Postpartum Severe Low Back Pain Due to Piriformis Muscle Syndrome Treated with Injection Botulinum Toxin Type A

Piriformis muscle syndrome (PMS) is a condition that occurs due to prolonged or excessive contraction of the piriformis muscle, causing excruciating pain in the buttocks, hips, and lower limbs, due to irritation or compression of the sciatic nerve, mimicking “sciatica.” Injection botulinum toxin type A (BoNT-A) is frequently used to reduce muscle hypertonia and muscle contracture and thus alleviate pain. Overlooking piriformis syndrome as a potential cause of sciatica may result in unnecessary morbidity, and sometimes, spine surgery. This case report describes the successful treatment of PMS using a hybrid technique (ultrasound and fluoroscopy guided) injection of BoNT-A in piriformis muscle, which resulted in long-term pain relief with a resolution of radicular symptoms, indicating the effectiveness of BoNT-A injection for managing this condition.