Piriformis syndrome versus radiculopathy following lumbar artificial disc replacement.
Robinson ES, Lindley EM, Gonzalez P, Estes S, Cooley R, Burger EL, Patel VV.
Spine Center, University of Colorado, Denver, Colorado, USA.
To describe the presentation, diagnostic challenges, and treatment of five patients with piriformis syndrome after lumbar artificial disc replacement.
SUMMARY OF BACKGROUND DATA:
Until recently, spinal fusion was considered the standard for surgical treatment of severe lumbar degenerative disc disease. However, artificial disc replacement now offers an alternative solution. Piriformis syndrome results from entrapment of the sciatic nerve at the greater sciatic notch, with symptoms of pain and numbness radiating from the buttock to the foot, mimicking radiculopathy.
In this case series, we report five patients who developed piriformis at our institution after artificial disc replacement.
Five patients, aged 35 to 46 years, developed some or all of the following symptoms in the affected leg after artificial disc replacement: posterior leg and buttock pain, calf weakness, and toe and ball of foot numbness and tingling. The onset of symptoms ranged from 6 days to 8 months postoperative, and became debilitating over time. Each patient was diagnosed with piriformis syndrome through physical examination. Three of the patients received a piriformis injection and reported 50% to 100% pain relief lasting 1 to 3 weeks. The patients subsequently underwent physical therapy that provided relief of their piriformis syndrome-related pain and enabled them to resume their normal activities.
Piriformis syndrome has not previously been described in the literature as a sequela of lumbar artificial disc replacement. Our case series indicates that this complication may be underdiagnosed. Careful consideration after artificial disc replacement is required if the patient presents with buttock, leg or foot pain, and/or numbness. It is important for physicians to recognize the symptoms of piriformis syndrome and to differentiate piriformis syndrome from nerve root compression and irritation or referred pain from spinal structures. Although controversial, the proper diagnosis of piriformis syndrome may have prevented some of these patients from undergoing unnecessary surgical procedures.
PMID: 21270711 [PubMed - indexed for MEDLINE]
Sorry if anything might have to be edited mods but i think this is helpful info worth sharing with others who had ADR as myself and as this might explain my symptoms and i am printing this page handing it to my pain dr as this is what we been suspecting to be a posible cause due to periformis injections helping same as case study shows !
Hopefuly no edit is needed as its simply a case study , Alex,
Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
2012 scs implant ,