Refractory sciatica caused by gluteal varicosities

Abstract

We report acase of sciatica that fulfilled the diagnostic criteria for inferior gluteal vein varicosities according to patient history and on magnetic resonance imaging. Since conservative treatment was ineffective, excision-ligation of the varicose vein was performed as recommended in the previous literature. However, pain was only slightly relieved and then aggravated. Reoperation involving wide release and resection of the piriformis outlet was performed. Pain resolved immediately thereafter. We suggest that this case of sciatica resulted from both piriformis entrapment and vein varicosities. The piriformis entrapment led to inferior gluteal vein backflow obstruction, and varicosities could have been the trigger of piriformis syndrome. Excision-ligation of the varicose vein and piriformis release were recommended.