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Cardiovasc Intervent Radiol. 2012 Apr;35(2):375-82. doi: 10.1007/s00270-011-0185-z. Epub 2011 May 24.

Piriformis syndrome: long-term follow-up in patients treated with percutaneous injection of anesthetic and corticosteroid under CT guidance.

Author information

1
Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiation Therapy, Fondazione Policlinico Tor Vergata, viale Oxford 81, 00133 Rome, Italy. salva.masala@tiscali.it

Abstract

PURPOSE:

This study was designed to evaluate the efficacy of CT-guided injection of anesthetic and corticosteroid for the treatment of pain in patients with piriformis syndrome unresponsive to conservative treatment.

METHODS:

We enrolled 23 patients with piriformis syndrome, proposing a percutaneous intramuscular injection of methylprednisone-lidocaine. Among them, 13 patients accepted and 10 refused to undergo the procedure; the second group was used as a control group. Clinical evaluation was performed with four maneuvers (Lasègue sign, FAIR test, Beatty and Freiberg maneuver) and a VAS questionnaire before the injection, after 5-7 days, and after 2 months. A telephonic follow-up was conducted to 3, 6, and 12 months.

RESULTS:

Procedural success was achieved in all patients who were treated without any complications. After 2 months, among 13 treated subjects, 2 of 13 patients showed positivity to FAIR test (hip flexion, adduction, and internal rotation), 2 of 13 were positive to Lasègue sign, and the Beatty maneuver was positive in 1 patient. Patients who underwent conservative treatment were positive respectively in 7 of 10 (p = 0.01), 6 of 10 (p = 0.03), and 6 of 10 (p = 0.01). The VAS score showed a difference between patients treated with percutaneous approach and those managed with conservative therapy at the baseline evaluation (p = 0.04), after 2 months (p = 0.02), and 12 months (p = 0.002). We observed a significant reduction in pain for patients treated percutaneously, who were evaluated with the VAS scale at 5-7 days, 2 months, 3, 6, and 12 months (p < 0.001).

CONCLUSIONS:

Our findings suggested potential benefit from the percutaneous injection of anesthetics and corticosteroids under CT guidance for the treatment of piriformis syndrome.

PMID:
21607823
DOI:
10.1007/s00270-011-0185-z
[Indexed for MEDLINE]

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