Sciatica of nondisc origin & piriformis syndrome -- magnetic resonance

[iSpine-Admin]

J Neurosurg Spine. 2005 Feb;2(2):99-115


Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.
Filler AG, Haynes J, Jordan SE, Prager J, Villablanca JP, Farahani K, McBride DQ, Tsuruda JS, Morisoli B, Batzdorf U, Johnson JP.
Institute for Spinal Disorders, Cedars Sinai Medical Center, Los Angeles, California, USA. afiller@nervemed.com

OBJECT: Because lumbar magnetic resonance (MR) imaging fails to identify a treatable cause of chronic sciatica in nearly 1 million patients annually, the authors conducted MR neurography and interventional MR imaging in 239 consecutive patients with sciatica in whom standard diagnosis and treatment failed to effect improvement.

METHODS: After performing MR neurography and interventional MR imaging, the final rediagnoses included the following: piriformis syndrome (67.8%), distal foraminal nerve root entrapment (6%), ischial tunnel syndrome (4.7%), discogenic pain with referred leg pain (3.4%), pudendal nerve entrapment with referred pain (3%), distal sciatic entrapment (2.1%), sciatic tumor (1.7%), lumbosacral plexus entrapment (1.3%), unappreciated lateral disc herniation (1.3%), nerve root injury due to spinal surgery (1.3%), inadequate spinal nerve root decompression (0.8%), lumbar stenosis (0.8%), sacroiliac joint inflammation (0.8%), lumbosacral plexus tumor (0.4%), sacral fracture (0.4%), and no diagnosis (4.2%). Open MR-guided Marcaine injection into the piriformis muscle produced the following results: no response (15.7%), relief of greater than 8 months (14.9%), relief lasting 2 to 4 months with continuing relief after second injection (7.5%), relief for 2 to 4 months with subsequent recurrence (36.6%), and relief for 1 to 14 days with full recurrence (25.4%). Piriformis surgery (62 operations; 3-cm incision, transgluteal approach, 55% outpatient; 40% with local or epidural anesthesia) resulted in excellent outcome in 58.5%, good outcome in 22.6%, limited benefit in 13.2%, no benefit in 3.8%, and worsened symptoms in 1.9%.

CONCLUSIONS: This Class A quality evaluation of MR neurography's diagnostic efficacy revealed that piriformis muscle asymmetry and sciatic nerve hyperintensity at the sciatic notch exhibited a 93% specificity and 64% sensitivity in distinguishing patients with piriformis syndrome from those without who had similar symptoms (p < 0.01). Evaluation of the nerve beyond the proximal foramen provided eight additional diagnostic categories affecting 96% of these patients. More than 80% of the population good or excellent functional outcome was achieved.

[marion]

Hi ther this is very interesting and promising where would one go with this information if I suspected I have periformis syndrome cause by an unidentified source in the uk? marion

[CraigT]

Hi Marion,

I am in the US, New Jersey to be precise and my piriformis was diagnosed by a nerve conduction study by Dr Fishman in New York City and confirmed by MR Neurography. Dr Fishman developed the nerve conduction study process and specializes in piriformis syndrome. Regular MRIs cannot detect this issue, I've had 3 loweback MRIs and 3 of the pelvis, all were negative. I hope this helps. Keep doing your research.


Craig

[mmglobal]

Craig... did you / are you having the piriformis release surgery? If so... what style. (I presume that a surgeon into neurography is into the minimally invasive release instead of the removal of large amounts of muscle???)

Mark

[ans]

I've been thinking of seeing Dr. Filler and wondering "why" re: MRN.

NerveMed | The Leading Nerve and Spine Health Information Resource

Seems worth it!

Thanks.

[Tucson1]

I have the greatest repect for Dr Filler in Santa Monica as he was able to
determine that I had not only a piriformis problem, but also a compressed
sciatic nerve. These are both in the same hip. If I sit or lay down it causes
jerks in my legs and upper body especially my head. I had MRI's of my back,
neck and head. Was told it was stenosis in my lumbar spine and had L2-L4
fused. I kept telling the neurologists and neurosurgeons I injured my hip. None would listen to me except Dr A. Filler. After an MR Neurography and
injections to varify his findings, he stated I could try injections, but did not
believe I would have much success with them considering my having a dual
problem. I live in Tucson, AZ and elected to try injections here from a pain
specialist. The doctor here a Dr Annabi could not believe the findings at first.
He did an exam of me and was surprised to say the least that Dr Filler was
infact correct. Dr Annabi who is also an assistant professor of anesthesiology
said neither he nor his colleages had ever seen this before. Doctor Annabi did try the injections on me, but they did not last, but a couple of weeks. I cannot go back to Dr Filler, because he does not accept Medicare. I am a
senior and it is my primary insurance. I have found two other doctors that
do peripheral nerve surgery as they call it that is required for my problem.
One is in Phoenix, AZ and his name is Nichalus Theodore. He accepts Medicare and he also uses MR Neurography for diagnsis. The other is at UCLA Medical Center where MR Neurography was developed inconjuction with Dr
A. Filler and Cedars Sinia. His name is Dr Pouratian. And of course UCLA
also uses MR Neurograpy and even advertises it on their WEB site as one of their diagnostic tools in their Neurology department. They also accept
Medicare as does Dr Pouratian. Good Luck and hope this helps.

Tucson1

[mmglobal]

Tucson, thanks for the info.

Henry Bohlman in Cleveland wrote the book on piriformis release surgery. I don't know if he takes medicare. What he does is different from what Dr. Filler does, but I have had several clients with PS go to him with great success.

All the best,

Mark

[clintrad4]

Originally Posted by Tucson1

I have the greatest repect for Dr Filler in Santa Monica as he was able to
determine that I had not only a piriformis problem, but also a compressed
sciatic nerve. These are both in the same hip. If I sit or lay down it causes
jerks in my legs and upper body especially my head. I had MRI's of my back,
neck and head. Was told it was stenosis in my lumbar spine and had L2-L4
fused. I kept telling the neurologists and neurosurgeons I injured my hip. None would listen to me except Dr A. Filler. After an MR Neurography and
injections to varify his findings, he stated I could try injections, but did not
believe I would have much success with them considering my having a dual
problem. I live in Tucson, AZ and elected to try injections here from a pain
specialist. The doctor here a Dr Annabi could not believe the findings at first.
He did an exam of me and was surprised to say the least that Dr Filler was
infact correct. Dr Annabi who is also an assistant professor of anesthesiology
said neither he nor his colleages had ever seen this before. Doctor Annabi did try the injections on me, but they did not last, but a couple of weeks. I cannot go back to Dr Filler, because he does not accept Medicare. I am a
senior and it is my primary insurance. I have found two other doctors that
do peripheral nerve surgery as they call it that is required for my problem.
One is in Phoenix, AZ and his name is Nichalus Theodore. He accepts Medicare and he also uses MR Neurography for diagnsis. The other is at UCLA Medical Center where MR Neurography was developed inconjuction with Dr
A. Filler and Cedars Sinia. His name is Dr Pouratian. And of course UCLA
also uses MR Neurograpy and even advertises it on their WEB site as one of their diagnostic tools in their Neurology department. They also accept
Medicare as does Dr Pouratian. Good Luck and hope this helps.

Tucson1

Is the MR Nuerography at UCLA the same as Dr. Filler's in Pasadena? I understand Filler invented the technology and has a patent. I'm debating whether to get one at UCLA since my insurance covers it or taking on the debt with Filler.