations for Piriformis Syndrome: A Single-Center Retrospective Study
Get access
ABSTRACT
Piriformis syndrome (PS), first described by Yeoman in 1928, is a general term referring to low back pain, sciatica, and instability. PS has a 6% incidence rate worldwide. In this study, we aim to retrospectively evaluate the effectiveness of computed tomography (CT)-guided percutaneous infiltration in a series of consecutive PS patients who have symptoms that are refractory to conservative therapies. An institutional database search identified 20 such consecutive patients who underwent infiltration with a mixture of long-acting corticosteroid and local anesthetic. Preoperational evaluation included physical examination and magnetic resonance imaging. The correct position of the 22-gauge spinal needle was verified with CT scan after contrast medium injection. Pain measured before the procedure and at 1 wk and 1, 6, and 12 mo after the procedure was compared by means of a numeric visual scale (NVS) questionnaire. The mean pain score before CT-guided percutaneous infiltration was 8.95 ± 1.432 NVS units. This score was reduced to a mean value of 0.85 ± 0.933 units at 1 wk, 0.90 ± 0.852 at 1 mo, 1.10 ± 1.165 at 6 mo, and 1.20 ± 1.399 at 12 mo follow-up (p < 0.001). Two patients of 20 (10%) underwent a second infiltration that was performed at 7 and 10 d after the first, respectively. No complications were observed. CT-guided infiltration seems to be a feasible, efficacious, and safe approach for pain reduction and mobility improvement in patients with symptomatic PS.
-
Y e o m a n W . T h e r e l a t i o n o f a r t h r i t i s o f t h e s a c r o i l i a c j o i n t t o s c i a t i c a , w i t h a n a n a l y s i s o f 1 0 0 c a s e s . L a n c e t 1 9 2 8 ; 2 : 1 1 1 9 - 2 2 . .
-
K i r s c h n e r J S , F o y e P M , C o l e J L . P i r i f o r m i s s y n d r o m e , d i a g n o s i s a n d t r e a t m e n t . M u s c l e N e r v e . 2 0 0 9 ; 4 0 ( 1 ) : 1 0 - 8 . .
-
J a w i s h R M , A s s o u m H A , K h a m i s C F . A n a t o m i c a l , c l i n i c a l a n d e l e c t r i c a l o b s e r v a t i o n s i n p i r i f o r m i s s y n d r o m e . J O r t h o p S u r g R e s . 2 0 1 0 ; 5 : 3 . .
-
M a s a l a S , C r u s c o S , M e s c h i n i A , T a g l i e r i A , C a l a b r i a E , S i m o n e t t i G . P i r i f o r m i s s y n d r o m e : L o n g - t e r m f o l l o w - u p i n p a t i e n t s t r e a t e d w i t h p e r c u t a n e o u s i n j e c t i o n o f a n e s t h e t i c a n d c o r t i c o s t e r o i d u n d e r C T g u i d a n c e . C a r d i o v a s c I n t e r v e n t R a d i o l . 2 0 1 2 ; 3 5 ( 2 ) : 3 7 5 - 8 2 . .
-
R o b i n s o n E S , L i n d l e y E M , G o n z a l e z P , E s t e s S , C o o l e y R , B u r g e r E L , P a t e l V V . P i r i f o r m i s s y n d r o m e v e r s u s r a d i c u l o p a t h y f o l l o w i n g l u m b a r a r t i f i c i a l d i s c r e p l a c e m e n t . S p i n e . 2 0 1 1 ; 3 6 ( 4 ) : E 2 8 2 - 7 . .
-
H o p a y i a n K , S o n g F , R i e r a R , S a m b a n d a n S . T h e c l i n i c a l f e a t u r e s o f t h e p i r i f o r m i s s y n d r o m e : A s y s t e m a t i c r e v i e w . E u r S p i n e J . 2 0 1 0 ; 1 9 ( 1 2 ) : 2 0 9 5 - 1 0 9 . .
-
F i s h m a n L M , Z y b e r t P A . E l e c t r o p h y s i o l o g i c e v i d e n c e o f p i r i f o r m i s s y n d r o m e . A r c h P h y s M e d R e h a b i l . 1 9 9 2 ; 7 3 ( 4 ) : 3 5 9 - 6 4 . .
