By Ara J. Deukmedjian, M.D., Board Certified Neuro-Spine Surgeon
A patient recently came to me with shooting pain from his buttocks and down the legs. He said an orthopedic surgeon had told him he needed back surgery. The patient’s MRI confirmed he had bulging discs in his lower back. Turned out, though, that his lumbar discs were not the problem. The pain came from a muscle — the piriformis muscle — deep in the buttock that had been strained and was constricting the sciatic nerve. No surgery required — a shot the bum and proper stretching with a trained therapist was all that was required.
So how can you tell?
Dr. Patel and I see more than a few cases of Piriformis Syndrome. Proper diagnosis is essential. Complete health history, hands on physical examination and appropriate imaging give us — with precision — the data we need. It also helps that we at Deuk Spine Institute specialize in back and neck issues and treat several thousand new patients each year.
Just because you have a bulging or herniated disc doesn’t mean you need surgery. There are some herniated discs that cause no pain and we only treat issues causing pain, numbness and weakness. Of course, there may be issues we find not causing pain at the moment that, left uncorrected, could certainly be dangerous later. But back to the pain shooting down the legs of this patient.
Why precise diagnosis matters
I reviewed the MRI and saw the bulging discs, but the health history and physical exam led me to send the patient over to see Dr. Patel. My view was piriformis muscle constriction from strained or overused muscles. Dr. Patel concurred and injected the patient’s piriformis muscle in the buttock (under direct fluoroscopic guidance) with an anesthetic and anti-inflammatory medication. The injection reduced inflammation and the numbing agent lessened the pain so the patient could schedule physical therapy.
Lessons here: A precise diagnosis from specialists improves results, helps prevent unnecessary surgery — and it may not be your back — it may be your bum.