Piriformis syndrome after percutaneous endoscopic lumbar discectomy via the posterolateral approach

Abstract

Percutaneous endoscopic lumbar discectomy (PELD) can be performed under local anesthesia with intravenous analgesics. To define the incidence of piriformis syndrome (PS) after PELD via the posterolateral approach under local anesthesia compared to that of general patients presenting with low back pain with/without lower leg pain. The incidence and time of occurrence of positive FAIR test after PELD within a 3-month follow-up period were evaluated retrospectively, and compared with the prevalence of general patients who visited the pain clinic for LBP with/without lower leg pain. Factors that may increase the incidence of PS after PELD were also evaluated. There was no patient with positive FAIR test immediately after PELD in the operation room and before walking. The prevalence of PS in general patients was 317/2,320 (13.7%); however, the incidence of PS after PELD within a 3-month follow-up period was 61/151 (40.4%), peaking at 32 days. High anxiety scale scores during operation led to increased incidence of PS after PELD. PELD under local anesthesia with high level of anxiety may increase the incidence of PS after walking, peaking around the first month, compared with the results for general patients with low back pain with/without lower leg pain.

Fig. 1

The FAIR test. At 90° of flexion, passive adduction and internal rotation can produce symptoms

Fig. 2

Percutaneous endoscopic lumbar discectomy L4–L5: a anteroposterior, b lateral fluoroscopic views

Fig. 3

An imaginary triangle of the piriformis muscle under the fluoroscope

Fig. 4

Piriformis intramuscular injection: a anteroposterior and b lateral fluoroscopic views