Superior and Middle Cluneal Nerve Entrapment as a Cause of Low Back Pain

다국어 초록 (Multilingual Abstract)

Low back pain (LBP) is encountered frequently in clinical practice. The superior and the middle cluneal nerves (SCN and MCN) are cutaneous nerves that are purely sensory. They dominate sensation in the lumbar area and the buttocks, and their entrapment around the iliac crest can elicit LBP. The reported incidence of SCN entrapment (SCN-E) in patients with LBP is 1.6%–14%. SCN-E and MCN entrapment (MCN-E) produce leg symptoms in 47%–84% and 82% of LBP patients, respectively. In such patients, pain is exacerbated by lumbar movements, and the symptoms mimic radiculopathy due to lumbar disorder. As patients with failed back surgery or Parkinson disease also report LBP, the differential diagnosis must include those possibilities. The identification of the trigger point at the entrapment site and the disappearance of symptoms after nerve block are diagnostically important. LBP due to SCN-E or MCN-E can be treated less invasively by nerve block and neurolysis. Spinal surgeons treating patients with LBP should consider SCN-E or MCN-E.

참고문헌 (Reference)

1 Kim K, "Update of peripheral nerve disease treatment" 2018

2 Tomohiro Yamauchi, "Undiagnosed Peripheral Nerve Disease in Patients with Failed Lumbar Disc Surgery" 대한척추외과학회 12 (12): 720-725, 2018

3 Maigne JY, "Trigger point of the posterior iliac crest: painful iliolumbar ligament insertion or cutaneous dorsal ramus pain? An anatomic study" 72 : 734-737, 1991

4 Kim K, "Treatment of low back pain in patients with vertebral compression fractures and superior cluneal nerve entrapment neuropathies" 6 (6): S619-S621, 2015

5 Iwamoto N, "Treatment of low back pain elicited by superior cluneal nerve entrapment neuropathy after lumbar fusion surgery" 1 : 152-157, 2017

6 Kim K, "The usefulness of ICG video angiography in the surgical treatment of superior cluneal nerve entrapment neuropathy: technical note" 19 : 624-628, 2013

7 Maigne JY, "The lateral cutaneous branches of the dorsal rami of the thoraco-lumbar junction. An anatomical study on 37 dissections" 11 : 289-293, 1989

8 Strong EK, "The cluneal nerve syndrome; a distinct type of low back pain" 26 : 417-429, 1957

9 Morimoto D, "Surgical treatment of superior cluneal nerve entrapment neuropathy" 19 : 71-75, 2013

10 Matsumoto J, "Surgical treatment of middle cluneal nerve entrapment neuropathy - technical note-" 2018

11 Takayama T, "Superior cluneal syndrome as a cause of low back pain" 23 : 885-900, 1961

12 Kokubo R, "Superior cluneal nerve entrapment neuropathy and gluteus medius muscle pain: their effect on very old patients with low back pain" 98 : 132-139, 2017

13 Akbas M, "Superior cluneal nerve entrapment eight years after decubitus surgery" 5 : 364-366, 2005

14 Talu GK, "Superior cluneal nerve entrapment" 25 : 648-650, 2000

15 Kuniya H, "Prospective study of superior cluneal nerve disorder as a potential cause of low back pain and leg symptoms" 9 : 139-, 2014

16 Aly TA, "Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases" 197 : 229-231, 2002

17 Ermis MN, "Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors" 24 : 137-144, 2011

18 Kim K, "Low back pain due to superior cluneal nerve entrapment - Clinicopathological study" 2018

19 Kim K, "Low back pain due to middle cluneal nerve entrapment neuropathy" 2017

20 Iwamoto N, "Low back pain caused by superior cluneal nerve entrapment neuropathy in patients with Parkinson disease" 87 : 250-254, 2016

21 Deyo RA, "Low back pain" 344 : 363-370, 2001

22 Morimoto D, "Long-term outcome of surgical treatment for superior cluneal nerve entrapment neuropathy" 42 : 783-788, 2017

23 McGrath MC, "Lateral branches of dorsal sacral nerve plexus and the long posterior sacroiliac ligament" 27 : 327-330, 2005

24 Matsumoto J, "Impact of additional treatment of paralumbar spine and peripheral nerve diseases after lumbar spine surgery" 2018

25 Speed S, "Entrapment of the medial branch of the superior cluneal nerve - a previously unrecognized cause of low back pain in cricket fast bowlers" 2 : 101-103, 2011

26 Aota Y, "Entrapment of middle cluneal nerves as an unknown cause of low back pain" 7 : 167-170, 2016

27 Maigne JY, "Entrapment neuropathy of the medial superior cluneal nerve. Nineteen cases surgically treated, with a minimum of 2 years' follow-up" 22 : 1156-1159, 1997

28 Trescot AM, "Cryoanalgesia in interventional pain management" 6 : 345-360, 2003

29 Kim K, "Common diseases mimicking lumbar disc herniation and their treatment" 1 : 43-51, 2017

30 Chiba Y, "Association between intermittent low-back pain and superior cluneal nerve entrapment neuropathy" 1-5, 2015

31 Tubbs RS, "Anatomy and landmarks for the superior and middle cluneal nerves: application to posterior iliac crest harvest and entrapment syndromes" 13 : 356-359, 2010

32 Kuniya H, "Anatomical study of superior cluneal nerve entrapment" 19 : 76-80, 2013

33 Konno T, "Anatomical study of middle cluneal nerve entrapment" 10 : 1431-1435, 2017

34 Konno T, "Anatomical etiology of "pseudo-sciatica" from superior cluneal nerve entrapment: a laboratory investigation" 10 : 2539-2545, 2017

35 Lu J, "Anatomic considerations of superior cluneal nerve at posterior iliac crest region" 347 : 224-228, 1998

36 Berthelot JM, "A potentially underrecognized and treatable cause of chronic back pain: entrapment neuropathy of the cluneal nerves" 23 : 2179-2181, 1996