Superior cluneal neuralgia (SCN) can often be misdiagnosed when evaluating a patient with low back pain (LBP). The pathomechanics of SCN can range from direct injury following surgeries or trauma to myofascial compression due to abnormal muscle tone or fibrosis. The authors present a case of SCN in a 65-year-old male that persisted for three years following a laminectomy complicated by retained hardware and subsequent fibrosis. The patient’s diagnosis was confirmed with a diagnostic nerve block with significant pain relief after initial misdiagnosis and unsuccessful interventions targeting other possible pain generators. He ultimately underwent a successful peripheral nerve stimulation (PNS) trial and implantation with significant long-term pain relief. This case report entails the need to consider SCN in the differential for low back pain and the successful utilization of PNS for treatment.