Comprehensive Management of Piriformis Syndrome With Endoscopic Release and Sciatic Neurolysis Provides Favorable Outcomes and Low Complication Rate.

Abstract

To evaluate the outcomes of endoscopic sciatic neurolysis and piriformis release as treatment for piriformis syndrome with a minimum 2-year follow-up, as well as present a comprehensive approach to enhance diagnostic accuracy. Prospectively collected data were retrospectively analyzed for all patients who underwent endoscopic piriformis release and sciatic neurolysis as a treatment for piriformis syndrome between 2010 and 2021. A diagnostic algorithm was employed for surgical indications throughout this time period. Included patients had completed preoperative and a minimum of 2-year postoperative questionnaires for the following patient-reported outcome measures: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain and patient satisfaction. The minimal clinically important difference was calculated for the mentioned patient-reported outcome and included in the analysis. A total of 18 patients with a mean follow-up time of 93.1 ± 38.2 months were included in the study. All patients experienced symptom relief postoperatively. Significant improvement was seen at latest follow-up compared to preoperative baseline for mHHS (P < .001), NAHS (P < .001), HOS-SSS (P = .019), and VAS (P < .001), as well as a high mean patient satisfaction of 8.3 ± 1.7. Furthermore, a high percentage of patients reached the calculated minimal clinically important difference for mHHS (83.3%), NAHS (77.8%), HOS-SSS (61.1%), and VAS (94.4%). Endoscopic release of the piriformis tendon and sciatic neurolysis have shown favorable outcomes, high patient satisfaction rates, and a high percentage of patients reaching clinically important thresholds, with a low rate of complications at a minimum 2-year follow-up. Level IV, retrospective case series.