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Piriformis Syndrome in a Patient After Cesarean Section Under Spinal Anesthesia
  1. Manuel C Vallejo, M.D.,
  2. Dean J Mariano, D.O.,
  3. Bupesh Kaul, M.D.,
  4. Neera Sah, M.D. and
  5. Sivam Ramanathan, M.D.
  1. From the Department of Anesthesiology (M.C.V., B.K., N.S., S.R.), Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
  2. Department of Pain Medicine (D.J.M.), Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
  1. Reprint requests: Manuel C. Vallejo, M.D., Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213 USA. E-mail: vallejomc{at}


Objectives The diagnosis, pathogenesis, and treatment of piriformis syndrome as a cause of persistent buttock and hip pain after spinal anesthesia are presented in this case report.

Case Report A 29-year-old woman presented 5 days after cesarean delivery with sudden onset of pain in the left buttock and left hip radiating to the posterior knee with fever. She was subsequently diagnosed with piriformis syndrome.

Conclusions Back pain with radiation into the buttocks after spinal anesthesia is frequently attributed to the spinal procedure itself. However, prolonged sitting and weight bearing in the upright position after cesarean delivery can cause sciatic nerve compression at the sacroiliac joint with concomitant irritation, inflammation, and spasm of the piriformis muscle. Piriformis syndrome is frequently underdiagnosed in the obstetric population. Because the diagnosis of piriformis syndrome is based mainly on clinical signs and symptoms, the clinician must have a high index of suspicion.

  • Piriformis syndrome
  • Sacroiliitis
  • Spinal anesthesia
  • Cesarean delivery

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