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High-frequency thermal coagulation to treat middle cluneal nerve entrapment neuropathy

  • Original Article - Peripheral Nerves
  • Published:
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Abstract

Objective

Middle cluneal nerve entrapment (MCN-E) around the sacroiliac joint can elicit low back pain (LBP). Pain control can be obtained with anesthetic nerve blocks; however, when their effectiveness is transient, surgical release may be necessary. We investigated the efficacy of radiofrequency thermocoagulation (RFTC) in patients with MCN-E.

Methods

Between December 2018 and August 2019, 11 consecutive patients (4 men, 7 women; mean age 76.4 years) with intractable medial buttock pain due to MCN-E underwent MCN RFTC. The mean symptom duration was 49.5 months; pre-RFTC local MCN blocks provided pain relief for a mean of 7.7 days. The severity of pain in the medial buttock due to MCN-E was recorded before and 2, 6, 12, and 24 weeks after RFTC on the numerical rating scale (NRS) and the Roland-Morris Disability Questionnaire (RDQ).

Results

All patients reported pain alleviation; there were no complications. While there was a significant difference in the pre- and post-RFTC treatment NRS (p < 0.05), the RDQ scores were significantly lower only after 12 weeks. The duration of pain relief was significantly prolonged by RFTC (p < 0.05). Two patients suffered pain relapse 10 weeks post-RFTC; pain alleviation was obtained by re-RFTC performed 2 weeks after pain recurrence. Two other patients relapsed 20 and 21 weeks post-RFTC; their symptoms also disappeared by MCN block administered 24 weeks after they had undergone RFTC.

Conclusion

RFTC may safely control intractable LBP due to MCN-E.

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Authors and Affiliations

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

    Fumiaki Fujihara, Kyongsong Kim & Rinko Kokubo

  2. Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan

    Fumiaki Fujihara, Toyohiko Isu & Koichi Miki

  3. Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan

    Daijiro Morimoto, Naotaka Iwamoto & Akio Morita

  4. Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan

    Tooru Inoue

Authors
  1. Fumiaki Fujihara
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  2. Kyongsong Kim
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  3. Rinko Kokubo
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  4. Toyohiko Isu
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  5. Koichi Miki
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  6. Daijiro Morimoto
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  7. Naotaka Iwamoto
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  8. Tooru Inoue
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  9. Akio Morita
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Corresponding author

Correspondence to Kyongsong Kim.

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The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants 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 Chiba Hokuso Hospital.

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Informed consent was obtained from all individuals 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., Kim, K., Kokubo, R. et al. High-frequency thermal coagulation to treat middle cluneal nerve entrapment neuropathy. Acta Neurochir 163, 823–828 (2021). https://doi.org/10.1007/s00701-020-04404-8

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  • DOI: https://doi.org/10.1007/s00701-020-04404-8

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