Piriformis release surgery, anyone???

Member

Wow,

Lot of posts. Hope all is well.

First, Donna way to go. VERY happy for you and it's news like this that gives people hope. As one who knows and has paid for it though, please go S-L-O-W! You've got this thing licked so keep it that way.

Menzie, the injections had little or no effect on me either while I was in CA. In fact, and someone may cry BS on this, I think mine took more than 14 days to kick in because it was 3-4 weeks after my injections that I had a wave of improvement. Enough so that I nearly canceled my surgery. When I asked Sheila about the plausibility of this delayed effect, she said it was very possible as we are all different. So tell your daughter(and yourself) that the effect may come later. We all are hoping this to be the case(good effect part, not the later part).

Someone asked about what Filler injects. For me, and I don't think I'm atypical, he injected Lidocaine(sp??) and Celestone.

LOL, now I'm a "vet". I'm not sure I like that distinction in this context. Kick a guy when he is down if that makes people feel better. I'm laughing.

Went to work again today. Yippeee! I have an extremely understanding boss. He told me that in this day and age, work out of the house if I want. I have been but my staff needs to see my ugly old mug every once in a while just to keep things in line. Actually, I'm a very blessed man in that the people who work for me are true professionals and I never really do anything but point and then get out of their way lest I take the risk of getting run over.

To end this diatribe up, I do have a sincere question because some of you good folks are in the medical field. As I stated previously, my aches and pains seem to be a direct function of butt spasms(especially and almost totally the left side). My answer to this was to obtain a prescription of a muscle relaxant that is milder than Valium and would allow me to drive and work. Sheila ordered Skelaxin and I tested it yesterday and I can, indeed, function acceptably. The script say take 3 per day but I am taking them in halves only as needed. Here's my question:

If I take these things for any extended period of time(say a few weeks) to get through this tedious period, will my body(buttocks) become so accustomed to them that it will simply return to chronic spasm when I try to eliminate them from my life? I know, it seems like a silly question but, again, I am no expert in this area. In fact, and has been demonstrated by my other misadventures with medication, I'm almost clueless. Thus, I am asking. Thanks for any replies.

Your friend,

David

Member

Oh yea,

Sincere thanks for the information Shirley. My attitude has improved dramatically over the last few days due in large part to some of the posts on here about this cycle being normal and my talk with Sheila who echoed the same sentiment. I don't enjoy the down parts but I have cut myself a lot more slack and have granted myself a much larger portion of patience. You just reinforced this attitude and I'm very appreciative.

David

Member

Shirley:

I was injected with Marcaine and Celestone....whatever that is!

David:

You said you almost cancelled your surgery because of the delayed improvement from the injection....did the Dr. or nurse tell you that the pain would ultimately return which is why you decided on having the surgery in the end?

Thanks.

Leesa

Member

My history and searches for answers sounds all too familiar on this board. I am an emergency physician and have struggled with pain for over 4 years now. However, I feel I have much insight into "our" similar problems after exhaustingly researching the literature and meeting with multiple physicians.

I am 53 and otherwise in excellent health. My problem began within days after a right hip replacement over 4 years ago. Began having a burning neuropathic pain in right foot and pain in right buttox with sitting and relieved with standing and yoga, walking, light jogging etc. All my orthopedist who did my hip replacement has ever said is "it is coming from your back". Amazing, the problem has remained relatively stable over these years--most problems like this either get better or worse. The more I sit during a day the more the pain builds up.

Briefly, I had multiple steroid injections of spine and even the piriformis without relief. I have a known L4-L5 spondolisthesis (offset of L4 on L5) but no obvious nerve root involvement in this area by MRI. One surgeon wanted to do a spine fusion. Several others unsure of problem.

I had a piriformis release here in North Carolina over two years ago. The neurosurgeon was sure he found my problem because he found an impressive impingement of the piriformis muscle into the sciatic nerve. However, it did not change my symptoms at all-no better, no worse.

I saw Dr. David Kline in New Orleans about 2 years ago, he has since retired but was a world renown neurosurgeon on peripheral nerves (ie. nerves that come out of the spine). Dr. Filler even did a year fellowship under Kline during his training. Kline wasn't sure the etiology of my problem, but thought maybe it was a "double crush" phenomena--meaning that somewhere from the time the nerve roots exit the spine all the way to the toes there where two or more impingements that, together, caused the pain down to the foot.