-
S a n t a m a t o A , M i c e l l o M F , V a l e n o G , B e a t r i c e R , C i n o n e N , B a r i c i c h A , P i c e l l i A , P a n z a F , L o g r o s c i n o G , F i o r e P , R a n i e r i M . U l t r a s o u n d - g u i d e d i n j e c t i o n o f b o t u l i n u m t o x i n t y p e A f o r p i r i f o r m i s m u s c l e s y n d r o m e : A c a s e r e p o r t a n d r e v i e w o f t h e l i t e r a t u r e . T o x i n s ( B a s e l ) . 2 0 1 5 ; 7 ( 8 ) : 3 0 4 5 - 5 6 . .
-
K e l e k i s A D , S o m o n T , Y i l m a z H , B i z e P , B r o u n t z o s E N , L o v b l a d K , R u e f e n a c h t D , M a r t i n J B . I n t e r v e n t i o n a l s p i n e p r o c e d u r e s . E u r J R a d i o l . 2 0 0 5 ; 5 5 ( 3 ) : 3 6 2 - 8 3 . .
-
S a n t i a g o F R , K e l e k i s A , A l v a r e z L G , F i l i p p i a d i s D K . I n t e r v e n t i o n a l p r o c e d u r e s o f t h e s p i n e . S e m i n M u s c u l o - s k e l e t R a d i o l . 2 0 1 4 ; 1 8 ( 3 ) : 3 0 9 - 1 7 . .
-
M y s t a k i d o u K , C l e e l a n d C , T s i l i k a E , K a t s o u d a E , P r i m i k i r i A , P a r p a E , V l a h o s L , M e n d o z a T . G r e e k M . D . A n d e r s o n s y m p t o m i n v e n t o r y : V a l i d a t i o n a n d u t i l i t y i n c a n c e r p a t i e n t s . O n c o l o g y . 2 0 0 4 ; 6 7 ( 3 - 4 ) : 2 0 3 - 1 0 . .
-
F i l i p p i a d i s D K , B i n k e r t C , P e l l e r i n O , H o f f m a n n R T , K r a j i n a A , P e r e i r a P L . C i r s e q u a l i t y a s s u r a n c e d o c u m e n t a n d s t a n d a r d s f o r c l a s s i f i c a t i o n o f c o m p l i c a t i o n s : T h e C i r s e c l a s s i f i c a t i o n s y s t e m . C a r d i o v a s c I n t e r v e n t R a d i o l . 2 0 1 7 ; 4 0 ( 8 ) : 1 1 4 1 - 6 . .
-
H a l p i n R J , G a n j u A . P i r i f o r m i s s y n d r o m e : A r e a l p a i n i n t h e b u t t o c k ? N e u r o s u r g e r y . 2 0 0 9 ; 6 5 ( 4 S u p p l ) : A 1 9 7 - 2 0 2 . .
-
M i c h e l F , D e c a v e l P , T o u s s i r o t E , T a t u L , A l e t o n E , M o n n i e r G , G a r b u i o P , P a r r a t t e B . P i r i f o r m i s m u s c l e s y n d r o m e : D i a g n o s t i c c r i t e r i a a n d t r e a t m e n t o f a m o n o c e n t r i c s e r i e s o f 2 5 0 p a t i e n t s . A n n P h y s R e h a b i l M e d . 2 0 1 3 ; 5 6 : 3 7 1 - 8 3 . .
-
C r a m p F , B o t t r e l l O , C a m p b e l l H , E l l y a t t P , W i l d e B . N o n - s u r g i c a l m a n a g e m e n t o f p i r i f o r m i s s y n d r o m e : A s y s t e m a t i c r e v i e w . P h y s T h e r R e v . 2 0 0 7 ; 1 2 ( 1 ) : 6 6 - 7 2 . .
-
F i l i p p i a d i s D K , K e l e k i s A . A r e v i e w o f p e r c u t a n e o u s t e c h n i q u e s f o r l o w b a c k p a i n a n d n e u r a l g i a : C u r r e n t t r e n d s i n e p i d u r a l i n f i l t r a t i o n s , i n t e r v e r t e b r a l d i s k a n d f a c e t j o i n t t h e r a p i e s . B r J R a d i o l . 2 0 1 6 ; 8 9 ( 1 0 5 7 ) : 2 0 1 5 0 3 5 7 . .
