Abstract
Purpose
The clinical features and etiology of low back pain and buttock pain remain poorly understood. We report ten patients with buttock pain who underwent gluteus medius muscle (GMeM) decompression under local anesthesia.
Methods
Between December 2012 and November 2013 we surgically treated ten patients (four men, six women; mean age 65.1 years) for buttock pain. The affected side was unilateral in seven and bilateral in three patients (total sites, n = 13). The interval from symptom onset to treatment averaged 174 months; the mean postoperative follow-up period was 24 months. Decompression of the tight gluteal aponeurosis over the GMeM was performed under local anesthesia. Assessment of the clinical outcomes was on the numeric rating scale (NRS) for low back pain (LBP), the Japanese Orthopedic Association (JOA) score, and the Roland–Morris Disability Questionnaire (RDQ) score before and at the latest follow-up after treatment.
Results
There were no intraoperative surgery-related complications. The buttock pain of all patients was improved after surgery; their NRS decreased from 7.0 to 0.8 and JOA and RMDQ scores indicated significant improvement (p < 0.05).
Conclusion
In patients with buttock pain, pain around the GMeM should be considered as a causative factor. Less invasive surgery with cutting and opening of the tight gluteal aponeurosis over the GMeM under local anesthesia yielded excellent clinical outcomes.
Similar content being viewed by others
References
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G, COST B13 Working Group on Guidelines for Chronic Low Back Pain (2006) European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15:S192–S300
de Vet HC, Heymans MW, Dunn KM, Pop DP, van der Beek AJ, Macfarlane GJ, Bouter LM, Croft PR (2002) Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine 27:2409–2416
Deyo RA, Weinstein JN (2001) Low back pain. N Engl J Med 344:363–370
Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, Wyatt M, Cassidy JD, Rossignol M, Leboeuf-Yde C, Hartvigsen J, Leino-Arjas P, Latza U, Reis S, Gil Del Real MT, Kovacs FM, Oberg B, Cedraschi C, Bouter LM, Koes BW, Picavet HS, van Tulder MW, Burton K, Foster NE, Macfarlane GJ, Thomas E, Underwood M, Waddell G, Shekelle P, Volinn E, Von Korff M (2008) A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 33:95–103
Hestbaek L, Leboeuf-Yde C, Mannlche C (2003) Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J 12:149–165
Koes BW, van Tulder MW, Thomas S (2006) Diagnosis and treatment of low back pain. BMJ 332:1430–1434
Nelson-Wong E, Callaghan JP (2010) Is muscle co-activation a predisposing factor for low back pain development during standing? A multifactorial approach for early identification of at-risk individuals. J Electromyogr Kinesiol 20:256–263
Ward SR, Winters TM, Blemker SS (2010) The architectural design of the gluteal muscle group: implications for movement and rehabilitation. J Orthop Sports Phys Ther 40:95–102
Cooper NA, Scavo KM, Strickland KJ, Tipayamongkol N, Nicholson JD, Bewyer DC, Sluka KA (2015) Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Eur Spine J (epub ahead of print)
Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Jt Surg Am 72:403–408
Chiba Y, Isu T, Kim K, Iwamoto N, Morimoto D, Yamazaki K, Hokari M, Isobe M, Kusano M (2015) Intermittent low back pain attributable to superior cluneal nerve entrapment neuropathy. J Neurosurg Spine 13:1–5
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
Morimoto D, Isu T, Kim K, Imai T, Yamazaki K, Matsumoto R, Isobe M (2013) Surgical treatment of superior cluneal nerve entrapment neuropathy. J Neurosurg Spine 19:71–75
Kuniya H, Aota A, 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 9:139–151
Michel F, Decavel P, Toussirot E, Tatu L, Aleton E, Monnier G, Garbuio P, Parratte B (2013) Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med 56:371–383
Miller TA, White KP, Ross DC (2012) The diagnosis and management of piriformis syndrome: myths and facts. Can J Neurol Sci 39:577–583
Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, Bogduk N (2007) Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J 16:1539–1550
Vanelderen P, Szadek K, Cohen SP, De Witte J, Lataster A, Patijn J, Mekhail N, van Kleef M, Van Zundert J (2010) Sacroiliac joint pain. Pain Pract 10:470–478
Cloward RB (1963) Lesions of the intervertebral disks and their treatment by interbody fusion methods. The painful disk. Clin Orthop Relat Res 27:51–77
Pedersen HE, Blunck CF, Gardner E (1956) The anatomy of lumbosacral posterior rami and meningeal branches of spinal nerves (sinu-vertebral nerves) with an experimental study of their functions. J Bone Jt Surg Am 38:377–391
Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van Wingerden JP, Snijders CJ (1995) The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Spine 20:753–758
Rudolph T, Løkebø JE, Andreassen L (2011) Bilateral gluteal compartment syndrome and severe rhabdomyolysis after lumbar spine surgery. Eur Spine J 20:S180–S182
Hill SL, Bianchi J (1997) The gluteal compartment syndrome. Am Surg 63:823–826
Nathan ST, Roberts CS, Deliberato D (2012) Lumbar paraspinal compartment syndrome. Int Orthop 36:1221–1227
Styf J, Lysell E (1987) Chronic compartment syndrome in the erector spinae muscle. Spine 12:680–682
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest and no financial disclosures.
Rights and permissions
About this article
Cite this article
Kim, K., Isu, T., Chiba, Y. et al. Decompression of the gluteus medius muscle as a new treatment for buttock pain: technical note. Eur Spine J 25, 1282–1288 (2016). https://doi.org/10.1007/s00586-016-4440-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-016-4440-5