Skip to main content

Advertisement

SpringerLink
Log in

A clinicopathological study of low back pain due to middle cluneal nerve entrapment: case series

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The middle cluneal nerve (MCN) is a pure sensory nerve around the middle buttock. Its entrapment between the iliac crest and the long posterior sacroiliac ligament elicits low back pain (LBP) that can be treated by MCN neurolysis or neurectomy. Because few studies examined the pathology of MCN entrapment (MCN-E) we subjected 7 neurectomized specimens from 6 LBP patients to pathologic study.

Methods

We present 6 consecutive patients (7 sides) with intractable LBP who underwent successful MCN neurectomy. Their symptom duration ranged from 6 to 96 months (average 47.3 months); the follow-up period ranged from 6 to 17 months (average 11.7 months). The surgical outcomes were evaluated using the numerical rating scale (NRS) for LBP and the Roland-Morris Disability Questionnaire (RDQ) score. The resected MCNs underwent neuropathological analysis.

Results

Postoperatively, all 6 patients reported immediate LBP amelioration; their NRS and RDQ scores were improved significantly. Pathological study of the 7 resected nerves showed that the myelinated fiber density was decreased in 6 nerves; we observed marked enlargement (n = 5), perineurial thickening and disruption (n = 6), intrafascicular fibrous changes (n = 5), myelinated fibers separated by fibrous cells under the perineurium (n = 4), and Renaut bodies (n = 3). The 7th nerve appeared normal with respect to the density and size of the myelinated fibers, however, the perineurium was slightly thickened.

Conclusion

We present pathological evidence at the MCN compression site of 7 nerves from 6 patients whose LBP was alleviated by MCN neurectomy, indicating that MCN entrapment can elicit LBP.

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

Similar content being viewed by others

References

  1. Deyo RA, Weinstein JN (2001) Low back pain. N Engl J Med 344:363–370

    Article  CAS  PubMed  Google Scholar 

  2. Ermis MN, Yildirim D, Durakbasa MO, Tamam C, Ermis OE (2011) Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors. J Back Musculoskelet Rehabil 24:137–144

    Article  PubMed  Google Scholar 

  3. 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 31:139

    Article  Google Scholar 

  4. 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 

  5. Morimoto D, Isu T, Kim K et al (2013) Surgical treatment of superior cluneal nerve entrapment neuropathy. J Neurosurg Spine 19:71–75

    Article  PubMed  Google Scholar 

  6. Morimoto D, Isu T, Kim K et al (2017) Long-term outcome of surgical treatment for superior cluneal nerve entrapment neuropathy. Spine 42:783–788

    Article  PubMed  Google Scholar 

  7. 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 

  8. Kuniya H, Aota Y, Saito T et al (2013) Anatomical study of superior cluneal nerve entrapment. J Neurosurg Spine 19:76–80

    Article  PubMed  Google Scholar 

  9. Lu J, Ebraheim NA, Huntoon M, Heck BE, Yeasting RA (1998) Anatomic considerations of superior cluneal nerve at posterior iliac crest region. Clin Orthop Relat Res 347:224–228

    Article  Google Scholar 

  10. Kim K, Shimizu J, Isu T et al (2018) Low back pain due to superior cluneal nerve entrapment: a clinicopathologic study. Muscle Nerve 57:777–783

    Article  CAS  PubMed  Google Scholar 

  11. 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 

  12. Konno T, Aota Y, Saito T et al (2017) Anatomical study of middle cluneal nerve entrapment. J Pain Res 10:1431–1435

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fujihara F, Isu T, Kim K et al (2021) Clinical features of middle cluneal nerve entrapment neuropathy. Acta Neurochir 163:817–822

    Article  PubMed  Google Scholar 

  15. Fujihara F, Kim K, Kokubo R et al (2021) High frequency thermal coagulation therapy for middle cluneal nerve entrapment neuropathy. Acta Neurochir 163:823–828

    Article  PubMed  Google Scholar 

  16. 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:S309-313

    Article  Google Scholar 

  17. 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 

  18. 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 

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

    Article  PubMed  Google Scholar 

  20. 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 

  21. Hjermstad MJ, Fayers PM, Haugen DF et al (2011) Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manag 41:1073–1093

    Article  Google Scholar 

  22. Berini SE, Spinner RJ, Jentoft ME et al (2014) Chronic meralgia paresthetica and neurectomy: a clinical pathologic study. Neurology 82:1551–1555

    Article  PubMed  PubMed Central  Google Scholar 

  23. Mackinnon SE, Dellon AL, Hudson AR, Hunter DA (1986) Chronic human nerve compression—a histological assessment. Neuropathol Appl Neurobiol 12:547–565

    Article  CAS  PubMed  Google Scholar 

  24. Neary D, Ochoa J, Gilliatt RW (1975) Subclinical entrapment neuropathy in man. J Neurol Sci 24:283–298

    Article  CAS  PubMed  Google Scholar 

  25. Thomas PK, Fullerton PM (1963) Nerve fibre size in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 26:520–527

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

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

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Nippon Medical School, Chiba Hokuso Hospital, 1715, Kamagari, Inzai-City, Chiba, Japan

    Kyongsong Kim

  2. Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan

    Jun Shimizu & Akatsuki Kubota

  3. Department of Rehabilitation, Tokyo University of Technology, Bunkyo-Ku, Tokyo, Japan

    Jun Shimizu

  4. Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro-City, Hokkaido, Japan

    Toyohiko Isu

  5. Department of Neurological Surgery, Nippon Medical School, Bunkyo-Ku, Tokyo, Japan

    Daijiro Morimoto, Akio Morita & Yasuo Murai

Authors
  1. Kyongsong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jun Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toyohiko Isu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daijiro Morimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Akatsuki Kubota
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akio Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuo Murai
    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 by KK, JS, TI, DM, and AK. The first draft of the manuscript was written by KK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kyongsong Kim.

Ethics declarations

Conflict of interest

None of the authors have any conflict of interest to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Chiba Hokuso Hospital, Nippon Medical School (dated May 7, 2021; number B-2020-329).

Additional information

Publisher's Note

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

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

Kim, K., Shimizu, J., Isu, T. et al. A clinicopathological study of low back pain due to middle cluneal nerve entrapment: case series. Eur Spine J 33, 490–495 (2024). https://doi.org/10.1007/s00586-023-07944-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07944-6

Keywords

Search

Navigation