CT-guided corticosteroid injection as a therapeutic management for the pyriformis syndrome: case report (original) (raw)
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Outcome of Corticosteroid Injection for Sciatica through the Caudal Route
Medical Journal of Shree Birendra Hospital, 2015
Introduction: Sciatica is an important medical problem with socioeconomic impact; its effective management remains a challenge. Approximately 80% of the total population experiences low back pain at some point in their lives which may be associated with sciatica. As it is more common in adult working group, the pain caused by sciatica can incapacitate a person fromdoing his or her normal work. So the goal of our treatment is not to cure anatomic abnormalities but rather to reduce pain, which allows the patient to engage in early rehabilitation and return to a more normal lifestyle.Methods: Fifty patients were initially included in the study and all patients received three injection of 4ml methyle prednisolone acetate (160 mg) and 6 ml of Normal saline that is of total volume 10 ml.at an interval of 48 hours. Among 50 study patients, five patients dropped out in subsequent follow-up. So only forty-five patients were analyzed for final results.Results: The mean age of the patient was ...
Epidural Corticosteroid Injections in the Management of Sciatica
Annals of Internal Medicine, 2012
Background: Existing guidelines and systematic reviews provide inconsistent recommendations on epidural corticosteroid injections for sciatica. Key limitations of existing reviews are the inclusion of trials with active controls of unknown efficacy and failure to provide an estimate of the size of the treatment effect.
Role of Caudal Epidural Corticosteroid Injection in the Management of Sciatica
2011
Objective: To determine the effectiveness of caudal epidural corticosteroid injection in patients with sciatica. Study Design: Descriptive Case series Place and Duration: Orthopaedic Surgery Unit Mardan Medical Complex Teaching hospital Bacha Khan Medical College Mardan KPK from May 2010 to June 2011, Materials and Methods: 42 patients of sciatica were injected with caudal epidural injection 80 mg of methylprednisolone in combination with 3 ml of 2% plain xylocaine and 3 ml of normal saline. Efficacy of the injection was determined by improvement in the Oswestry Disability Index (Version 2) and Visual Analogue Scale (VAS) measured preinjection and at follow-up visit at 3, 6, 10 and 12 weeks. Patient with post-injection Oswestry Disability Index ≥ 40% or pain score ≥ 5 at 3 weeks were injected a second injection. No more than two injections were given to any patient presented. Results: All the patients enrolled in our study had pre-injection mean Oswestry Disability Index 58.4% and p...
Skeletal Radiology
Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included Bpiriformis syndrome,^a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. The concept of fibrous bands playing a role in causing symptoms related to sciatic nerve mobility and entrapment represents a radical change in the current diagnosis of and therapeutic approach to DGS. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. A broad spectrum of known pathologies may be located nonspecifically in the subgluteal space and can therefore also trigger DGS. These can be classified as traumatic, iatrogenic, inflammatory/infectious, vascular, gynecologic and tumors/pseudo-tumors. Because of the ever-increasing use of advanced magnetic resonance neurography (MRN) techniques and the excellent outcomes of the new endoscopic treatment, radiologists must be aware of the anatomy and pathologic conditions of this space. MR imaging is the diagnostic procedure of choice for assessing DGS and may substantially influence the management of these patients. The infiltration test not only has a high diagnostic but also a therapeutic value. This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments, with emphasis on MR imaging and endoscopic correlation.
Sciatic neuropathy following intramuscular injection: Clinical and electrophysiological findings
2018
Introduction: Post injection sciatic neuropathy in very common in developing country like India and mostly it is because of faulty technique and injecting substances. Due to thin fat pad and less muscle bulk of buttocks in children, it makes them more prone to sciatic nerve injury than adults. Objective: The aim of this study was to evaluate clinical and electrophysiological findings of post-injection sciatic neuropathy. Materials and Methods: We included 30 consecutive patients who had history of intragluteal injection and subsequently developed neuropathy and their clinical and electrophysiological examination was done. Results: The most affected nerve was Sural Nerve (83.33%) while Superficial Peroneal nerve was least affected (16.67%). Fifteen cases had both Tibial and Peroneal nerve affection. Cases who had both sensory motor axonal neuropathy were twenty seven while one case exclusively had motor axonal neuropathy. One case exclusively showed pure sensory neuropathy. Demyelin...
