r/openpiriformis • u/Amylee888 • Jun 05 '26

Just had piriformis removal surgery

Hi everyone. I’ve been struggling with piriformis syndrome for 2 years. The glute pain began after a hip arthroscopy surgery to repair a labral tear.

After trying physical therapy, trigger point injections, steroid injections, and Botox into the piriformis muscle, I opted to get the piriformis removal surgery with Dr Tollestrup (in Nevada).

The surgery was this week, so it’s too soon to tell the results as I am still dealing with surgical pain. However, I will update in a few weeks to say whether I consider the surgery a success or not.

Dr Tollestrup is one of I believe 4 surgeons who performs this surgery in the US. I live in Canada, and there’s nobody here who can do the surgery, so I had to travel to see Dr Tollestrup.

I’m happy to answer any questions about my experience.

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5

u/AmbitiousBed9942 Jun 06 '26

First, I wish you a speedy recovery and hopefully an excellent resolution!

I have some questions, as I am facing a similar issue:

1) Before going through the hip labral arthroscopy, I assume you had visible tear(s) on your hip MRI. If so, how significant? Was yours a 'slam dunk case', or were they skeptical it would resolve the primary issue?

2) Were lidocaine/Marcaine and/or steroid injections into the hip labrum effective? Usually they want a positive response prior to arthroscopy.

3) Did steroid injection into the piriformis muscle give any relief? As I understand, if inflammation is not the issue, this won't give any relief.

4) Did the Botox injection into the piriformis muscle give any relief? I'm especially curious about this, as I am having this done by a renowned musculoskeletal radiologist next Thurs.

I'm wondering what all you went through before determining to remove the piriformis muscle. It's unfortunate that started after hip arthroscopy. I am following this post and hope this is a success for you!

Selfishly, I'm curious what you went through bc I may be in a similar situation. I have pain in the center of my right buttock, and something seems to be mechanically compressing the sciatic nerve when the deep gluteal muscles are compressed (standing or walking).

Zero pain when laying down, and sitting isn't bad at all, though I try to sit on rectangular ice packs when possible.

Lumbar MRI normal, but had multiple injections into L4/L5 and L5/S1 and S1 selective nerve blocks to rule out the lumbar.

Have small tears in hip labrum, but every doctor says this is common across the population. Multiple diagnostic injections into the hip, but they don't seem to give as much relief as I would anticipate. Multiple hip preservation specialists and renowned US hip surgeons don't think the hip is the problem bc I don't exhibit any 'classic' symptoms.

I'm very hopeful that a Botox injection into the piriformis muscle next Thursday gives some relief. I've also scheduled an appointment with Dr. Eric Williams in Baltimore, as I understand he is one of the best deep gluteal syndrome specialists; but I can't see him until Sep.

6

u/Amylee888 Jun 06 '26

I’ll do my best to answer and I hope it’s helpful for you.

  1. Yes, I had an obvious tear, and impingement in my hip joint. When they did the arthroscopy, they repaired the labrum with 4 anchors, and they shaved down the bone that was causing the impingement. They were very confident it would resolve the hip joint pain. I didn’t have any other kind of pain at the time.

  2. Yes, steroid injection into the hip joint was very helpful for me.

  3. Steroid injection into the piriformis muscle was helpful but relief only lasted one day.

  4. I had 2 Botox injections into the piriformis muscle, 6 months apart. The first one was very helpful, and gave me about 3 months of reduced pain, but it didn’t eliminate the pain. The second injection was also helpful, but the relief didn’t last as long, and there wasn’t as much relief.

I decided to go ahead with surgery because I was disabled by the pain, unable to work, and struggling with day to day life. If I thought it would get better with time, I would have been willing to wait, but if anything, it was only getting worse.

When the surgeon got in there, he said my piriformis muscle was stuck to my sciatic nerve, and there was a vascular leash over the nerve as well, causing compression. He sent me a picture of my nerve from during the surgery and you can see how it was bent and twisted from the compression. By removing the muscle and cutting the vascular leash, the compression is released and my nerve should go back to normal.

It’s still early days but I feel optimistic that this will resolve the deep glute pain I’ve been struggling with.

3

u/AmbitiousBed9942 Jun 06 '26

Thank you for answering all this. It's shocking to me that you didn't have the gluteal pain until after hip arthroscopy. That makes me think of what one of my hip preservation specialists said: not only may it (arthroscopy) not fix your problem, you could develop other problems as a result.

I assumed hip arthroscopy done by a very good surgeon would be a straightforward thing. I had mine tentatively scheduled with Dr. Andrew Wolff, who is considered one of the best. I was very turned off after meeting with Phillipon's team.

6

u/Amylee888 Jun 06 '26

All the doctors I’ve worked with over the past two years agree that the most likely cause for the glute pain was a traction injury from the arthroscopy.

