Comprehensive Management of Piriformis Syndrome with Endoscopic Release and Sciatic Neurolysis Provides Favorable Outcomes and Low Complication Rate
Author(s): Quesada-Jimenez R, Walsh EG, Kahana-Rojkind AH, Schab AR, McCarroll TR, Domb BG
DOI Link: 10.1016/j.arthro.2025.06.023
Background:
Piriformis syndrome can cause deep gluteal pain and sciatic nerve irritation, often refractory to conservative management. Endoscopic piriformis release with sciatic neurolysis has emerged as a minimally invasive surgical option. This study evaluated midterm outcomes and clinical effectiveness of a standardized diagnostic and surgical algorithm.
Methods:
This Level IV retrospective case series used prospectively collected data on patients undergoing endoscopic piriformis release and sciatic neurolysis between 2010 and 2021. Patients with ≥2-year follow-up completed PROs including mHHS, NAHS, HOS-SSS, VAS pain, and satisfaction scores. MCID achievement was assessed across all measures.
Key Findings
- 18 patients included with mean follow-up ~93 months
- Significant improvements in all PROs (P < .05 to P < .001)
- High postoperative patient satisfaction (8.3 ± 1.7)
- MCID achievement rates:
- mHHS: 83.3%
- NAHS: 77.8%
- HOS-SSS: 61.1%
- VAS: 94.4%
- 100% reported symptom relief
- Low complication rate reported
Conclusion
Endoscopic piriformis release with sciatic neurolysis demonstrates favorable midterm outcomes, high patient satisfaction, and consistent achievement of clinically meaningful improvement with low complication rates in appropriately selected patients.
What Does This Mean for Providers?
In patients with refractory piriformis syndrome, endoscopic decompression is a reliable minimally invasive option with durable symptom relief. A structured diagnostic algorithm may help improve patient selection and optimize outcomes.