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Piriformis Syndrome - Treatment

In the United States each year, 1.5 million people have lumbar MRI scans to look for the cause of the buttock and leg pain called "sciatica."

Yet more than 1.2 million of those scans fail to find the cause in the spine. Three hundred thousand of the scans are sufficiently positive that the patient has lumbar spine surgery. And of the 300,000 surgeries, as many as 25% fail to relieve the pain — in many cases because the diagnosis of a spinal cause for the sciatica was incorrect.

Piriformis syndrome also causes sciatica. Its treatment is much less invasive and severe than the treatment of herniated lumbar disks. However, many doctors never consider piriformis syndrome as a possible diagnosis. Many physicians who are aware of it are uncertain how to properly diagnose and treat it.

Dr. Aaron Filler credits the advent of MR Neurography and Open MR injection techniques with new large-scale outcome as leading to the successful diagnosis and treatment of many more sciatica sufferers.

There are many diagnoses and treatments of piriformis syndrome. Please click on any of the links below to learn more about individualized cases from the files of Dr. Filler.

Outpatient minimally invasive surgical treatment


Treatment: New minimal access, outpatient surgery greatly improves outcome and reduces recovery time

Animation: Elements of piriformis surgery including incision locations.

Piriformis surgery is now a small procedure which can be carried out under local anaesthetic as an outpatient.

Traditional piriformis surgery is a large and debilitating operation but no patient should be having these operations today. There were two types of traditional piriformis surgery, one involves a large lateral hip incision similar to the approach used for a hip replacement surgery. The second involves a very large incision and involves completely detaching all of the gluteal muscles from the iliac crest. Both of these types of surgery result in weeks of debilitation, walking on crutches and pain, with only limited success treating the original problem.

The new type of "minimal access surgery" developed at the Institute for Nerve Medicine by Dr. Aaron Filler involves only a small incision, and in most cases can be performed on an outpatient basis. Large scale formal outcome trials involving hundreds of patients with follow-up out to eight years show no detectable effect on normal walking in any of the patients - this a great change from the traditional surgery that often leaves permanent problems with gait. Recovery takes only a few days in most patients.

Those patients who have positive physical exam findings, positive MR neurography findings and a clear positive response to MRI guided piriformis injection have had a 85% to 90% good to excellent outcome.

Open MRI Guided Injection of the Piriformis Muscle





Treatment: Piriformis Injections

Animation: 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.

Dr. Aaron Filler's 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 anesthetic is injected in the skin and then a titanium Lufkin needle is introduced and advanced into the piriformis muscle. An injection of Marcaine (10cc of 0.5% solution of this long-acting local anesthetic) 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.

Thanks to Dr. Filler's technique, piriformis surgery is now a small procedure which can be carried out under local anesthetic as an outpatient.



Dr. Aaron G. Filler, MD PhD

Dr. Aaron Filler is the world’s leading expert in treatment of nerve pain. He has revolutionized nerve-pain treatment by inventing several new technologies. One such technology, MR Neurography, enables doctors to use an MRI scanner to examine nerves — previously a difficult-to-impossible tissue to see through MR imaging. Dr. Filler's research in axonal transport is leading to a whole new generation of advanced pain medications. He has developed many new “minimal access” surgery methods that allow him to treat complex nerve problems with small outpatient surgeries. He has also pioneered the use of the Open MRI scanner to do surgeries and other therapies with the ultra-high precision and safety of the magnetic resonance imaging.   Click here to learn more.

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About NerveMed

NerveMed is a free online resource dedicated to helping patients worldwide with information about spine and nerve health issues. NerveMed is powered by the Institute for Nerve Medicine in Santa Monica, California, home to Dr. Aaron G. Filler, MD PhD, a leading neurosurgeon specializing in minimally invasive treatments for spine and nerve issues. Click here to learn more.

Dr. Aaron G. Filler, MD PhD

Dr. Aaron Filler is the world’s leading expert in treatment of nerve and spine pain, having revolutionized treatments by inventing several new technologies, including MR Neurography. Dr. Filler has also pioneered minimal-access surgery methods to treat complex nerve and spine problems with outpatient surgeries.   Click here to learn more.