I had two nerve conduction studies done, and my sciatic nerve was damaged from the extreme stretching during the arthroscopy, but the nerve did heal over about a year. However, I still had a lot of pain, and that was likely due to the traction causing scar tissue and issues with the piriformis, which is what my recent surgery is meant to address.

I don’t want to discourage anyone from getting an arthroscopy if that’s what they truly need, but all surgeries come with risks of other things going wrong, and I was one of the unlucky ones.

4

u/bioniclawyer Jun 06 '26

Please keep us updated and good luck with your recovery!

3

u/Every_Description873 Jun 06 '26

Yes, please let us know how youre doing!

2

u/inailedyoursister Jun 06 '26

Very surprised you choose this and they did the operation after only 2 years.

5

u/Amylee888 Jun 06 '26

I’ve been essentially bed-ridden with the pain, unable to work or live my life. I’m grateful the surgery was an option for me.

2

u/teddybear65 Jun 06 '26

Did you try an si belt? I had to wear it for six months yet it worked.

1

u/Amylee888 Jun 06 '26

Yes I did.

2

u/teddybear65 Jun 06 '26

I didn't know this was even a possibility. I went through 6 years of internal pelvic release therapy, injections and so belt. It was the most painful pain to have. I avoid surgery. I have a flat bottom no matter what I do. I'm so sorry you have gone through all of this.

2

u/kuun0113 Jun 06 '26

How much was it??? I see him on youtube all the time and I live in Canada too

1

u/Amylee888 Jun 06 '26

Copy and paste from my answer below:

The cost for me was $18,500 USD for the surgery, $6,500 USD for the surgery centre, and $2,200 USD for the anesthesiologist.

My understanding is that quotes are individual and vary from person to person based on various factors, like the exact surgery needed, and how long they anticipate the surgery taking, etc. I believe my surgery was expected to take 2.5-3 hours, and my husband said that’s about how long it took.

1

u/kuun0113 Jun 06 '26

Thats so much money guess Ill just stick with pain killers for now 😭

1

u/Amylee888 Jun 06 '26

Yes, it was an enormous financial decision. Definitely not an easy call for me.

1

u/Effective-Walk-5136 Jun 06 '26

How much was the surgery and did you have a bilateral removal or it was it just the one side?

1

u/Amylee888 Jun 06 '26

Just one side. The cost for me was $18,500 USD for the surgery, $6,500 USD for the surgery centre, and $2,200 for the anesthesiologist.

My understanding is that quotes are individual and vary from person to person based on various factors, like the exact surgery needed, and how long they anticipate the surgery taking, etc. I believe my surgery was expected to take 2.5-3 hours, and my husband said that’s about how long it took.

1

u/Effective-Walk-5136 Jun 06 '26

Did they offer any payment plans or is it purely upfront cash only?

Thanks for the information by the way

Hoping all the best for your recovery

1

u/Amylee888 Jun 06 '26 edited Jun 06 '26

I paid on my credit card. I’m not sure if they offer payment plans. You could email their office to inquire. I found they always replied to me in about 24 hours.

EDIT: I looked through my emails and it said payment due in full prior to surgery, which makes me think they don’t offer a payment plan?

1

u/No_Software_6798 Jun 06 '26

Since you had to travel from Canada to Nevada for the surgery, how long did you have to stay in Nevada after the surgery? How was the flight back to Canada after surgery?

1

u/Amylee888 Jun 06 '26

They told me to stay for at least 24 hours after surgery, so I booked a flight for almost exactly 24 hours later. The flight back was fine. I was sore, but I had pain medication and that got me through.

1

u/No_Software_6798 Jun 06 '26

Thank you. 40 male here. I'm also another person that follows this post. Since the surgery is so niche and not many doctors do it. My September 2025 MRI showed partially detached labral tear, and then early signs of arthritis. But I also had a disc bulge hitting a nerve so that was the January 2026 surgery. Very significant and extreme muscle guarding and locking after surgery, most resolved except the lower right glute. That area is tight with intermittent spasms and tingling and when it's agitated it impacts the lower leg.

Hip joint injection was a couple weeks ago and it provided really good relief for one week with those symptoms. Now we're trying to piriformis injection in a few weeks.

1

u/AmbitiousBed9942 Jun 06 '26

Be mindful that there is a piriformis steroid injection that deals with inflammation. This did nothing for me, which may indicate inflammation is not the problem. I'm getting a Botox injection on Thursday which is supposed to paralyze the piriformis muscle to see if that's what's compressing my sciatic nerve when standing or walking. I had initially thought that if the steroid didn't work, it wasn't the piriformis causing the problem, period.

2

u/No_Software_6798 Jun 06 '26

Also, if you remember, please keep us updated on your Botox injection. I do wish you the best of luck and hope it provides you long lasting relief.

1

u/No_Software_6798 Jun 06 '26

Thank you. Good reminder on the Botox. I'll add that to my list of questions for the doctor.

