For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
13
views
34
references
 Top references
cited by
23
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      264
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

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

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          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.

          Related collections

          Most cited references34

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Prospective study of superior cluneal nerve disorder as a potential cause of low back pain and leg symptoms

          Hiroshi Kuniya, Yoichi Aota, Takuya Kawai … (2014)
          Background Entrapment of the superior cluneal nerve (SCN) in an osteofibrous tunnel has been reported as a cause of low back pain (LBP). However, there are few reports on the prevalence of SCN disorder and there are several reports only on favorable outcomes of treatment of SCN disorder on LBP. The purposes of this prospective study were to investigate the prevalence of SCN disorder and to characterize clinical manifestations of this clinical entity. Methods A total of 834 patients suffering from LBP and/or leg symptoms were enrolled in this study. Diagnostic criteria for suspected SCN disorder were that the maximally tender point was on the posterior iliac crest 70 mm from the midline and that palpation of the tender point reproduced the chief complaint. When patients met both criteria, a nerve block injection was performed. At the initial evaluation, LBP and leg symptoms were assessed by visual analog scale (VAS) score. At 15 min and 1 week after the injection, VAS pain levels were recorded. If insufficient pain decrease or recurrence of pain was observed, injections were repeated weekly up to three times. Surgery was done under microscopy. Operative findings of the SCN and outcomes were recorded. Results Of the 834 patients, 113 (14%) met the criteria and were given nerve block injections. Of these, 54 (49%) had leg symptoms. Before injection, the mean VAS score was 68.6 ± 19.2 mm. At 1 week after injection, the mean VAS score significantly decreased to 45.2 ± 28.8 mm (p < 0.05). Ninety-six of the 113 patients (85%) experienced more than a 20 mm decrease of the VAS score following three injections and 77 patients (68%) experienced more than a 50% decrease in the VAS score. Surgery was performed in 19 patients who had intractable symptoms. Complete and almost complete relief of leg symptoms were obtained in five of these surgical patients. Conclusions SCN disorder is not a rare clinical entity and should be considered as a cause of chronic LBP or leg pain. Approximately 50% of SCN disorder patients had leg symptoms. Electronic supplementary material The online version of this article (doi:10.1186/s13018-014-0139-7) contains supplementary material, which is available to authorized users.
          Article 0 comments Cited 27 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Anatomy and landmarks for the superior and middle cluneal nerves: application to posterior iliac crest harvest and entrapment syndromes.

            R. Tubbs, Matthew R Levin, Marios Loukas … (2010)
            To date, only scant descriptions of the cluneal nerves are available. As these nerves, and especially the superior group, may be encountered and injured during posterior iliac crest harvest for spinal arthrodesis procedures, the present study was performed to better elucidate their anatomy and to provide anatomical landmarks for their localization. The superior and middle cluneal nerves were dissected from their origin to termination in 20 cadaveric sides. The distance between the posterior superior iliac spine (PSIS) and superior cluneal nerves at the iliac crest and the distance between this bony prominence and the origin of the middle cluneals were measured. The specific course of each nerve was documented, and the diameter and length of all cluneal nerves were measured. Superior and middle cluneal nerves were found on all sides. An intermediate superior cluneal nerve and lateral superior cluneal nerve were not identified on 4 and 5 sides, respectively. The superior cluneal nerves always passed through the psoas major and paraspinal muscles and traveled posterior to the quadratus lumborum. The mean diameters of the superior and middle cluneal nerves were 1.1 and 0.8 mm, respectively. From the PSIS, the superior cluneal branches passed at means of 5, 6.5, and 7.3 cm laterally on the iliac crest. At their origin, the middle cluneal nerves had mean distances of 2 cm superior to the PSIS, 0 cm from the PSIS, and 1.5 cm inferior to the PSIS. In their course, the middle cluneal nerves traversed the paraspinal muscles attaching onto the dorsal sacrum. Knowledge of the cutaneous nerves that cross the posterior aspect of the iliac crest may assist in avoiding their injury during bone harvest. Additionally, an understanding of the anatomical pathway that these nerves take may be useful in decompressive procedures for entrapment syndromes involving the cluneal nerves.
            Article 0 comments Cited 18 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Anatomic considerations of superior cluneal nerve at posterior iliac crest region.

              Kristin M Huntoon, S Heck, R A Yeasting … (1998)
              No previous studies describe the anatomic relationship of the superior cluneal nerve to the posterior iliac crest and thoracolumbar fascia. In the current study, 15 cadavers were dissected to determine the relationship of the superior cluneal nerve to the posterior iliac crest and thoracolumbar fascia. The distances from the medial branch of the superior cluneal nerve to the posterior superior iliac crest and the midline were 64.7 +/- 5.3 mm and 81.0 +/- 9.2 mm, respectively. The distances between the level of the iliac crest and perforating points of the superior cluneal nerve on the thoracolumbar fascia were 5.8 +/- 1.8 mm inferiorly for the medial branch, 2.2 +/- 1.8 mm superiorly for the intermediate branch, and 12.0 +/- 4.4 mm superiorly for the lateral branch, respectively. The proximal dissection above the perforating point of the nerve showed that the medial branch of the superior cluneal nerve is confined within a tunnel consisting of the thoracolumbar fascia and the superior rim of the iliac crest as it passes over the iliac crest. The intermediate and lateral branches of the superior cluneal nerve either pierce the thoracolumbar fascia or pass through an orifice or fissure in the thoracolumbar fascia. In two specimens, the medial branches of the superior cluneal nerve were constricted within the osteofibrous tunnel. The nerve was entrapped between the rigid fibers of the thoracolumbar fascia and the iliac crest.
              Article 0 comments Cited 17 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Neurospine
                Journal ID (iso-abbrev): Neurospine
                Journal ID (publisher-id): NS
                Title: Neurospine
                Publisher: Korean Spinal Neurosurgery Society
                ISSN (Print): 2586-6583
                ISSN (Electronic): 2586-6591
                Publication date (Print): March 2018
                Publication date (Electronic): 28 March 2018
                Volume: 15
                Issue: 1
                Pages: 25-32
                Affiliations
                [1 ]Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Japan
                [2 ]Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Japan
                [3 ]Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
                [4 ]Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan
                Author notes
                Corresponding Author Toyohiko Isu https://orcid.org/0000-0001-5298-1806 Department of Neurosurgery, Kushiro Rosai Hospital, 13-23, Nakazono-cho, Kushiro-city, Hokkaido, Japan Tel: +81-154-22-7191 Fax: +81-154-25-7308 E-mail: tqa00131@ 123456nifty.com
                Author information
                http://orcid.org/0000-0001-5298-1806
                Article
                Publisher ID: ns-1836024-012
                DOI: 10.14245/ns.1836024.012
                PMC ID: 5944640
                PubMed ID: 29656623
                SO-VID: 87d94443-e9f8-432a-9ead-db770f76c604
                Copyright © Copyright © 2018 by the Korean Spinal Neurosurgery Society
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 February 2018
                Date revision received : 16 March 2018
                Date accepted : 18 March 2018
                Categories
                Subject: Review Article

                Keywords: superior cluneal nerve,middle cluneal nerve,entrapment,low back pain,neurolysis,clinical review
                Data availability:
                Keywords: superior cluneal nerve, middle cluneal nerve, entrapment, low back pain, neurolysis, clinical review

                Comments

                Comment on this article

                scite_

                Similar content264

                See all similar

                Cited by23

                See all cited by

                Most referenced authors170

                See all reference authors