Anatomical study of superior cluneal nerve entrapment

Kuniya, Hiroshi; Aota, Yoichi; Saito, T.; Kamiya, Yoshinori; Funakoshi, Kengo; Terayama, Hayato; Itoh, Masahiro

doi:10.3171/2013.4.spine12683

Cited by 57 publications

(54 citation statements)

References 16 publications

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“…These two studies were done by Lu et al on a Chinese cadaver population 3 and Kuniya et al on a Japanese cadaver population. The current study revealed similar measurements for the midline to SCN measurement when compared with the study done by Kuniya et al 10 Lu et al reported measurements of 10 mm more than both the current study and that conducted by Kuniya et al 10 When comparing the PSIS to SCN measurement, the current study found measurements similar to those found by Lu et al 3 However, Kuniya et al reported measurements almost 20 mm shorter 10 than those reported in the current study and by Lu et al The differences seen between males and females can be attributed to the high degree of sexual dimorphism of the bony pelvis. The male pelvis, when viewed from the posterior aspect, has more vertical and upright iliac crests when compared with the female pelvis that has flattened and more laterally projecting iliac crests.…”

Section: Discussionsupporting

confidence: 71%

Clinical anatomy of the superior cluneal nerve in relation to easily identifiable bony landmarks

Loubser

Raath

Schoor

2015

Southern African Journal of Anaesthesia and Analgesia

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Background: Lower back pain (LBP) remains a common ailment among adult populations and a superior cluneal nerve (SCN) entrapment accounts for 10% of reported LBP cases. The diagnostic criteria for SCN entrapment include anaesthesia of the area supplied by the SCN after performing a nerve block. Several surgical reports describe the anatomy of the SCN but purely anatomical studies of the course of the SCN are rare. This study aimed to describe the location of the SCN in relation to easily identifiable bony landmarks. Methods: The SCN was identified as it pierced the thoracolumbar fascia and crossed over the posterior part of the iliac crest on both sides of 27 adult cadavers. A sliding dial calliper was used to measure the distance from the posterior superior iliac spine (PSIS) to the SCN and from the midline lumbar spinous processes to the nerve. Results: The PSIS to SCN measurement was found to be 69.6 ± 15.0 mm (mean ± SD) while the midline to SCN measurement was 72.1 ± 10.2 mm. Discussion: This study showed clear gender differences in the PSIS to SCN measurement, due to the sexual dimorphism of the bony pelvis. There was also found to be a positive correlation between the height of the sample and the distances of the SCN from both the midline and PSIS. This study provides a clear anatomical description of the course of the SCN as it crosses the iliac crest, which will allow for the successful identification of the SCN.

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Section: Discussionsupporting

confidence: 71%

Clinical anatomy of the superior cluneal nerve in relation to easily identifiable bony landmarks

Loubser

Raath

Schoor

2015

Southern African Journal of Anaesthesia and Analgesia

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“…Anatomically, the SCN divides into 4–6 nerves before perforating the fascia. As each divided nerve perforates the fascia individually, 1 or more of these individual nerves without clear myelinated fiber changes may be compressed severely. Considering the clinical effectiveness of neurectomy in patients whose nerves lacked clear pathologic findings, local nerve decompression, obtained by dissection of the fascia or local surgery, should not be ruled out in patients with LBP.…”

Section: Discussionmentioning

confidence: 99%

“…Superior cluneal nerve entrapment (SCN‐E) has been proposed as a causative factor; its reported incidence ranges from 1.6%–14% . The SCN derives from the cutaneous branches of the dorsal rami at T11‐L4 and innervates the skin of the upper part of the buttocks . The nerves pass over the iliac crest through a tunnel formed by the thoracolumbar fascia and the superior rim of the iliac crest; the SCN may be compressed in this area.…”

mentioning

confidence: 99%

Low back pain due to superior cluneal nerve entrapment: A clinicopathologic study

Kim

Shimizu²,

Isu

et al. 2017

Muscle and Nerve

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“…9,11,13 In fact, 1.6%-12.0% 8,13 of LBP has been reported to be due to SCNEN. Surgical release at the point where the SCN exits through the osteofibrous orifice is effective.…”

Section: Discussionmentioning

confidence: 99%

Association between intermittent low-back pain and superior cluneal nerve entrapment neuropathy

Chiba

Isu

Kim

et al. 2016

SPI

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OBJECT Superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) is a cause of low-back pain (LBP) that can be misdiagnosed as a lumbar spine disorder. The clinical features and etiology of LBP remain poorly understood. In this study, 5 patients with intermittent LBP due to SCNEN who had previously received conservative treatment underwent surgery. The findings are reported and the etiology of LBP is discussed to determine whether it is attributable to SCNEN. METHODS Intermittent LBP is defined as a clinical condition in which pain is induced by standing or walking but is absent at rest. Between April 2012 and March 2013, 5 patients in this study who had intermittent LBP due to SCNEN underwent surgery. The patients included 3 men and 2 women, with a mean age of 66 years. The affected side was unilateral in 2 patients and bilateral in 3 (total sites, 8). The interval from symptom onset to treatment averaged 51.4 months; the mean postoperative follow-up period was 17.6 months. The clinical outcomes were assessed using the numerical rating scale (NRS) for LBP, the Japanese Orthopaedic Association (JOA) scale, and the Roland-Morris Disability Questionnaire (RDQ) preoperatively and at the last follow-up; these data were analyzed statistically. RESULTS None of the 5 patients reported LBP at rest. Intermittent LBP involving the iliac crest and buttocks was induced by standing or walking an average of 136 m. In 2 patients with unilateral involvement, LBP was improved only by SCN block. Surgeries were performed on 6 sites in 5 patients because the SCN block was only transiently effective. Patients’ SCNs penetrated the orifice of the thoracolumbar fascia. SCN kinking at the orifice was exacerbated at the lumbar-extension provocation posture, and radiating pain increased upon manual intraoperative compression of the SCN in this posture. After releasing the SCN surgically, disappearance of the pain was intraoperatively confirmed by manual compression of the SCN with the patients in the lumbar-extension posture. Surgery was effective in all 5 patients, and all clinical outcome scores indicated significant improvement (p < 0.05). CONCLUSIONS To the authors’ knowledge, this is the first report of patients with intermittent LBP due to SCNEN. Clinical and surgical evidence presented suggests that their LBP was exacerbated by lumbar extension and that symptom relief was obtained by SCN block or surgical release of the SCN entrapment. These results suggest that SCNEN should be considered as a causal factor in patients for whom walking elicits LBP.

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Anatomical study of superior cluneal nerve entrapment

Cited by 57 publications

References 16 publications

Clinical anatomy of the superior cluneal nerve in relation to easily identifiable bony landmarks

Clinical anatomy of the superior cluneal nerve in relation to easily identifiable bony landmarks

Low back pain due to superior cluneal nerve entrapment: A clinicopathologic study

Association between intermittent low-back pain and superior cluneal nerve entrapment neuropathy

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