Background & Aims
Chronic low back pain (CLBP) is an important health problem that can affect 80% of the population at least once in their lifetime and cause high costs when evaluated in terms of diagnosis and treatment procedures, as well as loss of work force. Although chronic low back pain often originates from the lumbar discs, facet joints, and sacroiliac joints, superior cluneal nerve (SCN) neuralgia/entrapment is an important overlooked cause (1). It has been reported that SCN entrapment is seen between 1.6-14% in individuals with low back pain (2,3). The SCN originates from the cutaneous branches of the dorsal ramus at T11-L4 and innervates the skin of the upper part of the gluteal region. Nerves pass over the iliac crest through a tunnel formed by the thoracolumbar fascia and the upper edge of the iliac crest; SCN can be entrapped in this area (4). Although ultrasound-guided imaging and blockade of the SCN are well defined (5), there are no studies on ultrasound-guided RFA for SCN entrapment.
Methods
Total of 25 CLBP patients (12 patients underwent SCN RFA, 13 patients participated CPT) were enrolled. Patients who admitted to outpatient clinics with low back pain that lasts more than 3 months, aged ? 18 year-old and detected positive ‘iliac crest sign’ included in the study. Pre-procedural pain status and disability status were evaluated with Visul Analog Scale (VAS) (0-10) score and Oswestry Low Back Pain Disability Questionnaire (ODI), additionally quality of life scores will be recorded according to physical functioning and bodily pain subscales of Short Form-36 (SF 36). Physical therapy modalities including hot pack, transcutaneous electrical stimulation and therapeutic ultrasound deep heater were applied to the lumbar region of the patients in the conventional physical therapy group. In the patient group where the superior cluneal nerve was ablated with RFA. The patients’ VAS scores, ODI, SF-36 questionnaire values were recorded at admission , at the 2nd week and 3rd months.
Results
Total of 25 patients completed the study. There were not any significant difference between two groups in terms of sociodemographic and clinical characteristics (Table 1). Within group comparisons; both RFA and CPT group showed improvement compared to baseline in terms of VAS and ODI scores. Both physical funcitoning and bodily pain subscales showed difference compared to baseline (p=0.018; p=0.049, respectively), therefore baseline scores were worse in RFA group in bodily pain subscale (p=0.017).
In the comparison of two groups rest and motion VAS scores were statistically different in the 2nd week follow-up in favor of RFA group (p=0.019, p= 0.018 respectively). Oswestry Disability scores showed significant difference at baseline and 2nd follow-up comparing two groups in favor of RFA group (p=0.011,p=0.002). However we did not detect any significant difference between two groups in terms of VAS and ODI scores at 3rd month follow-ups (p>0.05).
Conclusions
The diagnosis of SCN is actually common and is generally overlooked. RFA may be performed in diagnosed patients for safe analgesic effect. However, it was not seem to be superior to CPT in middle-term.
References
References
1.Fujihara F, Isu T, Kim K, Sakamoto K, Matsumoto J, Miki K, Ito M, Isobe M, Inoue T. Clinical features of middle cluneal nerve entrapment neuropathy. Acta Neurochir (Wien). 2021;163:817-822.
2.Kuniya H, Aota Y, Kawai T et al.Prospective study of superior cluneal nerve disorder as a potential cause of low back pain and leg symptoms. J Orthop Surg Res 9:139.
3.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 ,Philadelphia, PA 1976; 22:1156–1159.
4.Kuniya H, Aota Y, Saito T, Kamiya Y, Unakoshi K, Terayama H, et al. Anatomical study of superior cluneal nerve entrapment. J Neurosurg Spine 2013;19:76–80.
5.Nielsen TD, Moriggl B, Barckman J, Jensen JM, Kolsen-Petersen JA, Søballe K, Børglum J, Bendtsen TF. Randomized trial of ultrasound-guided superior cluneal nerve block. Reg Anesth Pain Med. 2019 May 6:rapm-2018-100174.
Presenting Author
Hüma Bölük ?enlikci
Poster Authors
Hüma Bölük-Senlikci
MD
Ankara Bilkent City Hospital
Lead Author
Ay?e Merve Ata
Ankara Bilkent City Hospital, Physical Medicine and Rehabilitation Hospital
Lead Author
Ali Niyazi Kurtcebe
T.R. Ministry of Health, Ankara Provincial Health Director
Lead Author
Emine Sena Cander
Ankara Bilkent City Hospital, Physical Medicine and Rehabilitation Hospital
Lead Author
Berke Aras
Ankara Bilkent City Hospital, Physical Mediine and Rehabilitation Hospital
Lead Author
Öznur Uzun
Ankara Bilkent City Hospital, Physical Medicine and Rehabilitation Hospital
Lead Author
Ömer Kuzu
Ankara Bilkent City Hospital, Physical Medicine and Rehabilitation Hospital
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain