Double nerve crush syndrome by lumbar disc herniation and piriformis muscle compression

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A 60-year-old patient presented with a six-month history of severe sciatica. The patient showed tenderness of Valleix and Friberg's sign, and his symptoms disappeared after injection of lidocaine both onto the sciatic nerve and onto the L5 spinal nerve. MRI revealed left extraforaminal disc herniation at the L5/S1 level and thickness of the piriformis muscle. The symptoms did not improve after conservative treatment; second stage surgery was performed under a diagnosis of double lesion neuropathy at the lumbar spine and at the piriformis muscle. For release of sciatic nerve compression, incision of the piriformis muscle was performed. The symptoms decreased; however, they persisted. Surgical treatment for the lumbar lesion was performed. The symptoms disappeared immediately after surgical removal of the disc herniation and posterolateral fusion. It is important to consider double crush syndrome at lumbar lesion and piriformis levels.
2010-02-01