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It is important to note that the two can coexist. It is therefore important to consider a Pyriformis Syndrome in those cases where leg pain persists after surgery for a lumbar radiculopathy. What is the Treatment for a Pyriformis Syndrome? Pyriformis Syndrome is diagnosed by reproducing the pattern of pain by applying pressure over the sciatic notch. Confirmation of the diagnosis is achieved by injecting the pyriformis with a local anesthetic under CT guidance. In rare cases, the local anesthetic injection will be curative but in the majority of cases the pain will recur once the anesthetic has worn off. The treatment choice is then injection of Botox under CT guidance which will typically produce pain relief of 3 months duration or greater.
The duration of pain relief may be extended if the Botox injection is coupled with physical therapy specifically directed at the pyriformis. Acute back pain is defined as pain of less than 12 weeks duration. Subacute back pain is defined as pain of greater than 12 weeks duration and less than 6 months duration.