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

Kim, Kyongsong; Shimizu, Jun; Isu, Toyohiko; Inoue, Kiyoharu; Chiba, Yasuhiro; Iwamoto, Naotaka; Morimoto, Daijiro; Isobe, Masanori; Morita, Akio

doi:10.1002/mus.26007

Cited by 14 publications

(6 citation statements)

References 25 publications

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“…The SCN originates from the lower thoracic and lumbar spinal nerves, passes through the thoracolumbar fascia, and can be entrapped at the penetrating orifice of the thoracolumbar fascia [4,14]. The anatomic and functional bases for the development of SCN-EN include a rigid fascial edge and stretching of the gluteus maximus muscle and skin over a large area during flexion of the hip joint [6,16,17]. Several reports have suggested that 1.6%–14.0% of all cases of LBP involve SCNEN [5,8,15].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Low Back Pain due to Superior Cluneal Nerve Entrapment Neuropathy

et al. 2019

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Study DesignRetrospective analysis.PurposeThe present study aimed to investigate the features of low back pain (LBP) due to superior cluneal nerve (SCN) entrapment neuropathy (SCN-EN) using the Roland Morris Disability Questionnaire (RMDQ), and to analyze the differences between LBP due to SCN-EN and lumbar spinal canal stenosis (LSS).Overview of LiteratureThe SCN is derived from the cutaneous branches of the dorsal rami of T11–L5 and passes through the thoracolumbar fascia. LBP due to SCN-EN is exacerbated by various types of lumbar movement, and its features remain to be fully elucidated, often resulting in the misdiagnosis of lumbar spine disorder.MethodsThe present study included 35 consecutive patients with SCN-EN treated via nerve blocks or surgical release between April 2016 and August 2017 (SCN-EN group; 16 men, 19 women; mean age, 65.5±17.0 years; age range, 19–89 years). During the same period, 33 patients were surgically treated with LSS (LSS group; 19 men, 14 women; mean age, 65.3±12.0 years; age range, 35–84 years). The characteristics of LBP were then compared between patients with SCN-EN and those with LSS using the RMDQ.ResultsThe duration of disease was significantly longer in the SCN-EN group than in the LSS group (26.0 vs. 16.0 months, p =0.012). Median RMDQ scores were significantly higher in the SCN-EN group (13 points; interquartile range, 8–15 points) than in the LSS group (7 points; interquartile range, 4–9 points; p <0.001). For seven items (question number 1, 8, 11, and 20–23), the ratio of positive responses was higher in the SCN-EN group than in the LSS group.ConclusionsPatients with SCN-EN exhibit significantly higher RMDQ scores and greater levels of disability due to LBP than patients with LSS. The findings further demonstrate that SCN-EN may affect physical and psychological function.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Low Back Pain due to Superior Cluneal Nerve Entrapment Neuropathy

et al. 2019

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“…Elsewhere, we reported that superior/middle cluneal nerve entrapment around the iliac crest can elicit LBP; the symptoms are similar to LBP due to coexisting lumbar disease [22,23] whose clinical and pathological features are those of peripheral nerve neuropathy [23]. Neuropathic pain from these diseases may be alleviated by mirogabalin.…”

Section: Effects Of Mirogabalin On Low Back Painmentioning

confidence: 96%

Therapeutic Effect of Mirogabalin on Peripheral Neuropathic Pain due to Lumbar Spine Disease

