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Piriformis Muscle Release vs. Piriformis Muscle Removal

In this fascinating video, Dr. Tim Tollestrup takes you to into his OR to show the difference between Piriformis Release and Piriformis Removal Surgery. His patient Kasey had debilitating sciatica pain. Watch how Dr. Tollestrup fixed his pain problem. Warning this is an interoperative video so it is graphic.

Full transcript below:

Just to orient you, here is piriformis muscle and you can see it comes down. There’s the tendon. You can see that white stuff when it pulls back. There’s the tendon, and look how it’s constricting the sciatic nerve.

When this piriformis muscle is released, what happens is the tendon is part. You can see how it’s wrapped right around, kind of curls right underneath the sciatic nerve and just strangulates the nerve. And when you stimulate it, and the muscle contracts, it just crushes that nerve. So after a day of walking around and that muscle repeatedly compressing the nerve over and over, that’s why the pain gets so much worse by the end of the day.

Okay, so what we’ve done is we’ve disconnected this piriformis muscle, which was scarred down really tight here. We brought it from underneath that inferior gluteal nerve there, and you can see how tightly that was compressing the sciatic nerve.

I mean, just visually look at that nerve. You can see where it’s all red there, and you can actually see, it’s called hourglassing, where the nerve is actually a smaller diameter, and that sort of visual confirmation of the mechanical compression that the tendon of that piriformis muscle was exerting on the sciatic nerve. Also, you can see that the muscle is totally gone. Even if I retract it, you really can’t see it. You divide it way up there under a little bit of tension and it completely disappears.

Dr. Tollestrup sees many patients after piriformis muscle release surgeries with other physicians. These surgeries are often ineffective and can often cause additional nerve damage.

The correct surgery is piriformis muscle removal, a surgery Dr. Tollestrup developed and one he has done successfully on hundreds of patients.

In this video he explains the difference between piriformis muscle release and removal.

When you have a patient like that, who comes, who’s had a release procedure, you know the first thing you need to do really is to address and correct the primary problem and give them the right operation where you remove the muscle, so there’s nothing left compressing the nerves.

Anytime a patient is prone, or on their stomach for a long procedure, that can trigger that lateral femoral cutaneous nerve to become compressed. The superior cluneal nerves, middle cluneal nerves, the posterior femoral cutaneous nerve, the more you operate in the pelvis, if there’s any kind of a bleeding complication or other problems, any of these nerves can become irritated and become pain generators. It’s another reason why an orthopedic surgeon is not an ideal person to be doing peripheral neurosurgery because they may have read about doing a release procedure. And they think they have the right patient, and they do that.

Even if the release is done well, if there’s another problem that coexists with that or there’s a complication from the incision they make or whatever, then they really have no ability to figure out what else is going on and to address it.

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