IP innovative publication pvt ltd, 2020
Introduction: We describe the short term and intermediate efficacy of direct intra-muscular injection of Botulinum toxin in Pyriformis Syndrome, along with its safety profile. Materials and Methods: A diagnosis of pyriformis syndrome was made by exclusion, only after careful clinical assessment & MR Imaging. Patients were selected for Botox infiltration if adequate symptom relief was not noted after conservative management. Patients were placed prone on the CT table with a pillow placed under the lower pelvis for elevation of the hip joints. Subsequently a total of 03 spinal needles (22 G) were placed in the pyriformis muscle belly, at a distance of 1 to 1.5 cm apart. Finally, freshly reconstituted 50U of Botox was injected through each of the needles into the muscle belly (total dose of 150 U). Results: A total of 26 procedures were performed on 25 patients (15 male, 10 female) with one patient receiving a second procedure 15 months after the initial treatment. The mean age of the patient population was 48.6 years. 88.5% (23/26) patients reported very good pain relief when assessed on a Visual analogue scale (VAS) at 3 months, which was sustained at 6 months in 77% (20/26) patients. No procedure related complications were noted. Conclusion: CT guided Botox infiltration into the pyriformis is a safe and effective modality for pain relief in pyriformis syndrome. Three needle technique with infiltration across the length of the muscle appears be more effective in symptom alleviation, as compared to the conventional single site injection.
Turkish Neurosurgery, 2016
and anatomical variations (13). The accepted mechanisms of injury include direct needle trauma, secondary constriction by scar, penetrating injuries of popliteal fossa and neurotoxic chemicals in the injected agent (10,11). Rules of parenteral drug application are universal. In the literature, the most common used sites for intramuscular (IM) injection are dorsogluteal (DG), ventrogluteal (VG), vastus lateralis, and deltoid muscles (22). Application conditions, standards of technical facilities, █ INTRODUCTION T he sciatic nerve (SN) is positioned lateral and downward along the pelvis inner wall and leaves the pelvis from the great sciatic notch (14). It comprises two separate trunci: lateral truncus (fibular division) and medial truncus (tibial division) (7). SN is open to trauma because of its posterolateral position, smaller amount of supporting connective tissue, AIm: Sciatic nerve injury is the most frequent and serious complication of intramuscular gluteal injection. This study aims to highlight the incidence and causes of this continuing problem and to discuss the relevant literature. mATERIAl and mEThODS: A total of 217 subjects who were diagnosed with sciatic nerve injury in our neurophysiology laboratory between 2003 and 2013 were examined. Sensory and motor transmission studies and needle electromyography were performed by conventional methods in the two lower legs and the results were compared between each leg. RESUlTS: Of the subjects who experienced a sciatic injury secondary to intramuscular injection, 59 (27.2%) were female and 158 (72.8%) were male. In all subjects, the dorsogluteal site of the buttocks was selected for intramuscular injection. Sciatica occurred on the right side in 91 subjects, on the left side in 125, and bilaterally in one. The peroneal nerve was more affected than the tibial nerve. The most used agents were non-steroidal anti-inflammatory drugs. According to follow-up electromyography findings of 103 subjects, significant sequelae remained in 2/3 of cases. CONClUSION: The occurrence of sciatic neuropathy after gluteal injection causing permanent sequelae and leading to medicolegal problems is relatively rare. We suggest a double quadrant drawing technique in each gluteal region. We also draw attention to this issue with postgraduate and in-service training programs of medical staff, and providing continuity in education can reduce this serious complication.
CT-guided piriformis muscle injection for the treatment of piriformis syndrome
Turkish neurosurgery, 2014
Piriformis syndrome is a rare neuromuscular disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve. The treatment of piriformis syndrome includes injections into the piriformis muscle around the sciatic nerve. These invasive approaches have been used with various techniques to increase the safety of the procedure. Computed tomography (CT)-guided injection of the piriformis muscle and the clinical outcome of the patients are discussed. The authors presented 10 consecutive patients that underwent CT-guided piriformis injection between March and December 2007. Three patients had a history of a severe fall on the buttocks, one had gluteal abscess formation following deep intramuscular injection, and another one had a habit of prolonged sitting on the carpet. Etiology was not identified in the other patients. Main complaints of the patients were pain and numbness in the legs. Hypesthesia was the major neurological finding. Magnetic resonance imaging (MR...
Skeletal Radiology, 2015
Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included Bpiriformis syndrome,^a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. The concept of fibrous bands playing a role in causing symptoms related to sciatic nerve mobility and entrapment represents a radical change in the current diagnosis of and therapeutic approach to DGS. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. A broad spectrum of known pathologies may be located nonspecifically in the subgluteal space and can therefore also trigger DGS. These can be classified as traumatic, iatrogenic, inflammatory/infectious, vascular, gynecologic and tumors/pseudo-tumors. Because of the ever-increasing use of advanced magnetic resonance neurography (MRN) techniques and the excellent outcomes of the new endoscopic treatment, radiologists must be aware of the anatomy and pathologic conditions of this space. MR imaging is the diagnostic procedure of choice for assessing DGS and may substantially influence the management of these patients. The infiltration test not only has a high diagnostic but also a therapeutic value. This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments, with emphasis on MR imaging and endoscopic correlation.