|
|
Abstracts and Articles Discuss Sciatica of nondisc origin & piriformis syndrome -- magnetic resonance in the Main forums forums; J Neurosurg Spine. 2005 Feb;2(2):99-115 Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance ... |
|
LinkBack | Thread Tools | Display Modes |
|
|||
Sciatica of nondisc origin & piriformis syndrome -- magnetic resonance
J Neurosurg Spine. 2005 Feb;2(2):99-115
Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. Filler AG, Haynes J, Jordan SE, Prager J, Villablanca JP, Farahani K, McBride DQ, Tsuruda JS, Morisoli B, Batzdorf U, Johnson JP. Institute for Spinal Disorders, Cedars Sinai Medical Center, Los Angeles, California, USA. afiller@nervemed.com OBJECT: Because lumbar magnetic resonance (MR) imaging fails to identify a treatable cause of chronic sciatica in nearly 1 million patients annually, the authors conducted MR neurography and interventional MR imaging in 239 consecutive patients with sciatica in whom standard diagnosis and treatment failed to effect improvement. METHODS: After performing MR neurography and interventional MR imaging, the final rediagnoses included the following: piriformis syndrome (67.8%), distal foraminal nerve root entrapment (6%), ischial tunnel syndrome (4.7%), discogenic pain with referred leg pain (3.4%), pudendal nerve entrapment with referred pain (3%), distal sciatic entrapment (2.1%), sciatic tumor (1.7%), lumbosacral plexus entrapment (1.3%), unappreciated lateral disc herniation (1.3%), nerve root injury due to spinal surgery (1.3%), inadequate spinal nerve root decompression (0.8%), lumbar stenosis (0.8%), sacroiliac joint inflammation (0.8%), lumbosacral plexus tumor (0.4%), sacral fracture (0.4%), and no diagnosis (4.2%). Open MR-guided Marcaine injection into the piriformis muscle produced the following results: no response (15.7%), relief of greater than 8 months (14.9%), relief lasting 2 to 4 months with continuing relief after second injection (7.5%), relief for 2 to 4 months with subsequent recurrence (36.6%), and relief for 1 to 14 days with full recurrence (25.4%). Piriformis surgery (62 operations; 3-cm incision, transgluteal approach, 55% outpatient; 40% with local or epidural anesthesia) resulted in excellent outcome in 58.5%, good outcome in 22.6%, limited benefit in 13.2%, no benefit in 3.8%, and worsened symptoms in 1.9%. CONCLUSIONS: This Class A quality evaluation of MR neurography's diagnostic efficacy revealed that piriformis muscle asymmetry and sciatic nerve hyperintensity at the sciatic notch exhibited a 93% specificity and 64% sensitivity in distinguishing patients with piriformis syndrome from those without who had similar symptoms (p < 0.01). Evaluation of the nerve beyond the proximal foramen provided eight additional diagnostic categories affecting 96% of these patients. More than 80% of the population good or excellent functional outcome was achieved. |
|
|||
Hi Marion,
I am in the US, New Jersey to be precise and my piriformis was diagnosed by a nerve conduction study by Dr Fishman in New York City and confirmed by MR Neurography. Dr Fishman developed the nerve conduction study process and specializes in piriformis syndrome. Regular MRIs cannot detect this issue, I've had 3 loweback MRIs and 3 of the pelvis, all were negative. I hope this helps. Keep doing your research. Craig Last edited by CraigT; 12-23-2009 at 03:10 PM. |
|
||||
Craig... did you / are you having the piriformis release surgery? If so... what style. (I presume that a surgeon into neurography is into the minimally invasive release instead of the removal of large amounts of muscle???)
Mark
__________________
1997 MVA 2000 L4-5 Microdiscectomy/laminotomy 2001 L5-S1 Micro-d/lami 2002 L4-S1 Charite' ADR - SUCCESS! 2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova Summer 2009, more bad thoracic discs! Life After Surgery Website President: Global Patient Network, Inc. Founder: www.iSpine.org |
|
|||
I've been thinking of seeing Dr. Filler and wondering "why" re: MRN.
NerveMed | The Leading Nerve and Spine Health Information Resource Seems worth it! Thanks. |
|
|||
Dr Filler and MRN
I have the greatest repect for Dr Filler in Santa Monica as he was able to
determine that I had not only a piriformis problem, but also a compressed sciatic nerve. These are both in the same hip. If I sit or lay down it causes jerks in my legs and upper body especially my head. I had MRI's of my back, neck and head. Was told it was stenosis in my lumbar spine and had L2-L4 fused. I kept telling the neurologists and neurosurgeons I injured my hip. None would listen to me except Dr A. Filler. After an MR Neurography and injections to varify his findings, he stated I could try injections, but did not believe I would have much success with them considering my having a dual problem. I live in Tucson, AZ and elected to try injections here from a pain specialist. The doctor here a Dr Annabi could not believe the findings at first. He did an exam of me and was surprised to say the least that Dr Filler was infact correct. Dr Annabi who is also an assistant professor of anesthesiology said neither he nor his colleages had ever seen this before. Doctor Annabi did try the injections on me, but they did not last, but a couple of weeks. I cannot go back to Dr Filler, because he does not accept Medicare. I am a senior and it is my primary insurance. I have found two other doctors that do peripheral nerve surgery as they call it that is required for my problem. One is in Phoenix, AZ and his name is Nichalus Theodore. He accepts Medicare and he also uses MR Neurography for diagnsis. The other is at UCLA Medical Center where MR Neurography was developed inconjuction with Dr A. Filler and Cedars Sinia. His name is Dr Pouratian. And of course UCLA also uses MR Neurograpy and even advertises it on their WEB site as one of their diagnostic tools in their Neurology department. They also accept Medicare as does Dr Pouratian. Good Luck and hope this helps. Tucson1 |
|
||||
Tucson, thanks for the info.
Henry Bohlman in Cleveland wrote the book on piriformis release surgery. I don't know if he takes medicare. What he does is different from what Dr. Filler does, but I have had several clients with PS go to him with great success. All the best, Mark
__________________
1997 MVA 2000 L4-5 Microdiscectomy/laminotomy 2001 L5-S1 Micro-d/lami 2002 L4-S1 Charite' ADR - SUCCESS! 2009 C3-C4, C5-C6-C7, T1-T2 ProDisc-C Nova Summer 2009, more bad thoracic discs! Life After Surgery Website President: Global Patient Network, Inc. Founder: www.iSpine.org |
|
|||
Quote:
|
Bookmarks |
Thread Tools | |
Display Modes | |
|
|