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Piriformis release surgery, anyone???


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TLK
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PostPosted: 05/16/04 - 11:35    Post subject: Piriformis release surgery, anyone???
Hi,
I'm new here. Thought a running forum might be a good place to find anyone who has had this surgery.

I have just been diagnosed with piriformis syndrome, which started, now four years ago, after a hilly run in a triathlon. It was first diagnosed as a back problem, and after steroid injections and a mini-discectomy failed to get rid of the pain in the butt, my new doctor is 99% sure it's piriformis related, and nothing to do with my back, although it's causing lower back pain as well.

In light of the fact that it's been four years with chronic daily pain when walking, sitting and bending, and I have tried all methods of soft-tissue manipulation, therapy, acupuncture, etc, he is considering doing a piriformis release surgically (after he confirms the diagnosis, of course).

I am trying to find people who have had this surgery as I would like to hear firsthand, from a patient, what the recovery is like. My doc says it's very effective at taking care of the problem, although recovery is a good three months since the P. is so deep.

Hope to hear from someone who's had it done or from someone who knows someone who's had it done!

Thanksl
elaines2630
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PostPosted: 12/31/06 - 16:55    Post subject: piriformis release surgery
Wink Hi, I just located this site and saw your post. I have not had this surgery, however this has been recommended to me by a medical examiner for a workmens comp case I have. I had 2 spinal fusions in the past 2 years and unrelenting pain in the buttocks hip and groin and he insists this procedure is very simple and will at least allow me to sit comfortably and relieve a lot of the pain of have. I have not met anyone or spoke to anyone who has had this procedure. My own physicians over the years seem to think this is hookey! I wonder did you have it done? and if so how area you doing?
rkgoodwin44
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PostPosted: 01/27/07 - 21:34    Post subject: Piriformis release surgery
Hi, I too am new to this site. I have been diagnosed with piriformis syndrome after a year of unrelenting pain. I have seen many drs and all different types and been diagnosed with everything from bursitis, ms, nerve damage. My visit to a neurologist showed an archnoid cyst in my spinal cord, so all the drs thought that was causing the pain. I was terrified of spinal surgery and it was rough. But the worst part was realizing that was not the cause of my hip pain and finding the cyst was simply a coincidence. (Oh, and I had a ruptured brain aneurysm 10 yrs ago and had to have that clipped.)I finally found a pain specialist. he was very methodical and eliminated spine issues. He is the one that diagnosed the piriformis syndrome. I have had injections twice of a numbing agent and steroids. However, it doesn't seem like they r going to b any help. He thinks I will probably need to have the surgery but he can't find a dr that does this type of surgery. He consulted with orthopedic and neurosurgeons. I am from OK. If anyone knows a dr in this area that does this type of surgery, I would really appreciate your post. And one more thing, this pain is unbelievable.
elaines2630
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PostPosted: 01/28/07 - 12:29    Post subject: pirifornis release
Sorry to hear aboout all your pain and frustaration in dealing with this syndrome. I also had injections into the piriformis several years back with negative results. I absoultely feel this piriformis syndrome is part of my pain issues, even though I have had 2 spinal fusions. the most recent a yr this 2/14. Now level 3 is quite a problem , however at this time it is elective until I can't tolerate the pain. I have been on the computer studying this and this mcusle runs along the sciatic nerve whichand dwon the leg.can impinge on the muscle causing excruiating pain along the groin, hip, and down the leg. My Ortho surgeon who I really respect emphatically does not believe in this problem and neither has any other specialist that I have been to, one never even hearing of such a procedure. The only one who suggests and diagnosed this is the Medical Examiner I had to go to.My back injury and subsquent surguries are related to this injury. This Doctor says he does this release all the time and is very succesful. It will not cure my chronic pain from my back, however he insists that horrendous pain I suffer in the groin and hip will be gone. I know I have bursitis and osteoarthritis in this hip and have had injections in to the hip which definitely helps when the hip flares up. I feel the confusion comes with the problem that there is multiple problems that are in the same area and the pain mimic's the back problem. So I am undecided as whether to pursue the surgery for the piriformis. This is really a tough tough decision. Good luck.
ElliottW
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PostPosted: 02/27/07 - 21:19    Post subject: Piriformis Syndrome and Surgery
Hi,

I recently had piriformis re-section surgery so thought I'd share my experience with those looking for more information.

