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Piriformis Syndrome Surgery One Decade and 400+ Cases Later

Piriformis syndrome is a topic that’s near and dear to my heart. It’s an operation that I developed approximately a decade ago. 2011 was first pirifoma surgery muscle removal that I performed and since that time I’ve performed over 400 of these operations, which is, by far and away, the most of anyone in the world.

Piriformis syndrome, or the term and the concept of compression of the static nerve by the piriformis muscle is not something I came up with. It’s been around for a long time. Although it’s been like the redheaded stepchild of medical diagnoses.

In some circles, it’s an accepted diagnosis. A lot of spine surgeons, orthopedic surgeons, don’t believe that it’s even a real condition. At the time, I would see these patients who had sciatica pain, but who had no obvious pathology coming from the back.

First patient that actually came to me with piriformis syndrome was a young woman who had fallen down a flight of stairs and landed very hard on the buttock and after the initial bruising and soreness went away, she seemed to be okay. But about two months after the injury, she woke up one morning with a complete sciatic nerve palsy. So no ability to move the foot, no ability to bend the knee or flex the knee.

That was patient zero. I diagnosed her with the condition, and then I, just using peripheral nerve concepts that I understood from other types of peripheral nerve problems, I went into the anatomy lab and did a lot of dissection on cadavers and figured out what you would really need to do to cure the problem with an operation. And so I operated on her and she did very well.

Here we are about a decade later and more than 400 cases and I have patients now that come from all over the world to have this condition treated. There are orthopedic surgeons out there who will do piriformis muscle releases, but that’s a flawed operation because it doesn’t really get to the heart of why the pain is happening.

And when you just release the Piriformis muscle, it leaves a neurovascularly intact muscle in the deep gluteal space, which then just scars down around the sciatic nerve and can still contract and still impinge and put pressure on the nerve.

The only way to really guarantee that that won’t be a problem is to fully remove the muscle. It’s a much more technically challenging operation, but it’s also a much safer operation than doing an endoscopic release, for example, because you have good direct vision of everything, you can really assess all the nerve structures, you can avoid getting into bad bleeding, which often happens with these endoscopic procedures.

It’s an operation that’s a lot of fun. Patients do great. Patients that actually have piriformis syndrome, you remove their piriformis muscle, they’re cured. Their pain will be gone.

There aren’t words for the life changing alteration. There just aren’t words. I could never thank him for how he changed my life. And so quickly. I will forever be grateful.

Next day after surgery, I think I … and I’m going to get emotional again because I cried the whole entire day. I couldn’t believe the pain was gone. To find Dr. Tollestrup, that I believe is a small miracle for me personally. I know every case is totally different, but I’m so thankful that Dr. Tollestrup was put in front of me.

I suffered from piriformis syndrome for nine years and I tried several treatments, which ultimately made my condition worse. And then I had a horrific, damaging piriformis muscle release surgery. I’m very grateful for Dr. Tollestrup. I had one foot in the pain management graveyard and God used him and worked through him to pull me out.

He saved my life. He really did. The suffering that comes with addiction is beyond compare. I would not have survived. I would have killed myself. There are no words that can express the amount of gratitude I have for Dr. Tollestrup. He’s an amazing man. His compassion, his ethic, you just don’t see that anymore in a physician.