Treating Piriformis Syndrome with Sono-Guided Corticosteroid Local Injection: A Single-Center Experience

Abstract

Objective: The current treatment strategy for piriformis syndrome includes rehabilitation, symptomatic relief and local injection with either corticosteroid or botulinum toxin. Blind injection is sometimes used, as are CT-guided or electromyography-guided injection techniques. We report our local experience in treating piriformis syndrome with sono-guided corticosteroid injection. Methods: We enrolled 29 patients with piriformis syndrome whose initial symptoms were not relieved after medical treatment. They then received sono-guided local corticosteroid and lidocaine injection. Instead of traditional localization using anatomical landmarks, we used ultrasound to directly visualize the piriformis muscle and perform sono-guided local injection. The outcome was measured using a Likert pain scale. The pre-treatment pain score was recorded for every patient. During the six-month follow-up, the minimal pain score achieved was recorded for each patient as the post-treatment pain score. The Wilcoxon rank sum test was used to evaluate the difference between pre-treatment and post-treatment Likert pain scales. Results: Of the 29 patients with piriformis syndrome, 12 were male (41.4%), and 17 were female (58.6%). The ages of the patients ranged from 22 to 89 years, and the mean age was 59.1. The average pre-treatment and post-treatment pain scores were 7.7 ± 1.7 and 1 ± 2.8, respectively, which showed a statistically significant improvement (p＜0.001). In all, 65.5% of the patients had more than 50% reduction of pain. None of the 29 patients had complications after the treatment.Conclusion: Local corticosteroid injection guided by ultrasound is a safe and effective treatment modality for piriformis syndrome.