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

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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 &lt; 0.05).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Which level is responsible for gluteal pain in lumbar disc hernia?

“…Adelmanesh F [4, 6] reported that trigger points in the superior-lateral quadrant of the gluteal area are highly specific indicators for radicular LBP. Thiese MS [5] found that patients with LBP had pain in the gluteal areas. All of the studies reported an association between radicular LBP and gluteal pain.…”

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

“…After the first report of a series of patients whose LBP was ameliorated by SCN decompression at the orifice of the thoracolumbar fascia, 14 others [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] documented LBP due to SCN-E. However, the pathologic background of this type of LBP has not been extensively studied.…”

“…The range is from 0 to 24, with higher scores indicating more severe pain. On the NRS, the 6 patients whose LBP had been treated by neurectomy reported LBP alleviation by more than 75% after local nerve block …”

“…On the NRS, the 6 patients whose LBP had been treated by neurectomy reported LBP alleviation by more than 75% after local nerve block. 5,7,9,12 Statistical analysis was performed in Statmate III software (ATMS, Tokyo, Japan), with the paired t test. Preneurectomy and postneurectomy differences of P < 0.05 were considered statistically significant.…”

“…The etiology of low back pain (LBP) is heterogeneous and unknown in some patients with chronic pain. 1 Superior cluneal nerve entrapment (SCN-E) has been proposed as a causative factor [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] ; its reported incidence ranges from 1.6%-14%. 10,11 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.…”