Question
I had back surgery for decompression at L4-L5 (severe spinal stenosis) and and L5-S1 (had previous surgery with nerve compression from scarring.  I did absolutely wonderful for 2 months following surgery and was walking and riding a stationary bike.  Suddenly after about 2 months and after doing 4 miles on bike I developed SEVERE sciatic pain and this has continued for 2- 2 1/2 months.  Why would thus suddenly happen.  Could this be piriformis syndrome and can you get this syndrome AFTER surgery.  My pain was down Front of leg prior to surgery. A followup MRI showed only some mild slippage but didn't feel this was significant. My neurosurgeon said maybe could do ESI shots and only as extremely last resort fusion (don't want another surgery). The orthopedic suggesting scarring saying that this usually forms several month after surgery.  Anti-inflammatories are not helping. My questions are?  Can you get piriformis after surgery or could pain have been this and NOT from severe spinal stenosis and nerve entrapment.  Any suggestions to get pain to go away.

Answer
Dear Linda,

Yes this could absolutely be piriformis syndrome, it is often confused with "sciatica" originating from the lumbar spine, and it is very easy to check for this.  Conversely, it could be early scarring and fibrosis from the surgery...and you can functionally check these theories out. You have already gotten the follow-up MRI which show mild scarring so that is probably not the case.   There are specific orthopedic tests designed to stress the piriformis musculature trying to reproduce the pain which would be indicative of piriformis syndrome.  This is actually a fairly common issue.

Now, beforehand, you had mentioned that the pain was on the front of your thighs, which is completely different than "sciatica"...the sciatic nerve pain distribution does not go down the front of the thigh...it goes to the back of the leg into the calf musculature.  So, I do not think you previously had a piriformis syndrome before the surgery from what you have described.

Lastly, your pain can easily be referred from the sacroiliac (SI) joints in the pelvis as well, and this is often an overlooked area.  I see medially diagnosed sciatica patients in my office frequently who have SI joint dysfunction, and when you correct the dysfunction in the joint, the sciatic type pain goes away.  you see the SI joint broadly refers pain over the entire leg, even to the feet and can initiate pain from the front of the thigh to the back of the thigh as well, even into the groin.  So it can confuse patients as well as doctors.  It is called sclerotogenous pain referral and does not follow nerve root generated pain distributions, but does overlap them.  There are many standardized orthopedic tests for the SI joints as well.

My suggestion to you would be to go to a good local chiropractic physician and explain all of this...take the pre and post MRI's with you.  Have them test the lumbar spine nerve roots, the piriformis musculature, the SI joints as well as the sacrum motion to help differentiate pain.  I have 4 current post surgical patients in my office (2 of which who were referred in by their neurosurgeons)...some with chronic low back pain issues from the SI, the lumbar surgeries, and the musculature...but you have to address these problems differently for the best outcomes. I have been able to treat them all effectively in the office and any good chiropractic physician should be able to do the same in their office.  Now this is not a 100% solution, but in my experience, I can help 75-80% of these patients.

Hope this helps Linda.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net