I'm from the UK and had to come to LA to have the surgery under a surgeon called Aaron Filler (you can have a look at his website at http://www.nervemed.com). I had the classic symptoms of piriformis i.e. nasty sciatic pain down both legs triggered when sitting. Following unsuccessful botox injections here in the UK I eventually came across Dr Filler. As far as I can tell, in the field of piriformis surgery, he's the world leader. He has actually developed a totally new type of MRI software that is able to pinpoint where the nerves are being irritated. Just prior to going to LA I had an MRI in the UK of the piriformis region. It came back saying that everything was normal and no sciatic nerve irritation due to the piriformis. The first thing I had when I got to LA was a scan with Dr Filler's MRI, unbelievably it came back showing the exact point of the nerve compression which was precisely under the piriformis muscles on both sides. I could see it for myself - the nerve irritation shows up bright white on his MRIs. This revolutionary MRI isnt just for piriformis and can help diagnose all type of difficult nerve problems.

Once he'd confirmed that the problem was definitely piriformis he presented the options which included surgery. I decided to go ahead since I'd been suffering for so long and so badly (am a lawyer and have been off work for about 18months). He is currently doing about 4 piriformis surgeries a week, has an incredible amount of experience and a very high success rate. You can find on the web a paper written by him where he reports his findings.

Following the re-section surgery, which was on both sides, I had to stay in hospital for just 1 night and then a further 7 days in LA before heading home. The recovery is tough and can take up to a year but 2 months following sugery and I am about to go back to work. I can finally see that I might get my life back and it's all thanks to Dr Filler.

Despite what other doctors might say, piriformis syndrome is very real and can have a very debilitating effect on your life. Dr Filler has finally developed something in his MRI that can validate once and for all whether or not you are suffering from the condition and if you are he can treat you. He is apparently going to be licencing the technology to be used outside of the USA and in my opinion it's going to help lots and lots of people who are struggling to find an answer to their pain.

If anyone wants to know anymore about my experience then I'd be more than happy to answer any questions.

Elliott
rkgoodwin44
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PostPosted: 03/01/07 - 10:55    Post subject: ??? about the surgery
Hi Elliott, First of all glad to hear u r doing well. I am doing better with the pain since starting the injections and physical therapy. However it is not completely gone. I used to b a very active, physical person...my husband and I have been avid hikers for years. I would like to know more detailabout the surgery, I think that is the only way this is going to finally b over 4 me. I surprised u only had to spend 1 night in the hospital, can I ask how bad the pain was after the surgery. 5 months ago I had surgery to remove an arachnoid cyst from the spine and it was painful beyond belief. At this point I feel like I am about 40% normal and I am grateful for that. But I want my normal life back.
Did the doctor cut the muscle away from the hip bone? I have read that is one possibility. It is so hard for me to believe this is going to be with me the rest of my life.
Elliott, any detail u might share about the actual surgery and recovery will b greatly appreciated.
Robyn
ElliottW
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PostPosted: 03/13/07 - 13:25    Post subject:
Hi Robyn,

Sorry to hear you've been suffering so much, I know exactly what you're going through.

The piriformis resection operation that I had under Dr Filler is one that he has devised to be as quick as possible to recover from. He makes an incision about 3cms long in the middle of the buttock, goes down to the piriformis muscle, ties the nerves in a bundle to protect them and removes a small section of the piriformis muscle which would have been entrapping the nerves. Following the resection the compressed nerves are able to flow freely. He is then able to work up and down the sciatic nerve from the hip to the level of the pelvis to make sure that there are no other areas where it is being compressed. Each side (I needed it done on both sides) takes about 2.5hrs. I had the operation under general anaesthetic but you can if you want actually have it under local anaesthetic.

When you refer to the muscle being cut away from the bone I think that that is what used to be done (or is possibly still being done by some surgeons). Dr Filler's operation is much less invasive and the recovery time is much faster.

