Piriformis release surgery, discussion and information

In hopes that Elliot who saw Dr. Filler is still following this forum I have some questions. Did you have any other diagnoses other than piriformis syndrome? What imaging did you bring form home? You said you were 70% better then. How are you now.

I have had pain in my buttock, leg and foot for about 9 years. I have had botox injections into the piriformis which do give some but not complete relief. I also have a degenerative spondylolisthesis at L4-5 and some nerve damage in the right L5 and Left S1. My sciatica is on the right. I experience major in the buttock I think roughly where the piriformis but also at the attachments on each side. I am trying to sort out if this sciatica is L4-5 related or piriformis related or both. Did yu or anyone you met while there have a dual diagnosis?

How much did everything medically related cost?

I live in Kingston, Ontario and am going toapply to our public insurandce to cover this as it is not offered in Canada.

Anything you could tell me would help.

Scamp. I have contacted Dr. Filler. His fees are reasonable I suppose, 8 to 12 grand for the surgery, per side, 300 for the initial consult, and 2900 per injection. However, Cedar Sinai Hospital charges 40 to 50 grand in addition for use of their hospital. The nerve institute neglected to mention the 50 grand for the hospital in their initial quote. I am a physiotherapist and pretty knowledgable about this. Not sure what happened to Elliot, but it would be nice to know how he faired.

ronnyjotten, Are you thinking of going for piriformis surgery? I was told that the use of Cedar Sinai would be $1800. How could it possibly be $50,000? Have you already been?

ronnyjotten, I tried to reply to your posting but thinkI did it wrong so here I am again. Are you sure about the cost of the hospital facility at Cedar Sinai? I was quoted $1800--quite a difference. Haveyou been there? Had surgery? or interested because you are a physical therapist? I am just getting ready to send in my application for financial help from the provincial health insurance plan and I am definitely planning to go but it will be out of pocket if I am turned down so I want to be sure of what I am gtting into. I am badly flared up now and think the last botox injection didn't work. I have been working with a great physiotherapist here but there is just so muchshe can do as youknow.

I know just how all the people feel who run into doctors who don't believe inthis very real syndrome. It took me a long time to find a doctor who took it seriously. And reading all these postings helps because I have never met anyone else who has piriformis syndrome.

I'm also looking into piriformis surgery and have met with tons of resistance from my insurance company. I've had three botox injections which provided a bit of short term relief. Insurance paid for 2 out of the 3, but for some reason decided that the second one was "medically unnecessary". They also have told me that surgery is unnecessary! if only they could live with this pain for a while, maybe they would rethink "unnecessary"

Here is the quote I got from Dr Filler's office, including the hospitalization costs

These are rough estimates but,
the initial consultation is $150

MR Neurography approx.. $3000

Open MRI Guided Injections range is usually $1500-$4500

Surgery Fees $10,000-20,000 professional fees
approx $30,000 hospital fees.. which are usually covered by insurance because in most cases the hospital is a provider for your insurance


Unfortunately Dr Filler isn't on my list of preferred providers, so I'm looking into another surgeon, Dr Byrd, in Nashville TN, who has also written quite a bit about piriformis. I'll just have to wait and see what insurance ends up deciding.

let me know what you decide and how it goes for you. I hope it works out.

Hermana Ana

Thanks hermana ana. I just figured out how to get to page 2. The person Ispoke with must have been really out of it. I think it was someone at Cedar Siani. Good luck to you also. You are right--not many people understand how painful this syndrome can be. If I don't get help financially I will really have to thinkabout this. I think 50 years from nowmaybe this will allbe easier as more doctors will have access to MR Neurography.

What has happened to Elliott? Not seeing any more postings can only mean that he's back in the lawyers office doing very nicely! Pleased for you if you're out there Elliott. I too live in the UK by the way.

I have been having treatment for this syndrome in the UK for well over 5 years now. After having spinal fusion at L5/S1 level and the screws removed a year later, I am no better. It is quite possible that there were two pathologies going on and no one recognised piriformis until it was too late. In the meantime, I have lost my job, unable to drive a car - life is totally incapacitating on a bad run.

I have seen at least five specialists in UKs most specialised hospitals. I was offered release surgery up in Yorkshire (I live in SE England but decided to back out because I knew about Dr Filler's ground breaking MR Neurography and wondered why this seemed to be unavailable in the UK. The surgeon who was going to perform this op has now left for warmer climes! In the meantime,I was referred to a pain specialist at UCH, London. They do have the equipment but are waiting for the scanner to be relocated at the hospital. I have been waiting for 18 months for this now.

All the usual paths of conservative treatment have almost been exhausted e.g. steroid injections, stretching, physio, chiropractic, you name it, I've done it. A botox injection is scheduled for next month - the last hoop I have to jump through. If my specialist can't offer me a specialist who can perform release surgery then it looks like I'll be trying to sit on a plane to Norristown Philadelphia for a scan there. Dr Filler will be able to assess my case and after all, Philadelphia is a shorter ride than LA. Anyone interested in this option, then the scheduling is done through nervemeds LA base. Will try and keep others posted on progress. Please feel free to post any comments etc.

Sorry for all you sufferers!

I am wondering why you had a fusion and why it was undone. I asked about going to Pensylvania for the MR Neurography and they advised me form Dr. Filler's Nerve Medicine that it would be best to come to Californiaso I could have the full assessment and have a consult with Dr. Filler. As well they said if I stayed about a week they could do the full assessment and if it proved positive, I could have the surgery while I was there. The reason I am still awake is because I am having terrible burning in the butt, the hip, the leg and the foot. It feels like someone poured acid all up and down my right side on an open wound.

