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Long-term outcome after surgery for middle cluneal nerve entrapment neuropathy

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Abstract

Purpose

Entrapment of the middle cluneal nerve (MCN-E) can elicit low back pain (LBP). Patients whose LBP responds only transiently to the analgesic effects of MCN blockage may be candidates for surgery. This study addresses its long-term efficacy.

Methods

We initially subjected 34 MCN-E patients (48 sides) to surgical release. Of these, 4 were excluded from this study because their follow-up was shorter than 24 months. The mean age of the 30 included patients was 71.5 years; the mean postoperative follow-up period was 40.4 months. Clinical outcomes were assessed on the Numerical Rating Scale (NRS) for LBP and the Roland Morris Disability Questionnaire (RDQ) before surgery and at the latest follow-up visit.

Results

The 30 patients (44 sides) reported severe LBP, leg symptoms were elicited by 32 sides. A mean of 1.4 MCN branches were surgically released, 32 sides were addressed by neurolysis, 7 by neurectomy, and 5 underwent both procedures due to the presence of 2 nerve branches. There were no complications. In the course of a mean follow-up of 26.3 months, MCN-E elicited recurrent symptoms on 6 sides; all had undergone neurolysis or neurectomy and a second operation improved the symptoms. All patients showed significant improvement at the last follow-up visit. Postoperatively both their NRS for LBP and their RDQ scores were improved (pre- vs. postoperative scores, p < 0.05).

Conclusions

While surgical release of MCN-E is expected to yield long-term symptom relief, on 6 of 32 sides (18.8%) treated by neurolysis the patients reported pain recurrence. Whether neurectomy effectively prevents the recurrence of MCN-E in the long term requires further study.

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Author notes

  1. Takato Tajiri, Kyongsong Kim, Toyohiko Isu, Takao Kitamura, Fumiaki Fujihara, Juntaro Matsumoto, Masanori Isobe and Hiroshi Abe contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Kushiro Rosai Hospital, 13-23, Nakazonomachi, Kushiro City, Hokkaido, 085-0052, Japan

    Takato Tajiri, Toyohiko Isu, Takao Kitamura & Masanori Isobe

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

    Takato Tajiri, Fumiaki Fujihara, Juntaro Matsumoto & Hiroshi Abe

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

    Kyongsong Kim

Authors
  1. Takato Tajiri
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  2. Kyongsong Kim
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  3. Toyohiko Isu
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  4. Takao Kitamura
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  5. Fumiaki Fujihara
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  7. Masanori Isobe
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  8. Hiroshi Abe
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Correspondence to Takato Tajiri.

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Tajiri, T., Kim, K., Isu, T. et al. Long-term outcome after surgery for middle cluneal nerve entrapment neuropathy. Acta Neurochir 165, 2567–2572 (2023). https://doi.org/10.1007/s00701-023-05728-x

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  • DOI: https://doi.org/10.1007/s00701-023-05728-x

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