Unmasking Secondary Piriformis Syndrome: A Retrospective Analysis of 578 Patients with Hip and Buttock Pain

Abstract Background: Piriformis syndrome (PS), characterized by hip and buttock pain due to compression of the sciatic nerve by the piriformis muscle, has been described for over 70 years, yet it remains controversial. Often misunderstood in clinical settings due to its overlap with lumbar and sacral pathologies, this study aimed to determine the prevalence of secondary PS and assess the frequency of intervertebral disc (IVD) pathologies in affected patients. Materials and Methods: This retrospective study involved the review of electronic medical records of 578 patients with complaints of hip and buttock pain. The patients with positive clinical findings of Freiberg maneuver; flexion, adduction, and internal rotation test; and elicitable tenderness, with availability of lumbo-sacral magnetic resonance imaging, were included. The patients were categorized as primary and secondary PS, with a focus on identifying the underlying IVD pathologies. Results: A total of 99 (17.13%) patients were diagnosed with PS, including 5 (0.87%) with primary PS and 94 (16.26%) with secondary PS. Secondary PS was predominantly linked to lumbo-sacral pathologies (36.8%). The most prevalent IVD pathology was prolapsed IVD (PIVD) at L5–S1 (40%) and L4–L5 (28.5%). The IVD diseases were noted in 27 (4.67%) of patients. Spondyloarthropathy (30.5%) and degenerative arthropathy (15.7%) also contributed significantly, with sacroiliac joint arthropathy (80%) and facet arthropathy (20%) viewed as notable conditions. Conclusion: In patients with hip and buttock pain, secondary PS is highly prevalent, mainly attributed to lumbo-sacral pathologies, particularly PIVD involving the L5–S1 level. Moreover, the prevalence of intervertebral disc diseases was relatively low.