I have just turned my application into the Ontario health insurance plan to see if they will fund me to go to see Dr. Filler for MR Neurography, guided injection and a consult to determine if I definitely have piriformis andthen to do his minimal access surgery if needed.

Do you have trouble with sitting? walking? biking? What are your main symptoms?

It helps to talk to others who have this syndrome as I don't know anyone here who has it .

Hello Scamp
I had spinal fusion because my mri scan (2000) showed that the disc at L5/s! level had collapsed. I had no leg pain at that stage - just terrible low back pain but butt pain in one side occurred whenever I was driving, even when I was sitting on a dining room chair.
Anyway, my consultant thought the pain was caused by the collapsed disc and recommended fusion.
The pain got no better - in fact it worsened after surgery, so the rods and screws were removed - the consultant thought these might be the problem. Several attempts at physio - the piriformis was thought to be very very tight, and stretching was attempted but that only made things worse. Finally I was given a stretch to carry out - the consequences were that I had a swelling of around 3 cms. almost midline to my spine at sacral level. That's where my pain now emanates from - it then travels into my butt, hip, lateral thigh and when its really bade, I can't sit at all, or find a comfortable position to sleep. Basically I become incapacitated for 3 weeks or so.
Your symptoms seem typical of p.s. to me and I feel very sorry for anyone who has this as it's a very under-diagnosed condition.

I don't have private medical cover and would have to fund myself to get to CA - the cost of flying would be extortionate. I think Elliott must have travelled First Class - otherwise he would never have got home!
I quite understand the logic on nervedmed advice about you going straight to CA. Have you had any piriformis injections at all? It is worth trying just for the diagnosis.
I have chronic scar tissue enveloping the sciatic nerve so I think it's a case to freeing up the adhesions. It's finding the right surgeon to do the job with experience and as far as I can gather, Dr Filler has this expertise.
Whatever you do, I wish you all the luck and hope that you can regain some quality of life.
Jo

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Scamp. I suffer the Piiiformis problem that you do, and have done so for many years, but only recently have been having treatment. In years gone by it was a matter of "putting up with it". I am undergoing botox and osteopathy and will give that a few months to see if anything improves. (Not yet, but it is early in the program so far) I am considering Dr Filler also as a last resort, so will be interested to see whether your OHIP approval comes through. Please keep me updated. Thanks

Hello all, I need some help. I was hit by a tractor trailer and have been suffering with horrible back, hip and buttock pain shooting down into my left leg and foot ever since the accident. All test done have come up nothing. I was diagnoised with Pyriformis Syndrome about 4 months ago and since been thru months of physical therapy, E-stem and untrasound therapy. Shots, and recently had 2 pyriformis muscle injections and am STILL IN HORRIBLE PAIN. My doctor told me today that I had to have the surgery and to not wait. I am headed for the surgeon on this Wednesday. I am completely horrified of this and am wondering what to expect. What is the recovery time, is there a long hospital stay, will I be able to walk soon after the surgery? I have no clue what to expect. Everything I have researched seems to not be too helpful as not many doctors seem to know too much about this or even think it's real. If there is anyone out there who can give me some answers...It would be greatly appreciated.

Thanks so much........

Hi Carrie and Sisbert. Just got back in town so am jsut replying. My OHIP application is in process and still isn't in the hands of the Kingston out of country consultants because there is still something I have to sign but I have been out of town. It will be very interesting to see what the reply is.

Sisbert I feel for you as I know how painful it can be. Have you had an MRI? I think you said it showed nothing. Dr. Filler has proven that piriformis syndrome does exist. Have you seen his study published in 2005.Noone could say there is no such thing if they have seen his study and many doctors don't keep up with the times. But it is very frustrating when the doctors make you feel it is in your head.

Carrie I tried osteopathy and botox. The botox helps but does not solve the problem. I get some relief for about 3 months. And the first month I get pain from the injection itself. The osteopathy was relieving for about k2 days. Noone could actuall ktouch the piriformis. It was too aggravated so massage, physio had to kwork around it.

I will keep you informed about OHIP. Are you from Ontario?

Shirley

Thanks Jo for your words of advice. I have had prolotherapy into the SI joint ligaments. I don't think it helped. Just got back in ktown and will review your message again and reply more.

Shirley

Scamp. Yes I am from Ontario which is why I am particularly interested to see what OHIP approves. My hip was dropped forward and rotated and now that it is where it should be the prolotherapy seems to have helped keep it there. I understand how the hip issue could cause stretched ligaments in the sacroiliac joint and overdevelopment of the piriformis muscle. There was a huge dip in my butt when the botox kicked in and the piriformis relaxed. Apparently, (and obviously), the glutes on that side hadn't worked for a while. The whole side was pretty weak and underdeveloped. I do core/pelvic floor exercises as well to stabilize the pelvis.

Having said that, the sciatic pain has not gone at all. It is okay when I walk and horrible when I sit. I have read that sore nerves can take several months to heal after the irritant is removed. Mine may have been irritated for too many years. I'll give the therapy a few more months. There are some specialists at Sunnybrook Hospital that deal with nerve pain issues so that might be one more avenue to explore before breaking the bank and heading to California. Though I have to admit, the pain is very wearing.

I've read the entries on piriformis surgery with interest. I am two weeks' out of piriformis surgery with Dr. Filler. Be happy to answer any questions. But I have one of my own, for anyone who has had the surgery done.....did you have burning and pins and needles down into the foot, and has this pain resolved?

Rob