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.
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.
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Do You Really Need Back Surgery? by Dr. Aaron G. Filler, MD PhD, is a best-selling paperback every sufferer of spine and nerve pain should read. Written in everyday language, the book is a must-read.
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.