Medial Superior Cluneal Nerve Entrapment Neuropathy in Teenagers: A Report of Two Cases.

Aly, Tarek; Tanaka, Yasuhisa; Aizawa, Tadanori; Ozawa, Hiroshi; Kokubun, S.

doi:10.1620/tjem.197.229

Cited by 33 publications

(18 citation statements)

References 3 publications

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“…Few reports on surgical procedures address this entity. 1,2,4,6,7,[9][10][11] We present the preliminary outcomes of a less-invasive microsurgical release procedure, performed with local anesthesia, to address SCN entrapment neuropathy.…”

Section: ©Aans 2013mentioning

confidence: 99%

Surgical treatment of superior cluneal nerve entrapment neuropathy

Morimoto

Isu

Kim

et al. 2013

SPI

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Object Superior cluneal nerve (SCN) entrapment neuropathy is a poorly understood clinical entity that can produce low-back pain. The authors report a less-invasive surgical treatment for SCN entrapment neuropathy that can be performed with local anesthesia. Methods From November 2010 through November 2011, the authors performed surgery in 34 patients (age range 18–83 years; mean 64 years) with SCN entrapment neuropathy. The entrapment was unilateral in 13 patients and bilateral in 21. The mean postoperative follow-up period was 10 months (range 6–18 months). After the site was blocked with local anesthesia, the thoracolumbar fascia of the orifice was dissected with microscissors in a distal-to-rostral direction along the SCN to release the entrapped nerve. Results were evaluated according to Japanese Orthopaedic Association (JOA) and Roland-Morris Disability Questionnaire (RMDQ) scores. Results In all 34 patients, the SCN penetrated the orifice of the thoracolumbar fascia and could be released by dissection of the fascia. There were no intraoperative surgery-related complications. For all patients, surgery was effective; JOA and RMDQ scores indicated significant improvement (p < 0.05). Conclusions For patients with low-back pain, SCN entrapment neuropathy must be considered as a causative factor. Treatment by less-invasive surgery, with local anesthesia, yielded excellent clinical outcomes.

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Section: ©Aans 2013mentioning

confidence: 99%

Surgical treatment of superior cluneal nerve entrapment neuropathy

Morimoto

Isu

Kim

et al. 2013

SPI

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“…4-6 LBP due to SCNEN is exacerbated by lumbar extension, improved with flexion posture, 2,14,18 and both forward and backward bending are painful and limited in range.…”

Section: Discussionmentioning

confidence: 99%

“…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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confidence: 99%

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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“…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%

“…The nerve becomes subjected to stretching forces that cause tissue edema, irritation, inflammatory cell infiltration, and scarring, which leads to the subsequent entrapment. 5 Entrapment neuropathies are usually treated conservatively, unless the symptoms become severe and weakness or atrophy develops. 7 Diagnostic blocks with local anesthetics can be used and, if successful in relieving the pain, the patient may be treated by injection of local anesthetics with steroid, surgical release, cryotherapy, or phenol injection.…”

Section: Discussionmentioning

confidence: 99%