I only needed to stay in hospital for one night because of the general anaesthetic. I was able to walk carefully that same night and by the next day was able to walk without assistance to the car. Following the operation it is obviously very sore at the site of the wound but the nerve pain that I was suffering from was no worse than before. For the first 2 weeks you are told not to do anything for more than 20mins such as sitting, standing or lying in one position. You don't have to worry about your position during sleeping though! The pain killers they provided were very effective and aslong as i kept changing position the post-op pain really wasn't that bad.

It has now been 3 months since the op and I would say I am about 70% better. I have been told it can actually take up to a year before the nerves have fully healed so I am feeling relaxed about the long term outlook.

Hope the above was useful and let me know if you have any more questions
Elliott
PDH
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PostPosted: 04/19/07 - 15:47    Post subject: Piriformis Surgery
Hi All,

I suffered for one year with severe nerve pain down my left leg to the point that I became bedridden as if I walked, sat down, I paid severely with excruciating pain over the following days. The pain was constant, severe, and unrelenting.

I was diagnosed with Piriformis Syndrome by Dr. Robert Layzer at UCSF, and I had surgery a little over 3 weeks ago which was performed by Dr. Nicolas Barbaro, also at UCSF.

While I'm still in recovery, the severe nerve pain was relieved from the second I awoke in the recovery room. That is, even though there was pain from the procedure itself, I could feel that my nerve pain was gone and I was so very grateful.

It took me nearly a year to get to an answer and I'm so grateful for the procedure. It is not an EASY solution. There is a recovery period and it is as has been explained in this topic a slow recovery process.

I myself have a larger incision as my neurosurgeon doesn't use the smaller direct incision due to scar tissue formation and problems later on down the road. I know there is a physician in LA as someone else has discussed that uses a different method. I can only speak for my own procedure.

Although its sometimes a painful recovery, especially at first, and I'm still in the beginning phases of recovery and am sometimes frustrated because I am wishing to be mobile more quickly.....it is significantly - - hands down a million times better than I was prior to having the procedure performed.

I had the anesthetic injection test performed as part of my diagnostic testing. I also had the special MRI procedure performed and mine didn't show up clearly; however, upon surgical procedure it was found that my sciatic nerve was completely flattened by my piriformis muscle as well as finding scar tissue at the pelvis....therefore, the muscle as well as the scar tissue were completely removed.

If you have any other questions, feel free to ask. I can only share my own personal experience.

Take care and I hope you find relief from your pain soon. I can honestly say I know how you feel!
Pen
Susan A
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PostPosted: 05/13/07 - 10:47    Post subject: Piriformis Surgery
Hi Elliott,
I am thinking of going to see Dr Filler as I have also been diagnosed with bilateral piriformis syndrome. I am a bit apprehensive as I am worried if the release of the piriformis with affect my gait. I have read all of Dr. Fillers articles and it does state that the key hole surgery does not. How did you find your walking after the surgery?

Also, did you have the piriformis injection of steroids a week before the release surgery. If so did you get any relief from the pain with that? If so was that the deciding factor to do the surgery?

I have had this problem for at least 7 years now, and after failed L5 micro-disc surgery, prolotherapy on my sacroiliac joint ligaments, botox and sterioid shots into the piriformis, massage, rolfing, physical therapy, healing I am now at my wits end. My doctors here are accepting that I have severe piriformis syndrome but not willing to do the surgery, hence the reason why I want to see Dr Filler (even though my insurance will not cover it). I can't deal with this pain in the butt any longer!!!!!

I now have severe gluteal atrophy in both buttocks, which I think has been caused by the piriformis chocking the gluteal nerve.

After reading your post you have given me some hope as it is always good to hear from somebody who has gone through the experience and surgery themselves.

After your surgery how did you find the flight back home to England? You stated in your article that you are not suppossed to sit for more than 20 minutes, so how did you cope? I live on the east coast and will have at least a 4 hour direct flight to LA.

Any recommendation as to where to stay? Any reasonably priced hotels nearby?

Going off the subject I saw that you are English. I am also English, a retired police detective from Liverpool. Don't miss the NHS. LOL.

Hope that I have not asked too many questions.

