Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Spine
Abstract number: 25615
PIRIFORMIS SYNDROME FOLLOWING LUMBAR ARTIFICIAL DISC
REPLACEMENT
Evalina BURGER, Elizabeth ROBINSON, Peter GONZALEZ, Susan ESTES, Robert
COOLEY, Vikas PATEL
University of Colorado Denver, Aurora (UNITED STATES)
Introduction: Artificial disc replacement (ADR) offers an alternative solution for
surgical treatment of severe lumbar degenerative disc disease. To our knowledge, no
case of piriformis syndrome (PS) following ADR has been reported. Because the
symptoms of PS mimic those of radiculopathy it is vitally important to differentiate the
source of nerve irritation to avoid unnecessary or inappropriate procedures. Methods:
Case series of four patients who developed PS following ADR. Results: Four
patients, aged 38-46, developed some or all of the following symptoms after ADR:
posterior leg and buttock pain, calf weakness, and toe and ball of foot numbness and
tingling. The onset of symptoms ranged from six days to eight months postoperative.
Each patient was diagnosed with PS through physical examination. Three of the
patients received a piriformis injection and reported 50%-100% pain relief lasting one
to three weeks. All four patients subsequently underwent physical therapy that
provided relief of their PS-related pain and enabled them to resume normal activities.
Conclusions: Piriformis syndrome has not previously been described in the literature
as a sequelae of lumbar ADR. Our case series indicates that this complication may
be under-diagnosed. Careful consideration following ADR is required if the patient
presents with buttock, leg or foot pain, and/or numbness. It is important for
physicians to recognize the symptoms and indications of PS as compared to sciatica
or compression and irritation of the nerve root. The proper diagnosis of PS can save
patients from unnecessary fusion or exploratory discectomy.
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