Like many of you my research lead to Dr. Filler. I am now almost 3 weeks post surgery where he made a similar incision about 3-4 centimeters in buttox, as the piriformis proceedure. Of course my piriformis was already taken down. He thought my obturator internus muscle (another small muscle that has a similar function as the piriformis) was impinging on the sciatic nerve by his MR neurography. In the OR he released the nerve to this muscle (to get this muscle to relax) and also found what he felt were significant adhesions at the ischial tunnel area. He also found an adhesion from a remnant of the piriformis muscle to the sciatic nerve. Surgery took about 4 and 1/2 hours.

I stayed in the hospital overnight. Stayed the next day in a hotel. Flew home the next, all by myself(wife wanted to come but three young kids at home and out for the holidays). Went back to work full time 2 days later. I recovered quickly from his incision and postop soreness. I easily walked 18 holes twice last week(they said no heavy straining and I didn't consider this straining) and also swam a couple times without any problems. Today, my pain is still exactly as it was preoperatively. Still almost completely relieved with standing and stretching and worse with sitting. Although it was worse last week at night I considered this a good sign that at least maybe he was working at the area of the cause of the pain.

I will not regret if the surgery doesn't work. Filler thought my problem was what I had concluded after hours of research and living with it. I always felt I had some type of impingement on the sciatic nerve just distal (or further down) than the piriformis. That is what he found on neurography and that is what he tried to correct. However, even I was always a little doubtful he could fix it, but I felt his surgical technique with an endoscope was minimally invasive and not likely to make things worse(ie. anytime an operation is performed, adhesions will form afterward). So we'll see how it goes, it is still early. I will give more info later about my thoughts of his published study, MDs in general, meds etc. However, understand to all reading this: I AM NOT GIVING MEDICAL ADVICE TO ANYONE, I AM ONLY GIVING MY OPINION ON A MESSAGE BOARD.

Member

Huggable,

THank you so much for your post. I look forward to your future thoughts. I do hope this surgery works out for you for the best. Again, thank you so much for sharing your experience.

Julie

Member

Leesa,

No. In fact, I spoke with Sheila and she said it was a personal decision and that I had to make that call. So, my wife and I decided to let everything ride like real life. That meant no heat pads, return to bicycling, etc..

The elimination of heat pads brought back some pain. Then, a VERY LIGHT bicycle ride really brought it back full force. Waited a day or so and the pain stayed. Four days before the surgery, we committed.

I'm hoping it was the right decision. It certainly was for the right leg.

Huggable,

Thanks for the background. Look forward to hearing more. You must be way tougher than I am to be out on a golf course two days later. Way tougher.

David

Member

David:

Thanks. Sounds about right. If I lay down all day my pain is tolerable. If I walk too far (more than a couple of blocks), etc. it comes back full force. I haven't even tried doing any real exercise. I guess part of me is looking to heal without surgery but I know the truth. The truth hurts almost more than my butt!

If I may say, I believe you made the right decision. Based on what you've written over the past few months I know you had to do something.

Leesa

Member

Hello Huggable, fitzroyj, manzie, Margie & any lurkers.

It is fantastic that all you pre & post op patients have found each other & are willing to your share experiences and support!

Would you also be willing to take a patient survey of experiences with various piriformis syndrome treatments (medical & alternative) and their long term outcomes? This survey is being run by the patient based Piriformis Syndrome Support group at

http://health.groups.yahoo.com/group/piriformissyndrome/

Your experience with any treatments could be helpful to other patients, who have to decide which treatments are worth pursuing. The survey is anonymous & may take less than 20 minutes. If you are willing to take the survey, go to

http://www.surveymonkey.com/s.aspx?sm=mrq5t2Fw1OonnPqfmBTx4Q_3d_3d

Thanks for your help. Mary

Member

David, before comparing yourself remember you had bilateral surgery and were in for 7 hours.

Dr. huggable (feel funny calling an emerg doctor huggable) I too have a grade 1 L4-5 spondylolisthesis with stenosis but an EMG confirmed no nerve damage from that and I too have always felt my main pain is from a muscle in the butt. That is where my predominate pain is and y pain goes right to the foot. Keep us informed re: your recovery. You have sure gone through lots so I hope this is the final answer.

Shirley

PS There is a recent study in The New England Journal of Medicine saying that surgery for grade 1 spondylolisthesis at L4-5 with stenosis was considerably more successful than conservative treatment at a 2 year followup. I am not considering that at this point but wondering what you thought of that study.

Newbie

I had my surgery mid September last year. So 4 months ago. Dr. filler removed my piriformis because it so full of scar tissue. I have a PERFECT GAIT. No one would know. BUT I am still in major pain 24/7 I will say sciatic pain 100% gone thank god after sugery. Aching pain reduced probaly 2 notches I will take all of this as a plus. But I know it can take up to 18 months for nerve pain to end. But my pain is an aching pain not tingling, electric pain. So I think its NOT nerve pain. Anyone still have this this long after surgery. Just nonstop deep aching in buttock and trochanter also in hip flexer area. David?? Anyone?? I saw someone also had surgery when I did.

Thanks,
Kym

Member

Kym,

I'm only 6 weeks post op so I'm not the person to ask. I still have nerve pain in the left leg, my butt can get sore when it's spasmed but my GT joints have(knock on wood) settled down almost completely.

Shirley,

Good point. Apples and oranges.

Leesa,

Only time will tell if I made the right decision. I think I did if for no other reason than I didn't feel like I had a choice. Dr. Filler told my wife after surgery that, due to the tissue he found along the nerve in my left leg, there was no way I could have rehabbed my way back to health. So, it appears that my justification was warranted. Now, I just need time, patience and a very solid positive attitude.

Member

Margie,

How did your appt. with Dr. Barbaro go for you yesterday? I had a CT guided piriformis injection on Tuesday, it actually flared things up more, but am hoping that it is short term and the injection will be effective.

Sadie

P.S. Thank you to everyone, I am learning much from your info.....

Member

Shirly,your spondylolisthesis does confuse the picture, just like mine, and just like other people with abnormal MRI's of the lumbar spine that suggest for example a disc problem in the spine.

Here is my take on all of us with similar pain/symptoms:

There should be a diagnosis such as regional buttox syndrome that encompasses all these pains including piriformis that may include a neuropathic pain radiating down leg to foot. For many the etiology is multifactorial, perhaps part from the spine, part muscle pain (one of many muscles in the buttox/hip area), part impingement on the sciatic nerve somewhere in the pelvis/thigh area. For some who have this problem after injuries it may be a direct sciatic or other nerve contusion(bruise) type problem or a neuropraxic (stretching of nerve) problem--if so no surgery or rehab will not work---I think my hip replacement may be part something of this nature as the hip has to be dislocated in the OR to repalce it with an artificial one and that is when my problem began.

Piriformis syndrome is controversial and many doctors do not believe in it. The reason is, however, if everyone who had the surgery got better it would be more readily accepted--unfortunately, many who have the surgery do not(as happened to me--see my previous note). I do believe many do have this problem and they will tell you they got better with the surgery, but I would say 50% at most really are improved with this surgery and then only improved some. If you could do a study where half got a piriformis release and half got "sham" surgeyr(ie same surgery incision, anesthesia, etc), there would not be a huge difference in those who reported improvement in one year.

Many painful problems will just get better in time, and a lot of people operated on that feel better a year later contribute it to the surgery, but what really happened is they finally altered their activity (ie you hard core runners), perhaps did some physical therapy, and they would have gotten better anyway.

Even saying this, however, after a few years if things don't improve, I believe it is worth a try. It is not major surgery like a spine fusion or disc operation--that can often leave a person worse(I see many failed back surgeries in the ED with chronic pain). All that is done is the piriformis is cut in half (I think Filler actually takes out a segment of it), to in theory take pressure off the sciatic nerve. If you have the financial resources Dr. Filler probably does this better than anyone as he does it endoscopically (uses a small scope to go in to do the work), whereas, my piriformis release done in North Carolina was done openly with a large incision.

If you have limited resources you could at least see Dr. Filler and let him do his neurography and at least get an opinion from him.

Member

Sadie,

Just following up with you after your appt. with Dr. Barbaro. Did you get your injection? Did you get any relief? I saw Dr. Barbaro yesterday and he told me that the results I got from the injection (combined with other factors) indicate to him that, yes, it is definitely Piriformis Syndrome and he recommended the surgery. I went in with loads of questions and he spent a lot of time answering them all. He also offered to put me in contact with some of his other patients who've had the surgery so I can pick their brain as well. I'm looking forward to speaking with them.

Hope your injection provided you with some relief. Let me know how you're doing.

Margie

Member

To Dr. Barbaro's patients:

Does he take insurance or is he out of network like Dr. Filler. I'm looking into all my options.

Did you that found relief in the injection just have the butt pain or did you have sciatic pain as well?

I'm glad that you are on this forum, it's good to see that there are other doctors who are doing this, along with neurography, which give us patients a little more to chose from.

Thanks again,
Julie

Piriformis release surgery, anyone???

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