Endoscopic Technique: Sciatic Neurolysis and Piriformis Tendon Release for Treating Piriformis Syndrome
Author(s): Quesada-Jimenez R, Walsh EG, Kahana-Rojkind AH, Schab AR, McCarroll TR, Domb BG
Background:
Piriformis Syndrome (PS) is a neuromuscular condition characterized by sciatic nerve entrapment by the piriformis muscle, often presenting as buttock pain and sciatica. While most cases respond to conservative treatment, a subset of patients with persistent symptoms may require surgical intervention. Endoscopic piriformis release and sciatic neurolysis has emerged as a minimally invasive treatment option.
Methods:
This retrospective case series analyzed prospectively collected data from 18 patients undergoing endoscopic piriformis release with sciatic neurolysis between 2010 and 2021. A standardized diagnostic algorithm was employed, and all patients had preoperative and minimum 2-year postoperative assessments.
Patient-reported outcome (PRO) measures included:
- Modified Harris Hip Score (mHHS)
- Non-Arthritic Hip Score (NAHS)
- Hip Outcome Score – Sports Specific Subscale (HOS-SSS)
- Visual Analog Scale (VAS) for pain
- Overall patient satisfaction
Minimal Clinically Important Difference (MCID) thresholds were used to evaluate clinical relevance.
Key Findings:
- All patients experienced symptom relief postoperatively.
- Statistically significant improvements were observed in:
- mHHS (p < 0.001)
- NAHS (p < 0.001)
- HOS-SSS (p = 0.019)
- VAS for pain (p < 0.001)
- High patient satisfaction (mean score: 8.3 ± 1.7).
- Proportion achieving MCID:
- mHHS: 83.3%
- NAHS: 77.8%
- HOS-SSS: 61.1%
- VAS: 94.4%
- Low complication rate observed across the cohort.
Conclusion:
Endoscopic sciatic neurolysis with piriformis release provides significant and durable symptom relief for patients with refractory piriformis syndrome. The approach yields high satisfaction, robust improvements across multiple PROs, and maintains a low risk profile, supporting its role as an effective surgical solution for this challenging condition.
What Does This Mean for Providers?
- Surgical consideration for refractory cases: Patients who do not respond to physical therapy, injections, or pharmacologic management may be appropriate candidates for minimally invasive endoscopic release.
- Diagnostic rigor is essential: Use of a standardized algorithm improves diagnostic accuracy and patient selection, which is critical for optimizing outcomes.
- Procedure benefits: This approach yields high clinical success, particularly in pain reduction (VAS) and functional improvement, with low complication rates.
- Clinical impact: Providers should consider early surgical referral in appropriate cases to avoid prolonged disability and diminished quality of life due to unaddressed sciatic nerve entrapment.