Stephen J. Schueler, M.D.

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Pyriformis Syndrome Anatomy

To better understand piriformis syndrome, it helps to understand the anatomy of the lower back and pelvis.

The piriformis muscle is a flat, pyramid shaped muscle that is attached to the sacrum, passes through the pelvis, and inserts on the femur. The muscle follows the same course as the sciatic nerve through the pelvis.

The sciatic nerve starts in the lower back. It begins as nerve roots in the lumbar area of the spinal cord, which join together to form the large sciatic nerve.

Nerves of the low back:

The spine is an upright row of stacked bones, called the vertebral column. Individual bones of the spine are called vertebrae. The vertebral column starts under the skull and continues to the buttocks.

Bones of the spine:
  • Bones of the cervical, thoracic and lumbar spine
  • Lower spine

The front of each vertebra is a round, solid cylinder of bone. Between each pair of vertebrae, a disk attaches to the bottom of the vertebra above it, and to the top of the vertebrae below it. The discs act as rubber cushions between the vertebrae. In addition, strong ligaments and muscles hold the vertebral column together. All of these structures support, surround, and protect the spinal cord.

Anatomy of the vertebrae, disks and muscles:
  • The vertebral disks
  • View of disks and ligaments
  • Muscles of the back

Last Updated: Nov 4, 2008 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Pyriformis Syndrome References
  1. Benzon HT, Katz JA, Benzon HA, Iqbal MS. Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology. 2003 Jun;98(6):1442-8. [12766656]
  2. Fishman LM, Anderson C, Rosner B. BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil. 2002 Dec;81(12):936-42. [12447093]
  3. Lang AM. Botulinum toxin type B in piriformis syndrome. Am J Phys Med Rehabil. 2004 Mar;83(3):198-202. [15043354]
  4. Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin North Am. 2004 Jan;35(1):65-71. [15062719]
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