Regards Sue A
sambuco
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PostPosted: 05/20/07 - 14:12    Post subject: Re: Piriformis Surgery
[quote="PDH"]Hi All, Neutral

I am writing you from Italy (I am German please excuse my English) and I am scheduled for traditional piriformis surgery, I suppose the same you did. I would like to know more about the time AFTER the operation. How much time passes before you can walk without crutches, or drive a car, I mean, going back to a normal life? I am very anxious because I have my summerholiday booked from august 1th and they will call me this week in hospital, I don't know if the time is enough to get well. I you very much appreciate if you or ANYBODY else who has passed the operation can tell me details.
thanks
sambuco Very Happy
PDH
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PostPosted: 06/09/07 - 20:28    Post subject: Piriformis Surgery
I don't know if it is too late to respond to your question; however, I can only tell you that I had my surgery performed on 3/19/2007 and I am still not 100%. I am able to walk, sit some, and stand for periods of time; however, I'm not back to my original condition prior to surgery or prior to having the condition.

I still have pain every day, but not nearly as much pain as before; however, I'm far from pain free at this juncture.

As far as going on vacation, as long as you aren't running a marathon I think you will be fine. You just have to modify and listen to your own body. Push when you can for your recovery and back off when you need to. Again, listen to your own body. Everyone is different and pushing it when your body is telling you NO only results in a couple of down days. I'm speaking from experience. It took me a couple of times to understand that if you over do it, you pay the price for a couple of days after.

I was also told that it takes about a year for nerves to rejuvinate and heal from any damage that occurred....so I'm still on Lyrica for nerve pain, but again, the pain is far less than it was before so I'm grateful and just waiting for total healing.

To answer your question as to when can you walk etc., I starting walking and making laps in the hospital the morning after the procedure. Its the only way to avoid soreness setting in with the incision site. Now I wasn't the most speedy individual walking around the hospital floor, but I was walking.

I hope this helps and feel free to ask more questions.

PDH
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PostPosted: 06/22/07 - 13:13    Post subject: Piriformis surgery
Hi Elliot,

I've had bilateral piriformis syndrome for the past two years and have undergone the whole list of treatments, including 3 botox injections that haven't done much good. At my last appointment, my doctor said the only option she sees now is surgery.

Unfortunately the surgery has not been done here in Honduras so I'm looking into options in the US. Dr. Filler's technique sounds pretty good so I'd like to know more about that. How did the trip home go? What about places to stay? What kind of follow up /physical therapy did you go through after you returned home? Are there other surgeons who use the same method? I'd really appreciate any or all advice on rather or not to proceed with a trip to the US for the surgery.
Thanks
Hermana Ana
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PostPosted: 07/29/07 - 21:38    Post subject:
If Elliot is still out there, I'd like to know how the recovery is coming along. Four years suffering, one unsuccessful surgery where they removed a bit of hamstring tissue, and neglected to release the piriformis. What a nightmare. How much is it? Bottom line. Both sides, out the door including work up. I'm off work and thinking about robbing a bank or something. I hear it's about 20 grand.
scamp
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PostPosted: 08/01/07 - 23:44    Post subject: piriformis syndrome surgery
In hopes that Elliot who saw Dr. Filler is still following this forum I have some questions. Did you have any other diagnoses other than piriformis syndrome? What imaging did you bring form home? You said you were 70% better then. How are you now.

I have had pain in my buttock, leg and foot for about 9 years. I have had botox injections into the piriformis which do give some but not complete relief. I also have a degenerative spondylolisthesis at L4-5 and some nerve damage in the right L5 and Left S1. My sciatica is on the right. I experience major in the buttock I think roughly where the piriformis but also at the attachments on each side. I am trying to sort out if this sciatica is L4-5 related or piriformis related or both. Did yu or anyone you met while there have a dual diagnosis?

How much did everything medically related cost?

I live in Kingston, Ontario and am going toapply to our public insurandce to cover this as it is not offered in Canada.

Anything you could tell me would help.
ronnyjotten
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PostPosted: 08/02/07 - 13:45    Post subject:
Scamp. I have contacted Dr. Filler. His fees are reasonable I suppose, 8 to 12 grand for the surgery, per side, 300 for the initial consult, and 2900 per injection. However, Cedar Sinai Hospital charges 40 to 50 grand in addition for use of their hospital. The nerve institute neglected to mention the 50 grand for the hospital in their initial quote. I am a physiotherapist and pretty knowledgable about this. Not sure what happened to Elliot, but it would be nice to know how he faired.
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