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ADR and posible reason for sciatic mimicking radiculopathy !

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.
Case series.
To describe the presentation, diagnostic challenges, and treatment of five patients with piriformis syndrome after lumbar artificial disc replacement.
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 ,


  • ouch2oouch2 Posts: 1,270
    edited 01/23/2013 - 7:53 AM
    For sharing Alex! Very interesting case study. It can be so hard to figure out where butt, leg , foot pain is originating from. Do you know if Piriformis syndrome can be diagnosed by CT scan (I am having one tomorrow) or is more from injections and ruling out other causes?
    I constantly question whether my pain could be originating from somewhere other than my lower lumbar discs, since most of my problems are in butt, legs, foot, and hip, but realize it is most likely radiculopathy.
    >:D< >:-D< : Karen
    L3-S1 herniation and bulges, stenosis, mod facet,ddd,impinged nerves,coccydinia
    discectomy/lami July 2011-unsuccessful
    adr L5-S1 Feb 2012
  • I wish i had the answer to that but i realy dont , I am not sure the doctors are a 100 % sure either even with injections or ct and i think this is the reason its over looked , But when nothing else explains it because mri shows spine looks ok would lead me to believe this is worth looking in to as surgery created this symptom after ADR was implanted ,

    My question to my pain dr will be what you asked ouch2 to focus on this issue and find out more of who and what dr has more interest in this more so then the ADR and fusion ,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • michellemmichelle Posts: 197
    edited 01/23/2013 - 8:38 PM
    I was talking to a PA about this and was shown an exercise to see if it would help . So far nothing much noted .. He said to stand in a door way cross the affected leg over the other . Hold onto frame on unaffected side and lean into affected side to stretch the muscles . Not sure if doing it right or not but hell ill try anything lately
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