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

PURPOSE: 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.

METHODS

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.

RESULTS

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%).

CONCLUSIONS

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 OF EVIDENCE: Level IV, retrospective case series.