Editorial Commentary: Piriformis Syndrome Is a Complex Condition That Requires Precise Diagnosis and Can Be Adequately Treated by Sciatic Neurolysis and Release of the Piriformis Tendon.

Piriformis syndrome is an extrapelvic compression of the sciatic nerve at the infrapiriformis canal. Recently, this condition has been included with other extrapelvic sciatic compression syndromes under the term deep gluteal syndrome. Patients usually present with posterior gluteal pain irradiated to the posterior thigh, which frequently is triggered or exacerbated by sitting over long periods of time (30 minutes or longer). Even though piriformis syndrome is well understood, its diagnosis is usually one of exclusion, in which other causes of sciatica, including lumbosacral pathology, are excluded. An adequate history and physical examination combined with an array of studies frequently are used to narrow the differential diagnosis and to obtain a precise diagnosis of piriformis syndrome. Ultrasound-guided injections with local anesthetics combined with or without glucocorticoids are a powerful tool both as a diagnostic test procedure and a therapeutic measure. Treatment is initially conservative including the administration of nonsteroidal anti-inflammatory drugs, muscle relaxants, gabapentin, or pregabalin and physical therapy. Surgical treatment of the piriformis tendon is indicated after failure of conservative therapy. Open and endoscopic techniques have been described for release of the piriformis tendon and neurolysis of the sciatic nerve, both with adequate and similar success rates and similar complication rates.