et al. 2021

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This study aims to evaluate the effectiveness of mirogabalin in treatment of peripheral neuropathic pain due to lumbar spine disease. Overview of Literature: Mirogabalin is a novel selective ligand for the α2δ subunit of voltage-gated Ca channels. Methods: Between April and December 2019, we used mirogabalin to treat 60 consecutive patients (mean age, 67.6 years) with leg symptoms due to lumbar disease. The treatment outcome after 8 weeks of mirogabalin therapy was evaluated by comparing the preand post-administration Numerical Rating Scale (NRS) for leg symptoms and sleep disturbance, the NRS and Roland-Morris Disability Questionnaire for low back pain (LBP), and the quality of life (QOL) score (based on EuroQol five-dimension five-level scale). Results: Mirogabalin treatment was stopped at less than eight weeks in eight patients. The remaining 52 patients for evaluation were divided as group 1 (17 patients who presented with leg symptoms that lasted for less than 3 months) and group 2 (35 patients with leg symptoms that lasted longer than 3 months). The leg symptoms and LBP in both groups significantly improved at 4 and 8 weeks of treatment, and sleep disturbance and QOL were improved at 8 weeks as well. Compared to group 2, the pretreatment leg symptoms and QOL were significantly worse in group 1, and their improvement after 8 weeks of mirogabalin treatment was significantly better (p<0.05). Of the 60 original patients, 17 suffered adverse effects, which were mild in 16 patients and required treatment cessation due to excessive weight gain in one patient. Conclusions: We have validated the effect of mirogabalin on neuropathic pain due to lumbar spine disease, which has effectively addressed the associated leg symptoms, LBP, and sleep disturbance.

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“…7 Though histopathologic evidence on CN is lacking, one pathological study on 2 patients s/p SCN-neurectomy revealed thickened perineurium, subperineurial edema, Renaut bodies, and nerve enlargement related to an increase in thinly myelinated fibers, which paralleled findings in other studies as well. [8][9][10][11][12][13] This sheds some light on the microanatomical considerations on cluneal neuralgia, but more literature exists on SCN-e and MCN-e on a macroscopic level. In the following paragraphs, we investigate the anatomy of the SCN and its described pathophysiologies, followed by that of the MCN, and conclude with a brief investigation of risk factors and possible associations relating to, and causing, cluneal neuralgia.…”

Section: Pathophysiology/risk Factorsmentioning

confidence: 99%

A Comprehensive Review of Cluneal Neuralgia as a Cause of Lower Back Pain

et al. 2022

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Lower back pain (LBP) is one of the most common presenting complaints in clinical adult medical patients. While most often diagnosed as “nonspecific mechanical” in etiology, several lesser known, rarer causes of LBP exist, some of which can even cause neuropathic pain. One of these infrequent causes, cluneal neuralgia (CN), is associated most often with damage or entrapment of the cluneal nerves, particularly the superior cluneal nerve (SCN) and/or the middle cluneal nerve (MCN). These nerves supply sensation to the posterior lumbar and buttock area. However, the LBP caused by CN is often difficult to recognize because it can mimic radiculopathy or sacroiliac joint (SIJ) pain or lead to symptoms in the legs. This makes CN significantly important for clinicians and surgeons to include in their differential. A thorough history proves beneficial in the diagnostic workup, as many risk factors for CN have been reported in the literature. If a CN diagnosis is made, several effective conservative measures can alleviate patients’ pain, such as nerve blocks, peripheral nerve stimulation, or high frequency thermal coagulation. Additionally, surgical treatments, such as CN release or endoscopic decompression, have resulted in fantastic patient outcomes. The purpose of the present investigation is to investigate the existing literature about CN as a cause for LBP, consider its epidemiology, discuss its pathophysiology and risk factors, elucidate its clinical presentation and diagnosis, and examine the various treatment modalities that have been reported across the world.

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

Abstract: The pathologic findings and effectiveness of neurectomy suggest that, in our patients, SCN neuropathy likely elicited LBP via nerve compression. Muscle Nerve 57: 777-783, 2018.

Cited by 14 publications

References 25 publications

Characteristics of Low Back Pain due to Superior Cluneal Nerve Entrapment Neuropathy

Characteristics of Low Back Pain due to Superior Cluneal Nerve Entrapment Neuropathy

Therapeutic Effect of Mirogabalin on Peripheral Neuropathic Pain due to Lumbar Spine Disease

A Comprehensive Review of Cluneal Neuralgia as a Cause of Lower Back Pain

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