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European Spine Journal

, Volume 27, Supplement 3, pp 309–313 | Cite as

Low back pain due to middle cluneal nerve entrapment neuropathy

  • Kyongsong Kim
  • Toyohiko Isu
  • Juntaro Matsumoto
  • Kazuyoshi Yamazaki
  • Masanori Isobe
Case Report

Abstract

Purpose

The etiology of low back pain (LBP) is complicated and the diagnosis can be difficult. Superior cluneal nerve entrapment neuropathy (SCN-EN) is a known cause of LBP, although the middle cluneal nerve (MCN) can be implicated in the elicitation of LBP.

Methods

A 76-year-old woman with a 4-year history of severe LBP was admitted to our department in a wheelchair. She complained of bilateral LBP that was exacerbated by lumbar movement. Her pain was severe on the right side and she also suffered right leg pain and numbness. Based on palpation and nerve blocking findings we diagnosed SCN-EN and MCN entrapment neuropathy (MCN-EN).

Results

Her symptoms improved with repeated SCN and MCN blocking; the MCN block was the more effective and her symptoms improved. As her right-side pain around the MCN -EN with severe trigger pain recurred we performed microscopic right MCN neurolysis under local anesthesia. This led to dramatic improvement of her LBP and leg pain and the numbness improved. At the last follow-up, 7 months after surgery, she did not require pain medication.

Conclusions

The MCN consists of sensory branches from the dorsal rami of S1–S4. It sandwiches the sacral ligament between the posterior superior and inferior iliac spine as it courses over the iliac crest. Its entrapment at this hard orifice can lead to severe LBP with leg symptoms. An MCN block effect is diagnostically useful. Less invasive MCN neurolysis under local anesthesia is effective in patients who fail to respond to observation therapy.

Keywords

Low back pain Middle cluneal nerve Entrapment neuropathy Neurolysis 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no personal, financial, or institutional interests, in any of the drugs, materials, or devices described article.

References

  1. 1.
    Deyo RA, Weinstein JN (2001) Low back pain. N Engl J Med 344:363–370CrossRefPubMedGoogle Scholar
  2. 2.
    Chiba Y, Isu T, Kim K, Iwamoto N, Morimoto D, Yamazaki K, Hokari M, Isobe M, Kusano M (2015) Association between intermittent low-back pain and superior cluneal nerve entrapment neuropathy. J Neurosurg Spine 13:1–5Google Scholar
  3. 3.
    Iwamoto N, Isu T, Kim K, Chiba Y, Kokubo R, Morimoto D, Shirai S, Yamazaki K, Isobe M (2016) Low back pain caused by superior cluneal nerve entrapment neuropathy in patients with Parkinson disease. World Neurosurg 87:250–254CrossRefPubMedGoogle Scholar
  4. 4.
    Kim K, Isu T, Chiba Y, Iwamoto N, Yamazaki K, Morimoto D, Isobe M, Inoue K (2015) Treatment of low back pain in patients with vertebral compression fractures and superior cluneal nerve entrapment neuropathies. Surg Neurol Int 6:S619–S621CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    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 9:139CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    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 22:1156–1159CrossRefPubMedGoogle Scholar
  7. 7.
    Morimoto D, Isu T, Kim K, Chiba Y, Iwamoto N, Isobe M, Morita A (2017) Long-term outcome of surgical treatment for superior cluneal nerve entrapment neuropathy. Spine 42:783–788CrossRefPubMedGoogle Scholar
  8. 8.
    Strong EK, Davila JC (1957) The cluneal nerve syndrome; a distinct type of low back pain. Ind Med Surg 26:417–429PubMedGoogle Scholar
  9. 9.
    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 13:356–359CrossRefPubMedGoogle Scholar
  10. 10.
    McGrath MC, Zhang M (2005) Lateral branches of dorsal sacral nerve plexus and the long posterior sacroiliac ligament. Surg Radiol Anat 27:327–330CrossRefPubMedGoogle Scholar
  11. 11.
    Aota Y (2016) Entrapment of middle cluneal nerves as an unknown cause of low back pain. World J Orthop 7:167–170CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Trescot AM (2003) Cryoanalgesia in interventional pain management. Pain Physician 6:345–360PubMedGoogle Scholar
  13. 13.
    Kurosawa D, Murakami E, Ozawa H, Koga H, Isu T, Chiba Y, Abe E, Unoki E, Musha Y, Ito K, Katoh S, Yamaguchi T (2017) A diagnostic scoring system for sacroiliac joint pain originating from the posterior ligament. Pain Med 18:228–238PubMedGoogle Scholar
  14. 14.
    Broetz D, Eichner M, Gasser T, Weller M, Steinbach JP (2007) Radicular and nonradicular back pain in Parkinson’s disease: a controlled study. Mov Disord 22:853–856CrossRefPubMedGoogle Scholar
  15. 15.
    Etchepare F, Rozenberg S, Mirault T, Bonnet AM, Lecorre C, Agid Y, Bourgeois P, Fautrel B (2006) Back problems in Parkinson’s disease: an underestimated problem. Jt Bone Spine 73:298–302CrossRefGoogle Scholar
  16. 16.
    Kim YE, Jeon BS (2013) Musculoskeletal problems in Parkinson’s disease. J Neural Transm 120:537–542CrossRefPubMedGoogle Scholar
  17. 17.
    Kim YE, Lee WW, Yun JY, Yang HJ, Kim HJ, Jeon BS (2013) Musculoskeletal problems in Parkinson’s disease: neglected issues. Parkinsonism Relat Disord 19:666–669CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Kyongsong Kim
    • 1
    • 2
  • Toyohiko Isu
    • 1
  • Juntaro Matsumoto
    • 1
  • Kazuyoshi Yamazaki
    • 1
  • Masanori Isobe
    • 1
  1. 1.Department of NeurosurgeryKushiro Rosai HospitalKushiro-cityJapan
  2. 2.Department of Neurosurgery, Chiba Hokuso HospitalNippon Medical SchoolInzai-cityJapan

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