Comparative Presence of Piriformis Syndrome in Patients With Lumbar Disc Bulging and Protrusion

INTRODUCTION: In patients presenting with complaints of sciatica, the first anticipated diagnosis is lumbar disc pathology. It is often overlooked that Piriformis Syndrome (PS) may accompany these patients and may even be the main cause of sciatica. This study aims to make a comparison between patients with lumbar disc bulging and protrusion in terms of the possible presence of accompanying PS.
METHODS: A total of 76 patients with sciatica (38 bulging and 38 protrusion) were included in the study. Patients' bulging and protrusion diagnoses were distinguished based on Lumbar Magnetic Resonance Imaging. All patients were evaluated in the outpatient clinic by applying the Lasegue test for disc pathology, Fair and Freiberg tests and tender point positivity for PS.
RESULTS: The bulging and protrusion groups were statistically similar in age, gender, BMI, right/left pain, pain duration. Protrusion group had higher scores in terms of pain level and rate of Laseque test positivity. On the other hand, bulging group had higher positivity rates in the Fair test, Freiberg test, total tender points, and trochanteric tender points.
DISCUSSION AND CONCLUSION: Patients with lumbar disc herniation and sciatica may also have PS. The diagnosis of PS should not be missed in these patients, especially in those with lumbar disc bulging.

Keywords: Piriformis Syndrome, Lumbar Disc Herniation, Sciatica, Bulging, Protrusion