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As a minimal invasive alternative to open disc surgery percutaneous nucleotomy has remarkably development for the treatment of contained lumbar herniation. In our experience since 1979, today available percutaneous concepts have to be clearly individualized in their range of indication following their specific technical limits. So a direct correlation of operative results remain restricted on overlapping ranges of indications. Progress in the technical field, in correlation with discoscopy, introduced since 1982, brought percutaneous interbody fusion in 1988, alloplastic percutaneous implants are in development. This facts let us foresee a remarkable evolution of percutaneous spine surgery comparable to arthroscopic knee surgery in the near future.

The case we present here is that of a fifty-year-old male patient who first came to the Orthopedic Hospital for out-patient treatment suffering from symptoms of lumboischialgia. Shortly afterwards, he developed symptoms characteristic of paraplegia. It was only 21 days after the initial symptoms had manifest themselves that the tentative previous diagnosis, suspected "spinal infarct", could be confirmed by magnetic resonance tomography (MRT). Possibilities offered by differential diagnosis are discussed; the discussion is followed by an enumeration of this highly heterogeneous group of illnesses.

Die vorliegende Arbeit liefert einen Uberblick und eine kritische Analyse der Literatur zum Piriformissyndrom (PS). Das PS gilt mehrheitlich als Engpasssyndrom des N. ischiadicus im Foramen infrapiriforme, verursacht durch pathologische Veranderungen des M. piriformis. Die Diagnosenstellung erfolgt primar klinisch. Das am haufigsten beschriebene Symptom ist Gesasschmerz, gefolgt von Schmerzen in der Oberschenkelruckseite und bei Palpation der tiefen Gesasmuskeln. Fur die eigens zur Diagnostik des PS entwickelten Tests gibt es keine kritische Evaluation. An der Schmerzentstehung konnten weitere Muskeln im dorsalen Becken wie der M. obturatorius internus beteiligt sein. Die nach Sacketts 52 Evidenzpyramide bewertete Qualitat der Studien ist grostenteils gering. This article presents an overview and a critical analysis of the literature concerning the piriformis syndrome (PS). PS is generally considered as an entrapment syndrome of the sciatic nerve in the infrapiriform foramen caused by pathologic alterations of the piriform muscle. Diagnosis is mainly carried out clinically. The most frequently described symptom is buttock pain followed by pain in the posterior thigh and on palpation of the deep gluteal muscles. There exists no critical evaluation of the tests specifically developed for the diagnosis of PS. Other muscles such as the obturatorius internus muscle could possibly also be involved in the development of pain. The studies were assessed by Sackett’s 52 evidence pyramid and were mostly found to be of low quality.

Es wird uber gute Erfolge der Behandlung der Ischialgien mit der Periduralanasthesie berichtet, wobei insbesondere auf die Verkurzung der Behandlungszeit bei sofortiger Anwendung dieser Methode hingewiesen wird. Weiterhin wird dargestellt, wie sich die elektrodermatometrischen Kurven unter der Behandlung verandern, die Hohendiagnose prazisieren und den Heilerfolg objektiv anzeigen.