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Clinical features of middle cluneal nerve entrapment neuropathy

  • Original Article - Peripheral Nerves
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Abstract

Background

Entrapment of the middle cluneal nerve (MCN), a peripheral nerve in the buttock, can elicit low back pain (LBP). We examined the epidemiology, clinical course, and treatment of MCN entrapment (MCN-EN).

Methods

Among 383 LBP patients who visited our institute, 105 were admitted for intractable LBP. They were 42 men and 63 women; their average age was 64 years. Based on clinical symptoms, palpation, and the effects of MCN block, we suspected MCN-EN in these 105 patients, 50 of whom are our study subjects. Their treatment outcomes were assessed at the time of discharge and at follow-up visits.

Results

MCN-EN was diagnosed in 50 of the 383 patients (13.1%) and they were hospitalized. In 43 (11.2%), MCN-EN was associated with other diseases (superior cluneal nerve entrapment, n = 21, sacroiliac joint pain, n = 9, other, n = 13). At the time of discharge, the symptoms of patients with LBP due to MCN-EN were significantly improved by repeat MCN blocks. In 7 of the 383 patients (1.8%), LBP was improved by only MCN blocks; 5 of them had reported leg symptoms in the dorsal part of the thigh. After discharge, 22 of the 50 hospitalized patients required no additional treatments after 2–5 blocks; 19 required only conservative treatment, and 9 underwent microsurgical release of the MCN.

Conclusions

We confirmed MCN-EN in 50 of 105 patients admitted for intractable LBP. Repeat MCN blocks were effective in 22 patients; 19 required additional conservative treatment, and 9 underwent surgery. Buttock pain radiating to the posterior thigh was an MCN-EN symptom that has been diagnosed as pseudo-sciatica. Before subjecting patients with intractable LBP to surgery, the presence of MCN-EN must be ruled out.

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Authors and Affiliations

  1. Department of Neurological Surgery, Kushiro Rosai Hospital, 13-23, Nakazonomachi, Kushiro City, Hokkaido, Japan

    Fumiaki Fujihara, Toyohiko Isu, Kimiya Sakamoto, Masaki Ito & Masanori Isobe

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

    Fumiaki Fujihara, Juntaro Matsumoto, Koichi Miki & Tooru Inoue

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

    Kyongsong Kim

Authors
  1. Fumiaki Fujihara
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  2. Toyohiko Isu
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  3. Kyongsong Kim
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  4. Kimiya Sakamoto
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  5. Juntaro Matsumoto
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  6. Koichi Miki
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  7. Masaki Ito
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  8. Masanori Isobe
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  9. Tooru Inoue
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Correspondence to Fumiaki Fujihara.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures 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. Our study was approved by the institutional ethics committee of Kushiro Rosai Hospital.

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Informed consent was obtained from all patients included in this study.

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This article is part of the Topical Collection on Peripheral Nerves

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Fujihara, F., Isu, T., Kim, K. et al. Clinical features of middle cluneal nerve entrapment neuropathy. Acta Neurochir 163, 817–822 (2021). https://doi.org/10.1007/s00701-020-04676-0

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  • DOI: https://doi.org/10.1007/s00701-020-04676-0

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