Anatomical study of superior cluneal nerve entrapment

Laboratory investigation

View More View Less
  • 1 Departments of Orthopaedic Surgery and
  • | 2 Neuroanatomy, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa; and
  • | 3 Department of Anatomy, Tokyo Medical University, Shinjyuku, Tokyo, Japan
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Entrapment of the superior cluneal nerve (SCN) in an osteofibrous tunnel in the space surrounded by the iliac crest and the thoracolumbar fascia is a cause of low-back pain (LBP). Several anatomical and surgical reports describe SCN entrapment as a cause of LBP, and a recent clinical study reported that patients with suspected SCN disorder constitute approximately 10% of the patients suffering from LBP and/or leg symptoms. However, a detailed anatomical study of SCN entrapment is rare. The purpose of this study was to investigate the courses of SCN branches and to ascertain the frequency of SCN entrapment.

Methods

Branches of the SCN were dissected in 109 usable specimens (54 on the right side and 55 on the left side) obtained in 59 formalin-preserved cadavers (average age at death 84.8 years old). All branches were exposed at the points where they perforated the thoracolumbar fascia. The presence or absence of an osteofibrous tunnel was ascertained and, if present, the entrapment of the branches in the tunnel was determined.

Results

Of 109 specimens, 61 (56%) had at least 1 branch running through an osteofibrous tunnel. Forty-two medial (39%), 30 intermediate (28%), and 14 lateral (13%) SCN branches passed through such a tunnel. Of these, only 2 medial branches had obvious entrapment in an osteofibrous tunnel. There were several patterns for the SCN course through the tunnel: medial branch only (n = 25), intermediate branch only (n = 11), lateral branch only (n = 4), medial and intermediate branches (n = 11), medial and lateral branches (n = 2), intermediate and lateral branches (n = 4), and all branches (n = 4).

Conclusions

Several anatomical variations of the running patterns of SCN branches were detected. Entrapment was seen only in the medial branches. Although obvious entrapment of the SCN is rare, it may cause LBP.

Abbreviations used in this paper:

LBP = low-back pain; SCN = superior cluneal nerve.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Hiroshi Kuniya, M.D., Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Fukuura 3–9, Kanazawa-ku, Yokohama City, Kanagawa 236-0004, Japan. email: kuniyayo@live.jp.

Please include this information when citing this paper: published online May 3, 2013; DOI: 10.3171/2013.4.SPINE12683.

  • 1

    Aizawa Y, & Kumaki K: [The courses and the segmental origins of the cutaneous branches of the thoracic dorsal rami.]. Kaibogaku Zasshi 71:195210, 1996. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 2

    Akbas M, , Yegin A, & Karsli B: Superior cluneal nerve entrapment eight years after decubitus surgery. Pain Pract 5:364366, 2005

  • 3

    Aly TA, , Tanaka Y, , Aizawa T, , Ozawa H, & Kokubun S: Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases. Tohoku J Exp Med 197:229231, 2002

    • Search Google Scholar
    • Export Citation
  • 4

    Asano S, & Kaneda K: [Cause and management of donor site pain after harvesting autologous iliac bone grafts.]. Sekitsui Sekizui 6:191195, 1993. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 5

    Banwart JC, , Asher MA, & Hassanein RS: Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine (Phila Pa 1976) 20:10551060, 1995

    • Search Google Scholar
    • Export Citation
  • 6

    Berthelot JM, , Delecrin J, , Maugars Y, , Caillon F, & Prost A: A potentially underrecognized and treatable cause of chronic back pain: entrapment neuropathy of the cluneal nerves. J Rheumatol 23:21792181, 1996

    • Search Google Scholar
    • Export Citation
  • 7

    Fernyhough JC, , Schimandle JJ, , Weigel MC, , Edwards CC, & Levine AM: Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion. Spine (Phila Pa 1976) 17:14741480, 1992

    • Search Google Scholar
    • Export Citation
  • 8

    Hutchinson MR, & Dall BE: Midline fascial splitting approach to the iliac crest for bone graft. A new approach. Spine (Phila Pa 1976) 19:6266, 1994

