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Middle cluneal nerve entrapment mimics sacroiliac joint pain

  • Original Article - Peripheral Nerves
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Abstract

Background

Sacroiliac joint (SIJ)-related pain is associated with low back- and buttock pain and the SIJ score is diagnostically useful because it helps to differentiate between SIJ-related pain and pain due to other factors such as lumbar disc herniation and lumbar spinal canal stenosis. Middle cluneal nerve (MCN) entrapment (MCN-E) can produce pain involving the lower back and buttocks. Therefore, the origin of the pain must be identified. We successfully treated patients with a high SIJ score whose pain was attributable to MCN-E.

Methods

Between August 2016 and June 2017, we treated 40 patients with non-specific low back pain. Among them, 18 (45%) presented with a positive SIJ score. Although SIJ treatment was unsuccessful in 4 of these patients, they responded to MCN-E treatment.

Results

All 4 patients reported tenderness at the site of the sacrotuberous ligament (STL); 3 were positive for the one-finger test and experienced pain while sitting in a chair. The effect of SIJ block was inadequate in the 4 patients. As they reported severe pain at the trigger point in the area of the MCN, we performed MCN blockage. It resulted in pain control. However, in 1 patient, the effect of MCN block was transient and required MCN neurolysis. At the last visit, our patients’ symptoms were significantly improved; their average numerical rating scale score fell from 8.3 to 1.0, their Roland-Morris Disability Questionnaire score fell from 12.8 to 0.3, and their average Japanese Orthopaedic Association score rose from 12.5 to 19.5.

Conclusions

In patients with suspected SIJ-related pain, the presence of MCN-E must be considered when the effect of SIJ block is unsatisfactory.

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Authors and Affiliations

  1. Department of Neurosurgery, Kushiro Rosai Hospital, 13-23, Nakazono-cho, Kushiro, Hokkaido, Japan

    Juntaro Matsumoto, Toyohiko Isu, Koichi Miki, Fumiaki Fujihara & Masanori Isobe

  2. Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Tokyo, 113-0022, Japan

    Kyongsong Kim

Authors
  1. Juntaro Matsumoto
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  2. Toyohiko Isu
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  3. Kyongsong Kim
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  4. Koichi Miki
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  5. Fumiaki Fujihara
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  6. Masanori Isobe
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Correspondence to Juntaro Matsumoto.

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All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article is part of the Topical Collection on Peripheral Nerves

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Matsumoto, J., Isu, T., Kim, K. et al. Middle cluneal nerve entrapment mimics sacroiliac joint pain. Acta Neurochir 161, 657–661 (2019). https://doi.org/10.1007/s00701-019-03861-0

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  • DOI: https://doi.org/10.1007/s00701-019-03861-0

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