Piriformis Syndrome:

Open MRI provides the necessary accuracy and reliability to safely inject the piriformis muscle with therapeutic and diagnostic agents
The piriformis muscle is a relatively small structure located as far as eight inches below the surface of the buttock. If a blind injection misses the muscle, the injection test is meaningless. Immediately deep to the piriformis muscle is the sciatic nerve and the colon so misplacement of the needle may lead to significant complications. The use of Open MRI image guidance makes this a safe reliable and accurate procedure. In these images, the physician's finger is seen indicating the angle of approach in the first image. In subsequent views, local anaesthetic is injected in the skin and then a titanium Lufkin needle is introduced and advanced into the piriformis muscle. An injection of Marcaine (10 cc of 0.5% solution of this long acting local anaesthetic) and Celestone (1cc of this steroid medication) is then seen darkening the interior of the muscle in the last two image frames. These flash MRI images each take about 12 seconds to complete. In about 20% of cases the injection is therapeutic and the piriformis syndrome resolves completely and permanently. In others, the injection needs to repeated in a few months, and in still others, it last only a few days. In this category, surgery may be required to maintain the pain relief. Piriformis surgery is now a small procedure which can be carried out under local anaesthetic as an outpatient.
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