Decision to have surgery

[DGEORGE427]

Hello, I recently been diagnosed with PN and piriformis syndrome and am trying to make a decision to have surgery for both. My symptoms started 8 years ago and have been to so many different doctors, therapists and on different medications with not much relief. To say that I am frustrated is an understatement. I finally found a doctor out of state that is suggesting surgery. I have had internal injections but only one CT guided injection which confirmed PN. I am scheduled to have a CTguided injection with BOTOX for the piriformis issue on 11/1. I have scheduled surgery for 12/12 but am wanting to talk to someone who has had the surgery. Since I have been suffering so long, I may have nerve damage that I am not sure surgery will relieve my pain but it may be my only option at this point. Please reply if you have had the surgery to give me some advice. Thank you, Diane G

[stephanies]

I had PN surgery many years ago but still have pain. Have you had an imaging to look for other causes of PN? Specifically, I think it is important to have MRIs of the lumbar spine and sacrum/tailbone reviewed by a knowledgeable doctor. At the time I had surgery, I didn't know that spine issues (like tethered cord and Tarlov Cysts) can cause PN pain. The imaging can rule in or out these kinds of issues.

Stephanies

[DGEORGE427]

Thank for the reply. That’s great to hear that you were pain free for awhile but concerning that the pain returned. It sounds like the pain after surgery is bad too. The pain has moved into the lower back in the past two years. I did have a lumbar spine this year and a pelvic MRI in 2020. Neither showed anything that was concerning. I am doing some more PT and hoping an injection in the piriformis will give me some relief.

[Violet M]

Yes, it's really a tough decision to make. I had surgery 19 years ago and I'm doing great but it was a difficult recovery. Not really worse than the pain I was already in though.

I think the important thing is to determine whether your symptoms, diagnostic tests/nerve blocks, and history point to a true nerve entrapment.

I haven't had surgery or injections for piriformis syndrome. I still have some issues with that but it's OK if I don't sit too much.

Did your PT evaluate you for SI joint dysfunction, hypermobility, and hypomobility?

Violet

[DGEORGE427]

Thank you. Being in more pain as part of the recovery procedure is what I’m really worried about. I don’t want to have surgery and it create other problems. It’s really affected my mental health. I have only had one PN injection that I felt gave me very short term relief so I would like to know if there are other issues that I can fix to ensure that I truly do have nerve entrapment. I will ask my PT about the other conditions you mentioned.

[stephanies]

I think it is a great idea to rule out everything else before considering surgery. It might be a good idea to have your lumbar and pelvic imaging reviewed by other doctors to see if there is anything that might have been missed on them that could explain your symptoms. I have found that different doctors see different things as significant on imaging and that some things are left out of the radiology reports.

Stephanies

[Violet M]

Being in more pain as part of the recovery procedure is what I’m really worried about. I don’t want to have surgery and it create other problems.

I wish you could predict the outcome ahead of time. That's what makes the decision so hard.

Violet

[cwb125]

I think it is highly likely I am going to have the piriformis syndrome surgery soon. If there is anything I can do to help you, please let me know.

As far as I can tell, and please feel free to correct me if I am wrong, but the piriformis syndrome surgery seems to have a higher success rate and less complications than the PNE surgery. Do you know if you can only do one surgery? Or, do you have to do them both at the same time?

Also, I did the piriformis syndrome block and had great success with it. Maybe you could try it before committing to surgery?

I've had several others surgeries, some when doctors told me they were not a good idea. At the end of the day, I would trust your gut/instincts over anything else simply because it is easier to live with, at least for me, if I make the decision.