Ultrasound-guided Perineural Dextrose Injection for Treatment of Superior Cluneal Nerve Entrapment: Serial Case Report

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Abstract

Background:

Superior cluneal nerve entrapment is a neuropathic condition caused by the inclusion of the superior cluneal nerve that contributes to one of the causes of lower back pain leading to high morbidity. Several therapeutic modalities

are available for superior cluneal nerve entrapment, including medications, physiotherapy, perineural injection, and surgery. Perineural injection with 5% dextrose has become therapeutic alternative in many cases of neuropathy, but its long-term effectiveness is unknown.

Case Presentation:

This study described four patients with superior cluneal nerve entrapment with severe pain intensity treated with ultrasonography guided perineural 5% dextrose injection, resulting in significant clinical improvement during the 6-month evaluation.

Conclusion:

Perineural injection can be considered as long-term therapy in patients with superior cluneal nerve entrapment who have failed other conventional therapies.

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Most cited references 31

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Jeremy C. T. Fairbank, Paul B Pynsent (2000)

The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. This review is based on publications using the ODI identified from the authors' personal databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders. To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure. It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders. All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version. Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations. The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.

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Neuronal and vascular interactions.

Benjamin J Andreone, Baptiste Lacoste, Chenghua Gu (2015)

The brain, which represents 2% of body mass but consumes 20% of body energy at rest, has a limited capacity to store energy and is therefore highly dependent on oxygen and glucose supply from the blood stream. Normal functioning of neural circuits thus relies on adequate matching between metabolic needs and blood supply. Moreover, not only does the brain need to be densely vascularized, it also requires a tightly controlled environment free of toxins and pathogens to provide the proper chemical composition for synaptic transmission and neuronal function. In this review, we focus on three major factors that ensure optimal brain perfusion and function: the patterning of vascular networks to efficiently deliver blood and nutrients, the function of the blood-brain barrier to maintain brain homeostasis, and the regulation of cerebral blood flow to adequately couple energy supply to neural function.