Skip to main content

Advertisement

SpringerLink
Log in

Middle cluneal nerve entrapment sites in the surgical field

  • Original Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Introduction

Middle cluneal nerve (MCN) entrapment around the sacroiliac joint elicits low back pain (LBP). For surgical decompression to be successful, the course of the MCN must be known. We retrospectively studied the MCN course in 15 patients who had undergone MCN neurolysis.

Methods

Enrolled in this retrospective study were 15 patients (18 sides). We inspected their surgical records and videos to determine the course of the entrapped MCN. The area between the posterior superior- and the posterior inferior iliac spine was divided into areas A–D from the rostral side. The MCN transit points were identified at the midline and the lateral edge connecting the posterior superior- and posterior inferior iliac spine. Before and 6 months after surgery, the patients recorded the degree of LBP on the numerical rating scale and the Roland-Morris Disability Questionnaire.

Results

We decompressed 24 MCNs. The mean number was 1.3 nerves per patient (range 1–2). The MCN course was oblique in the cranio-caudal direction; the nerve tended to be observed in areas C and D. In six patients (40%), we detected two MCN branches, they were in the same area and adjacent. Postoperatively, LBP was improved significantly in all patients.

Conclusion

Between the posterior superior- and the posterior inferior iliac spine, the MCN ran obliquely in the cranio-caudal direction; it was prominent in areas on the caudal side. In six (40%) patients, we decompressed two adjacent MCNs. Our findings are useful for MCN decompression surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

None.

Code availability

None.

Abbreviations

LBP:

Low back pain

MCN:

Middle cluneal nerve

MCN-E:

Middle cluneal nerve entrapment

NRS:

Numerical rating scale

RDQ:

Roland-Morris Disability Questionnaire

References

  1. Aota Y (2016) Entrapment of middle cluneal nerve as an unknown cause of low back pain. World J Orthop 7:167–170

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K (2003) Association of the Japanese Orthopaedic Association score with the Oswestry disability index, Roland-Morris disability questionnaire, and short-form 36. Spine 28:1601–1607

    Article  PubMed  Google Scholar 

  3. Horwitz TM (1939) The anatomy of (a) the lumbosacral nerve plexus - its relation to variations of vertebral segmentation, and (b) the posterior sacral nerve plexus. Anat Rec 74:91–107

    Article  Google Scholar 

  4. Isu T, Kim K, Morimoto D, Iwamoto N (2018) Superior and middle cluneal nerve entrapment as a cause of low back pain. Neurospine 15:25–32

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kikuta S, Iwanaga J, Watanabe K, Shane Tubbs R (2019) Revisiting the middle cluneal nerves: an anatomic study with application to pain syndrome and invasive procedures around the sacrum. World Neurosurg 127:e1228–e1231

    Article  PubMed  Google Scholar 

  6. Kim K, Isu T, Matsumoto J, Yamazaki K, Isobe M (2018) Low back pain due to middle cluneal nerve entrapment neuropathy. Eur Spine J 27:S309–S313

    Article  Google Scholar 

  7. Kim K, Kokubo R, Isu T, Morimoto D, Morita A (2022) Patient satisfaction with cluneal nerve entrapment surgery. Acta Neurochir 164:2667–2671

    Article  PubMed  Google Scholar 

  8. Kim K, Isu T, Morimoto D, Kokubo R, Fujihara F, Morita A (2022) Perioperative complications and adverse events after surgery for peripheral nerve- and para-lumbar spine diseases. Neurol Med Chir 62:75–79

    Article  Google Scholar 

  9. Konno T, Aota Y, Saito T, Ning Qu (2017) Anatomical study of middle cluneal nerve entrapment. J Pain Research 10:1431–1435

    Article  Google Scholar 

  10. Kuniya H, Aota Y, Kawai T, Kaneko K, Konno T, Saito T (2014) Prospective study of superior cluneal nerve disorder as a potential cause of low back pain and leg symptoms. J Orthop Surg Res 9:139

    Article  PubMed  PubMed Central  Google Scholar 

  11. Maigne JY, Doursounian L (1997) Entrapment neuropathy of the medial superior cluneal nerve. Nineteen cases surgically treated, with a minimum of 2 years’ follow-up. Spine 22:1156–1159

    Article  CAS  PubMed  Google Scholar 

  12. Maigne JY, Lazareth JP, Guérin Surville H, Maigne R (1989) The lateral cutaneous branches of the dorsal rami of the thoracolumbar junction. An anatomical study on 37 dissections. Surg Radiol Anat 11:289–293

    Article  CAS  PubMed  Google Scholar 

  13. Matsumoto J, Isu T, Kim K, Iwamoto N, Morimoto D, Isobe M (2018) Surgical treatment of middle cluneal nerve entrapment neuropathy: technical note. J Neurosurg Spine 29:208–213

    Article  PubMed  Google Scholar 

  14. Matsumoto J, Isu T, Kim K, Miki K, Fujiwara F, Isobe M (2019) Middle cluneal nerve entrapment mimics sacroiliac joint pain. Acta Neurochir 161:657–661

    Article  PubMed  Google Scholar 

  15. McGrath MC, Zhang M (2005) Lateral branches of dorsal sacral nerve plexus and the long posterior sacroiliac ligament. Surg Radiol Anat 27:327–330

    Article  CAS  PubMed  Google Scholar 

  16. Tajiri T, Kim K, Isu T, Kitamura T, Fujihara F, Juntaro M, Isobe M, Abe H (2023) Long-term outcome after surgery for middle cluneal nerve entrapment neuropathy. Acta Neurochir 165(9):2567–2572

    Article  PubMed  Google Scholar 

  17. Tubbs RS, Levin MR, Loukas M, Potts EA, Cohen-Gadol AA (2010) Anatomy and landmarks for the superior and middle cluneal nerves: application to posterior iliac crest harvest and entrapment syndromes. J Neurosurg Spine 13:356–359

    Article  PubMed  Google Scholar 

Download references

Funding

This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sector.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Kushiro Rosai Hospital, 13-25, Nakazono-cho, Kushiro City, Hokkaido, 085-0052, Japan

    Taisuke Yoshinaga, Masanori Isobe & Toyohiko Isu

  2. Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Chiba, Japan

    Kyongsong Kim

  3. Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Taisuke Yoshinaga, Takato Tajiri, Fumiaki Fujihara & Hiroshi Abe

Authors
  1. Taisuke Yoshinaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyongsong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takato Tajiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fumiaki Fujihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masanori Isobe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toyohiko Isu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Taisuke Yoshinaga. The first draft of the manuscript was written by Taisuke Yoshinaga. Kyongsong Kim revised the manuscript critically for important intellectual content.

Corresponding author

Correspondence to Taisuke Yoshinaga.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants 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. Approval for the retrospective study was obtained from the ethics committee of Kushiro Rosai Hospital.

Consent to participate

All authors read and approved the final manuscript.

Consent for publication

Taisuke Yoshinaga agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Comments

The authors present a case series of 15 patients undergoing microscopic neurolysis for middle cluneal nerve entrapment (MCN-E) producing low back pain. They investigate and report intraoperative findings, focusing on variations in nerve location. Six patients required two nerve neurolysis, and they report that their positioning needs attention. I consider the report to be highly original. I consider this a useful report for surgeons performing this procedure.

Juntaro Matsumoto

Japan

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshinaga, T., Kim, K., Tajiri, T. et al. Middle cluneal nerve entrapment sites in the surgical field. Acta Neurochir 166, 142 (2024). https://doi.org/10.1007/s00701-024-06031-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00701-024-06031-z

Keywords

Search

Navigation