Ask the Experts — Pain in the Butt: Buttocks Pain from the Spine and its Masqueraders - Podcast 15

In episode 15, our experts covered your questions on:

• What are the spinal and non-spinal causes of buttocks pain?
• How do we evaluate and treat piriformis syndrome? Is it real?
• What is cluneal neuropathy?
• How valid are landmark or image-guided analgesic/diagnostic injections to identify pain sources?
• What history and exam results are important to differentiate spine-originating pain from other sources?
• Why is the diagnostic and therapeutic procedure for treating sacroiliac pain the “easiest hard” injection?
• How do you evaluate and treat trochanteric bursitis/gluteal tendinitis, ischial bursitis/proximal hamstring tendinopathy?
• When should we use ultrasound vs fluoroscopic guidance for intra-articular sacroiliac joint injections, lateral branch blocks, and/or radiofrequency ablation?
• When should peripheral stimulators be considered?

Your expert panel for this August 20, 2025 webinar included:

• Allen S. Chen, MD, MBA, MPH, Chief of Interventional Spine in the Department of Orthopedics at UCLA, who serves as Vice-Chair of the IPSIS Education Division, Co-Chair of the CME Committee, and as a member of the Education Development Committee; and
• Lisa Huynh, MD, Clinical Associate Professor in the Department of Orthopaedics, Physical Medicine and Rehabilitation Division at Stanford University, who serves on the IPSIS Board as a Member-at-Large, as well as on the Education Division, Conflict of Interest Committee, and Annual Meeting Program Committee.

The panel was moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who serves on the IPSIS Board as a Member-at-Large, as well as on the IPSIS Education Division, and as Co-Chair of the Education Development Committee. 

Besides this podcast, a video download is also available here.

Episode 15 Show Notes: These are the abstracts referenced by our experts.  

Cluneal Nerve:

• Nicolas M. Mas D Alessandro, Faria Nisar, Hesham Elsharkawy. Peripheral superior cluneal nerve stimulation for intractable low back pain: Combined fluoroscopy and ultrasound technique, A case series. Interventional Pain Medicine. Volume 4, Issue 1, 2025,100542,ISSN 2772-5944

Piriformis:

• Hicks BL, Lam JC, Varacallo MA. Piriformis Syndrome.
• Cassidy L, Walters A, Bubb K, Shoja MM, Tubbs RS, Loukas M. Piriformis syndrome: implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat. 2012 Aug;34(6):479-86.
• Smoll NR. Variations of the piriformis and sciatic nerve with clinical consequence: a review. Clin Anat. 2010 Jan;23(1):8-17.
• Ro TH, Edmonds L. Diagnosis and Management of Piriformis Syndrome: A Rare Anatomic Variant Analyzed by Magnetic Resonance Imaging. J Clin Imaging Sci. 2018;8:6.
• Cass SP. Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep. 2015 Jan;14(1):41-4.
• Kay J, de Sa D, Morrison L, Fejtek E, Simunovic N, Martin HD, Ayeni OR. Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review. Arthroscopy. 2017 Dec;33(12):2263-2278.e1
• PARSONS,F. G., AND SIR A. KEITH 1896-1897 Sixth Annual Report of the Committee of Collective Investigation of the Anatomical Society of Great Britain and Ireland. J. Anat. and Physiol., vol. 31,pp. 31-44, 1896
• Draghici NC, Bolchis R, Popa LL, Vacaraș V, Iluț S, Bashimov A, Domnița DM, Dragos HM, Vlad I, Mureșanu DF. Rare entrapment neuropathies of the lower extremity: A narrative review. Medicine (Baltimore). 2024 Aug 30;103(35):e39486.
• Beaton, L.E. and Anson, B.J. (1937), The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat. Rec., 70: 1-5.
• Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, Weber C. Piriformis syndrome: diagnosis, treatment, and outcome--a 10-year study. Arch Phys Med Rehabil. 2002 Mar;83(3):295-301. doi: 10.1053/apmr.2002.30622. PMID: 11887107.
• Jawish RM, Assoum HA, Khamis CF. Anatomical, clinical and electrical observations in piriformis syndrome. J Orthop Surg Res. 2010 Jan 21;5:3.
• Misirlioglu TO, Akgun K, Palamar D, Erden MG, Erbilir T. Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study. Pain Physician. 2015;18(2):163-171

SIJ Maneuvers:

• Schneider BJ, Ehsanian R, Rosati R, Huynh L, Levin J, Kennedy DJ. Validity of Physical Exam Maneuvers in the Diagnosis of Sacroiliac Joint Pathology. Pain Med. 2020 Feb 1;21(2):255-260. doi: 10.1093/pm/pnz183. Erratum in: Pain Med. 2020 May 1;21(5):1089. doi: 10.1093/pm/pnaa010. PMID: 31393577.

US vs Fluoro:

• Jee H, Lee JH, Park KD, Ahn J, Park Y. Ultrasound-guided versus fluoroscopy-guided sacroiliac joint intra-articular injections in the noninflammatory sacroiliac joint dysfunction: a prospective, randomized, single-blinded study. Arch Phys Med Rehabil. 2014 Feb;95(2):330-7. doi: 10.1016/j.apmr.2013.09.021. Epub 2013 Oct 9. PMID: 24121083.
• Perry JM, Colberg RE, Dault SL, Beason DP, Tresgallo RA.A Cadaveric Study Assessing the Accuracy of Ultrasound-Guided Sacroiliac Joint Injections. PM R. 2016 12;8(12):1168-1172.
• De Luigi AJ, Saini V, Mathur R, Saini A, Yokel N. Assessing the Accuracy of Ultrasound-Guided Needle Placement in Sacroiliac Joint Injections. Am J Phys Med Rehabil. 2019 Aug;98(8):666-670. doi: 10.1097/PHM.0000000000001167. PMID: 31318746.

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