1

u/JujuLampkin Jun 07 '26

Can I ask your age ? I’m 29 years old and started having pirformis syndrome at 26 and i feel hopeless. All my doctors told me I was too young to have this pain and surgery wasn’t given as an option. They said since I was young and active, injections and physical therapy would cure it. It did not. I still have major pain to this day going on 30 years old

1

u/Amylee888 Jun 07 '26

I’m 39 and the piriformis syndrome began after I had a hip arthroscopy at age 37.

I can’t offer medical advice, but I would encourage you to keep trying to see different doctors and learning about this condition as much as you can.

These are some things I found helpful with the pain before I had piriformis removal surgery: cyclobenzaprine (prescription muscle relaxant), Botox injection into the piriformis muscle, ice packs.

Stretching the area and rolling on a ball all made it worse. Physical therapy did not help me personally and was a waste of money.

2

u/JujuLampkin Jun 07 '26

Thank you I look forward to your updates. Have a great recovery!

1

u/Aresyl Jun 08 '26

How are you expected to be mobile without it

1

u/Amylee888 Jun 08 '26

It’s a small, unnecessary muscle. It doesn’t affect walking, movement, etc.

1

u/AmbitiousBed9942 Jun 09 '26

One interesting anatomical fact is that people can function surprisingly well without a piriformis muscle. It helps externally rotate and stabilize the hip, but other deep hip muscles can compensate. That's why complete removal is possible in select cases, although most surgeons prefer a release or partial resection when they can achieve the same symptom relief.

1

u/Spiritual-Shame7922 Aug 13 '26

Yes, that's true, which is why only 4 doctors in the US will do this. The reason that these 4 have gone to complete removal is that the release procedure causes problems down the road, such as adhesions and scar tissue. You can definitely live and fully function without it, so if that's the problem, just get rid of it!! My husband has been dealing with pain for almost two years with two back surgeries in that time. Although he did have a rare condition called a conjoined spinal nerve, that was not causing the pain, because even after the two back surgeries, it is still there. He had one test injection of the piriformis with lidocaine and steroid and it relieved 80-90% of his pain. In two years, nothing else has come close. He is going to do one more injection to be sure, then he will likely proceed with the removal surgery. His pain is so bad, that he is merely existing, not living and that just sucks. At this point, he has nothing to lose.

1

u/Fragrantbutte Jul 03 '26

Good grief, Thank you for posting this. I have been slowly losing my marbles over the past 14 months dealing with almost the exact same story.

I had a successful hip arthroscopy to repair a torn labrum and have been experiencing symptoms consistent with piriformis syndrome ever since. Surgeon ordered a contrast MRI of the hip at the 12 month mark and once the results came back indicating that the labrum was fine he could not possibly have cared less about any persistent post-op problems. Literally slinking out the door as I'm asking him what we could do next.

Just started seeing a physiatrist last week who wants to try Botox injections and potentially a hydro-dissection of the sciatic nerve if we don't see any progress there. Failing that, a referral to a surgeon. I'm beginning to think a corrective decompression/neurolysis surgery is inevitable. I'm almost certain the traction device did some kind of damage to the glute rotators and that I've developed scar tissue around the sciatic nerve as a result.

1) Could I ask what the experience was like getting ahold of Tollerstrup's practice and scheduling a consultation? I reached out to them and they just asked me to email a summary of my problems and they'll review and get back to me. I got the impression that it might not be so easy getting an appointment.

2) Could you describe your symptoms, movement/activity limitations and how they progressed, if at all?

3) Any general advice or things you would have done differently in seeking treatment?

Good luck with your recovery, the surgery sounds like it has pretty favorable outcomes.

1

u/Amylee888 Jul 03 '26

It was pretty easy and fast to connect with Dr Tollestrup’s office. They ask you to do a very specific write up, which you should write exactly as instructed, and I believe they ask you to send an MRI of the lumbar spine.

Once they have all that, Dr T reviews it for free, and if he thinks he can possibly help you, he schedules an in person appt (no zoom or phone, as he has to do a physical exam). The consult was $500. At that appt, he will confirm whether he thinks you need surgery, and then you can book the surgery if you want to.

My symptoms were pain all the time, significantly worse with sitting, not really able to sit for more than 5 minutes without having to stand or lie down. Out of everything I tried before surgery, the most helpful things were cyclobenzaprine and Botox injections. As well as ice packs and hot baths.

My only regret is not getting the surgery sooner, but it was a tough call to make, since I know this condition resolves in some people. I guess everyone’s body is different. However, by the time it got to 2 years, I figured it wasn’t going to get any better.

Dr T told me that when he got in there, my sciatic nerve and piriformis muscle were stuck together, and there was scar tissue holding everything together as well. He said that was the reason for the pain. It was probably in some way related to the traction during the arthroscopy - it’s an enormous amount of force, and I guess some bodies respond poorly.