-
R e u s M , d e D i o s B e r n a J , V a z q u e z V , R e d o n d o M V , A l o n s o J . P i r i f o r m i s s y n d r o m e : A s i m p l e t e c h n i q u e f o r U S - g u i d e d i n f i l t r a t i o n o f t h e p e r i s c i a t i c n e r v e . P r e l i m i n a r y r e s u l t s . E u r R a d i o l . 2 0 0 8 ; 1 8 ( 3 ) : 6 1 6 - 2 0 . .
-
C h e n C P , S h e n C Y , L e w H L . U l t r a s o u n d - g u i d e d i n j e c t i o n o f t h e p i r i f o r m i s m u s c l e . A m J P h y s M e d R e h a b i l . 2 0 1 1 O c t ; 9 0 ( 1 0 ) : 8 7 1 - 2 . .
-
O z i s i k P A , T o r u M , D e n k C C , T a s k i r a n O O , G u n d o g m u s B . C T - G u i d e d p i r i f o r m i s m u s c l e i n j e c t i o n f o r t h e t r e a t m e n t o f p i r i f o r m i s s y n d r o m e . T u r k N e u r o s u r g . 2 0 1 4 ; 2 4 ( 4 ) : 4 7 1 - 7 . .
-
F r i t z J , C h h a b r a A , W a n g K C , C a r r i n o J A . M a g n e t i c r e s o n a n c e n e u r o g r a p h y - g u i d e d n e r v e b l o c k s f o r t h e d i a g n o s i s a n d t r e a t m e n t o f c h r o n i c p e l v i c p a i n s y n d r o m e . N e u r o i m a g C l i n N A m . 2 0 1 4 ; 2 4 ( 1 ) : 2 1 1 - 3 4 . .
-
F i l l e r A G , H a y n e s J , J o r d a n S E , P r a g e r J , V i l l a b l a n c a J P , F a r a h a n i K , M c B r i d e D Q , T s u r u d a J S , M o r i s o l i B , B a t z d o r f U , J o h n s o n J P . S c i a t i c a o f n o n d i s c o r i g i n a n d p i r i f o r m i s s y n d r o m e : D i a g n o s i s b y m a g n e t i c r e s o n a n c e n e u - r o g r a p h y a n d i n t e r v e n t i o n a l m a g n e t i c r e s o n a n c e i m a g i n g w i t h o u t c o m e s t u d y o f r e s u l t i n g t r e a t m e n t . J N e u r o s u r g S p i n e . 2 0 0 5 ; 2 ( 2 ) : 9 9 - 1 1 5 . .
-
F a n u c c i E , M a s a l a S , S o d a n i G , V a r r u c c i u V , R o m a g n o l i A , S q u i l l a c i E , S i m o n e t t i G . C T - G u i d e d i n j e c t i o n o f b o t u l i n i c t o x i n f o r p e r c u t a n e o u s t h e r a p y o f p i r i f o r m i s m u s c l e s y n d r o m e w i t h p r e l i m i n a r y M R I r e s u l t s a b o u t d e n e r v a t i v e p r o c e s s . E u r R a d i o l . 2 0 0 1 ; 1 1 ( 1 2 ) : 2 5 4 3 - 8 . .
-
F i s h m a n L M , A n d e r s o n C , R o s n e r B . B O T O X a n d p h y s i c a l t h e r a p y i n t h e t r e a t m e n t o f p i r i f o r m i s s y n d r o m e . A m J P h y s M e d R e h a b i l . 2 0 0 2 ; 8 1 ( 1 2 ) : 9 3 6 - 4 2 . .
-
Y o o n S J , H o J , K a n g H Y , L e e S H , K i m K I , S h i n W G , O h J M . L o w - d o s e b o t u l i n u m t o x i n t y p e A f o r t h e t r e a t m e n t o f r e f r a c t o r y p i r i f o r m i s s y n d r o m e . P h a r m a c o t h e r a p y . 2 0 0 7 ; 2 7 ( 5 ) : 6 5 7 - 6 5 . .
-
Jabbari Bahman, Botulinum Toxin Treatment of Piriformis Syndrome, in Botulinum Toxin Treatment of Pain Disorders, 2022. Crossref