Alcohol Neurolysis for Persistent Pain Caused by Superior Cluneal Nerves Injury After Iliac Crest Bone Graft Harvesting in Orthopedic Surgery

Mahlı, Ahmet; Coşkun, Demet; Altun, Necdet; Simsek, Aykln; Ocal, Esra; Kostekci, Metin

doi:10.1097/00007632-200211150-00018

Cited by 27 publications

(14 citation statements)

References 23 publications

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“…1 An extensive literature search revealed relatively few reports describing SCN entrapment and therapy. [1][2][3][4][5][6] Common entrapment neuropathies include intercostal, median (carpal tunnel), lateral femoral cutaneous, and ulnar and peroneal nerves. 7 Lu et al 8 initially described the anatomic relationship of the SCN to the posterior iliac crest and thoracolumbar fascia.…”

Section: Discussionmentioning

confidence: 99%

Superior Cluneal Nerve Entrapment Eight Years after Decubitus Surgery

2005

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Section: Discussionmentioning

confidence: 99%

Superior Cluneal Nerve Entrapment Eight Years after Decubitus Surgery

2005

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“…Le sedi di prelievo più tradizionali sono l'ala iliaca del bacino e dalla tibia. Le limitazioni sono date dalla quantità prelevabile e dalle comorbidità in sede di prelievo, che ne riducono l'impiego clinico [4,5]. Questo ha stimolato la ricerca di sostituti ossei biocompatibili alternativi, di origine omologa (donatore cadavere), eterologa (animale) o sintetica, che possano comunque garantire i benefici dell'innesto autologo evitando, al contempo, i rischi ad esso connessi [4][5][6].…”

Section: Introduzioneunclassified

“…Le limitazioni sono date dalla quantità prelevabile e dalle comorbidità in sede di prelievo, che ne riducono l'impiego clinico [4,5]. Questo ha stimolato la ricerca di sostituti ossei biocompatibili alternativi, di origine omologa (donatore cadavere), eterologa (animale) o sintetica, che possano comunque garantire i benefici dell'innesto autologo evitando, al contempo, i rischi ad esso connessi [4][5][6]. A loro volta, questi materiali presentano vantaggi e svantaggi, variano per composizione, resistenza meccanica, proprietà osteoinduttive e osteoconduttive, meccanismo d'azione, modalità di riassorbimento, osteointegrazione e rimodellamento finale [7].…”

Section: Introduzioneunclassified

Utilizzo di un nanocomposto costituito da Mg-idrossiapatite e matrice ossea demineralizzata nelle osteotomie tibiali: studio prospettico randomizzato

et al. 2016

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The autologous bone substitutes are the gold standard of orthopedic surgery for the treatment of severe losses of substance. Nevertheless there are different issues, from co-morbidity of the donor site, the limited quantity and poor osteogenic properties. To overcome these limits the bank of the skeletal muscle tissue of the Rizzoli Institutes in cooperation with FIN-ceramic Faenza SpA have developed DBSint: a new synthetic bone composite, equipped with biomimetic and osteoinductive properties, consisting of demineralized bone matrix conveyed by nanostructured hydroxyapatite enriched with magnesium. The DBSint has recently been evaluated with a clinical preliminary study with the purpose to analyze the ability to form new bone tissue and the time necessary to determine bone repair. We enrolled 36 patients with indication to perform a valgus osteotomy of the tibia, divided into 3 groups, respectively, treated with nano hydroxyapatite structured in the form of paste (SINTlife) currently on the market, the cortico-cancellous bone chips provided by the BTM-IOR, and finally DBSint. There were no adverse effects, we performed biopsies and histological exam, and radiographic assessment, respectively, at 40 days and 6 months after treatment, showing that the DBSint is able to promote a fast bone regeneration, higher than in the two groups treated with Sintlife and homologous bone. IntroduzioneOggigiorno sono numerose le opzioni a disposizione dei chirurghi ortopedici per il trattamento delle perdite di sostanza ossea in tutte quelle condizioni traumatiche e/o patologiche (pseudoartrosi, critical size defect, osteomieliti) dove si renda necessario l'utilizzo di un innesto che promuova un'efficace guarigione, mediante processi di osteoconduzione, osteoinduzione e/o osteogenesi [1]. La rigenerazione ossea, infatti, si basa fisiologicamente sulla sinergia di tre elementi:-l'osteoconduzione, affidata alla matrice tridimensionale dell'osso o di un suo sostituto -l'osteoinduzione, derivante dalla presenza di specifici fattori di crescita [2], tra cui le proteine morfogenetiche dell'osso (BMP), fattori di crescita derivanti dalle piastrine (PRP), la famiglia dei transforming growth factors (TGF-beta), il fattore di crescita insulino simile (IGF-I), e i fattori di crescita dei fibroblasti (FGF). Queste molecole bioattive sono in grado di stimolare la proliferazione e la differenziazione in senso osteoblastico delle cellule mesenchimali staminali -l'osteogenesi, garantita dalla presenza delle cellule progenitrici osteoblastiche o staminali mesenchimali (MSC), in gradi di differenziarsi in senso condrogenico o osteogenico a seconda dell'attivazione da parte dei fattori di crescita locali.

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“…In patients with intermittent claudication, symptomatic improvement with spinal flexion, and evidence of spinal stenosis on imaging studies, LBP is considered to be due to LSS. [4][5][6] Superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) is a cause of unilateral LBP involving the iliac crest and buttocks [1][2][3][12][13][14]16,18,20 that tends to be misdiagnosed as lumbar spine disorder. The clinical features and etiology of LBP remain poorly understood.…”

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

Chiba

Isu

Kim

et al. 2016

SPI

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OBJECT 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. METHODS 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. RESULTS 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 < 0.05). CONCLUSIONS 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.

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Alcohol Neurolysis for Persistent Pain Caused by Superior Cluneal Nerves Injury After Iliac Crest Bone Graft Harvesting in Orthopedic Surgery

Abstract: The authors suggest that conventional treatments be limited to a 2-month period, and that alcohol neurolysis be applied as soon as possible to prevent lengthy pain experiences.

Cited by 27 publications

References 23 publications

Superior Cluneal Nerve Entrapment Eight Years after Decubitus Surgery

Superior Cluneal Nerve Entrapment Eight Years after Decubitus Surgery

Utilizzo di un nanocomposto costituito da Mg-idrossiapatite e matrice ossea demineralizzata nelle osteotomie tibiali: studio prospettico randomizzato

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

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