    • Search Google Scholar
    • Export Citation
  • 9

    Kuniya H, , Aota Y, , Nakamura N, , Kawai T, , Tanabe H, & Saito T: [Low back pain patients with suspected entrapment of the superior cluneal nerve.]. J Spine Res 2:10321035, 2011. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 10

    Kurz LT, , Garfin SR, & Booth RE Jr: Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine (Phila Pa 1976) 14:13241331, 1989

    • Search Google Scholar
    • Export Citation
  • 11

    Lu J, , Ebraheim NA, , Huntoon M, , Heck BE, & Yeasting RA: Anatomic considerations of superior cluneal nerve at posterior iliac crest region. Clin Orthop Relat Res 347:224228, 1998

    • Search Google Scholar
    • Export Citation
  • 12

    Maigne JY, & Doursounian L: Entrapment neuropathy of the medial superior cluneal nerve. Nineteen cases surgically treated, with a minimum of 2 years' follow-up. Spine (Phila Pa 1976) 22:11561159, 1997

    • Search Google Scholar
    • Export Citation
  • 13

    Maigne JY, , Lazareth JP, , Guérin Surville H, & Maigne R: The lateral cutaneous branches of the dorsal rami of the thoracolumbar junction. An anatomical study on 37 dissections. Surg Radiol Anat 11:289293, 1989

    • Search Google Scholar
    • Export Citation
  • 14

    Maigne JY, & Maigne R: Trigger point of the posterior iliac crest: painful iliolumbar ligament insertion or cutaneous dorsal ramus pain? An anatomic study. Arch Phys Med Rehabil 72:734737, 1991

    • Search Google Scholar
    • Export Citation
  • 15

    Mirovsky Y, & Neuwirth MG: Comparison between the outer table and intracortical methods of obtaining autogenous bone graft from the iliac crest. Spine (Phila Pa 1976) 25:17221725, 2000

    • Search Google Scholar
    • Export Citation
  • 16

    Moro T, , Kikuchi S, , Kon-no S, & Aoki Y: [Anatomy study of the superior cluneal nerves. The prevention of nerve injury when harvesting bone from the posterior iliac crest.]. Rinsho Seikei Geka 42:101104, 2007. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 17

    Peer S, , Kovacs P, , Harpf C, & Bodner G: High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease. J Ultrasound Med 21:315322, 2002

    • Search Google Scholar
    • Export Citation
  • 18

    Speed S, , Sims K, & Weinrauch P: Entrapment of the medial branch of the superior cluneal nerve a previously unrecognized cause of low back pain in cricket fast bowlers. J Med Cases 2:101103, 2011

    • Search Google Scholar
    • Export Citation
  • 19

    Talu GK, , Ozyalçin S, & Talu U: Superior cluneal nerve entrapment. Reg Anesth Pain Med 25:648650, 2000

  • 20

    Trescot AM: Cryoanalgesia in interventional pain management. Pain Physician 6:345360, 2003

  • 21

    Tubbs RS, , Levin MR, , Loukas M, , Potts EA, & Cohen-Gadol AA: Anatomy and landmarks for the superior and middle cluneal nerves: application to posterior iliac crest harvest and entrapment syndromes. Laboratory investigation. J Neurosurg Spine 13:356359, 2010

    • Search Google Scholar
    • Export Citation
  • 22

    Xu R, , Ebraheim NA, , Yeasting RA, & Jackson WT: Anatomic considerations for posterior iliac bone harvesting. Spine (Phila Pa 1976) 21:10171020, 1996

    • Search Google Scholar
    • Export Citation
  • 23

    Yazaki S, , Ohwaki Y, , Urata S, & Watanabe K: [Chronic posterior iliac crest donor site pain and anatomic considerations for superior cluneal nerves.]. Seikei Geka 48:397403, 1997. (Jpn)

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1124 287 29
Full Text Views 217 33 5
PDF Downloads 368 32 4
EPUB Downloads 0 0 0