Piriformis syndrome. Treatment under control of CT fluoroscopy

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OBJECTIVE

To demonstrate one of the effective methods of treatment of the piriformis syndrome under the control of a highly technological visualization method.

MATERIAL AND METHODS

Eight patients (7 women and 1 man), aged 44 to 63 years, with piriformis syndrome, were studied from 2016 to 2018. The main complaints of the patients were pain in the lumbosacral spine with irradiation to the gluteal region and/or legs. All patients underwent MRI and/or MSCT of the lumbosacral spine, the pelvic ultrasound, according to the results of which 1 patient was diagnosed with uterine myoma, 5 with lesions of intervertebral discs in the L4-L5 and L5-S1 segments of varying severity in combination with changes in posture. For therapeutic purposes, all patients under the control of CT fluoroscopy were administered to xeomin (n=3), dexamethasone (n=1) or betamethasone (n=4).

RESULTS

In all patients, a positive therapeutic effect was observed after 4—12 months for xeomin injections, 2—3 weeks for dexamethasone and up to 3 months for betamethasone. No complications during the manipulations were observed. The authors present a clinical case to describe the botulinum therapy technique under the control of CT fluoroscopy, which allows effective treatment of the piriformis syndrome.

CONCLUSION

In the treatment of the piriformis syndrome it is necessary to apply an integrated approach, the leading of which are methods of local impaction on the suffering muscle. Only a methodologically correct injection can increase the effectiveness of treatment in these patients and reduce the risk of complications.

Keywords:

piriformis syndrome

myofascial syndrome

CT fluoroscopy

computed tomography

botulinum toxin therapy

Authors:

Yudin A.L.

Pirogov Russian National Research Medical University;
Central Clinical Hospital of the Russian Academy of Sciences

Shomakhov M.A.

Central Clinical Hospital of the Russian Academy of Sciences

Yumatova E.A.

Pirogov Russian National Research Medical University

Abovich Yu.A.

Pirogov Russian National Research Medical University

Received:

16.06.2020

Accepted:

01.07.2020

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