Clinical anatomy of the superior cluneal nerve in relation to easily identifiable bony landmarks

Abstract

Background: Lower back pain (LBP) remains a common ailment among adult populations and a superior cluneal nerve (SCN) entrapment accounts for 10% of reported LBP cases. The diagnostic criteria for SCN entrapment include anaesthesia of the area supplied by the SCN after performing a nerve block. Several surgical reports describe the anatomy of the SCN but purely anatomical studies of the course of the SCN are rare. This study aimed to describe the location of the SCN in relation to easily identifiable bony landmarks. Methods: The SCN was identified as it pierced the thoracolumbar fascia and crossed over the posterior part of the iliac crest on both sides of 27 adult cadavers. A sliding dial calliper was used to measure the distance from the posterior superior iliac spine (PSIS) to the SCN and from the midline lumbar spinous processes to the nerve. Results: The PSIS to SCN measurement was found to be 69.6 ± 15.0 mm (mean ± SD) while the midline to SCN measurement was 72.1 ± 10.2 mm. Discussion: This study showed clear gender differences in the PSIS to SCN measurement, due to the sexual dimorphism of the bony pelvis. There was also found to be a positive correlation between the height of the sample and the distances of the SCN from both the midline and PSIS. This study provides a clear anatomical description of the course of the SCN as it crosses the iliac crest, which will allow for the successful identification of the SCN.

Superior cluneal nerve entrapment neuropathy due to lower crossed syndrome: A case with low back pain

“…It should be considered as a cause of LBP when all other causes are ruled out. [18] Our patient fulfilled all the diagnostic criteria mentioned above. Only the sacro-horizontal angle was increased on the lumbosacral radiography, and MRI was normal.…”

“…SCNEN is often confused with facet syndrome, lumbar disc problems, or an iliolumbar syndrome since the clinical features are similar. [9,12,18,19] Episacral lipoma, which can lead to similar clinical findings and detected in similar localizations, should be kept in mind in the differential diagnosis. Episacral lipoma has a specific nodule instead of a trigger point.…”

One of the Overlooked Causes of Low Back Pain: Superior Cluneal Nerve Entrapment Neuropathy

“…Buranın lokalizasyonu orta hatta spinöz çıkıntıların 7-8 cm lateralinde iliyak krest üzerindedir. [4][5][6][7][8][9][10][11][12][13][14][15][16] Anatomi çalışmalarında SKS'nin mediyal dalının osteofibröz tünelden geçmesi ile ilgili tartışmalı veriler vardır. Bazı çalışmalarda, SKS'nin bütün dallarının iliyak krest üzerinde torakolomber fasiyayı deldiği gösterilmiş; karşıt olarak başta Maigne olmak üzere, bazı araştırmacılar tüm mediyal dalların osteofibröz tünelden geçtiğini rapor ederken, diğer bazı araştırmacılar ise mediyal, intermediate ve lateral dalların azalan oranlarda bu tünelden geçtiğini raporlamışlardır.…”

“…Trescot, kluneal nöraljide spontan tuzaklanmanın kemik greftine bağlı yaralanmadan daha sık görüldüğünü raporlamıştır. 14,[24][25][26] Lomber cerrahiden sonra devam eden postoperatif ağrının önemli bir sebebi SKSTN olabilir. Iwamoto'nun çalışmasında, lomber füzyon cerrahisinden sonra ağrısı devam eden hastalarının 8'inde SKSTN tespit edilmiş ve bu vakalara lokal anestezi altında nöroliz operasyonu uygulanmıştır.…”

“…İliyak krestin mediyalindeki ağrı şikâyeti, sıklıkla faset sendrom, intervertebral disk problemi ve iliolomber sendrom olarak teşhis edilir. 14…”