Surgical treatment of superior cluneal nerve entrapment neuropathy

Technical note

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Object

Superior cluneal nerve (SCN) entrapment neuropathy is a poorly understood clinical entity that can produce low-back pain. The authors report a less-invasive surgical treatment for SCN entrapment neuropathy that can be performed with local anesthesia.

Methods

From November 2010 through November 2011, the authors performed surgery in 34 patients (age range 18–83 years; mean 64 years) with SCN entrapment neuropathy. The entrapment was unilateral in 13 patients and bilateral in 21. The mean postoperative follow-up period was 10 months (range 6–18 months). After the site was blocked with local anesthesia, the thoracolumbar fascia of the orifice was dissected with microscissors in a distal-to-rostral direction along the SCN to release the entrapped nerve. Results were evaluated according to Japanese Orthopaedic Association (JOA) and Roland-Morris Disability Questionnaire (RMDQ) scores.

Results

In all 34 patients, the SCN penetrated the orifice of the thoracolumbar fascia and could be released by dissection of the fascia. There were no intraoperative surgery-related complications. For all patients, surgery was effective; JOA and RMDQ scores indicated significant improvement (p < 0.05).

Conclusions

For patients with low-back pain, SCN entrapment neuropathy must be considered as a causative factor. Treatment by less-invasive surgery, with local anesthesia, yielded excellent clinical outcomes.

Abbreviations used in this paper:JOA = Japanese Orthopaedic Association; RMDQ = Roland-Morris Disability Questionnaire; SCN = superior cluneal nerve.

Article Information

Address correspondence to: Daijiro Morimoto, M.D., Ph.D., Department of Neurosurgery, Yokohama Shin Midori General Hospital, 1726-7, Toukaichiba, Midori, Yokohama, Kanagawa 226-0025, Japan. email: dai_sampo@yahoo.co.jp.

Please include this information when citing this paper: published online April 26, 2013; DOI: 10.3171/2013.3.SPINE12420.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Location of skin incision, 5 cm across the trigger point (asterisk) located 7–8 cm from the midline on the iliac crest.

  • View in gallery

    A: The SCN is seen penetrating the thoracolumbar fascia through the orifice just before crossing over the iliac crest. Distal to the orifice (arrow), the SCN (arrowhead) appears pale because of circulation disturbance attributable to nerve entrapment. B: The thoracolumbar fascia is surgically released from the orifice by sharp dissection with microscissors in a distal-to-rostral direction along the SCN. When the thoracolumbar fascia is cut, the nerve can be seen bulging within the subfascial fat layer. C: After the SCN is released by cutting the thoracolumbar fascia, the nerve is decompressed and mobilized. The superficial circulation of the nerve improves after sufficient decompression.

  • View in gallery

    A: Photographs of the SCN entrapment release procedure. The SCN is seen penetrating the thoracolumbar fascia through the orifice just before crossing over the iliac crest. Distal to the orifice (arrow), the SCN (arrowheads) appears pale because of circulation disturbance attributable to nerve entrapment. B: The orifice of the thoracolumbar fascia was opened with microscissors in a distal-to-rostral direction along the SCN. When the thoracolumbar fascia was cut, the nerve could be seen bulging within the subfascial fat layer. C: The entrapped SCN was released from the orifice in a rostral direction from the surrounding fat between the thoracolumbar fascia and the paraspinal muscles. D: After the SCN was released, intraoperative manual direct compression of the SCN produced no pain. E: After the orifice was opened, the exposed SCN in the operative field was constricted where it penetrated the orifice. The arrow points to the constriction site; the arrowheads point to the released SCN. The superficial circulation of the nerve improved after sufficient decompression.

References

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