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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.
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. 
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.