Background & Aims
A condition that has gained relevance in recent years is neuropathy due to the entrapment of the cluneal nerves, which are divided into superior, middle, and inferior and provide sensory innervation to the gluteal region and the proximal third of the thigh. Entrapment of the superior cluneal nerves is the most common condition and can manifest as a symptom of pain in the lower back and gluteal region with or without pain radiating to the extremity. Interventions, when cluneal nerve neuropathy is suspected, are considered to range from conservative management with rehabilitation and neuromodulatory drugs to analgesic interventionism. the objective of this case series was to evaluate the response to continuous (conventional) radiofrequency in a patient with a positive superior cluneal nerve block with low back pain refractory to pharmacological and rehabilitative management.
Methods
We present a case series, which included four patients who underwent ultrasound-guided continuous radiofrequency intervention of the superior cluneal nerves, using a previously undescribed technique and direction of intervention. Two scales were used to follow up with the patients. On the numerical rating scale, the patient described the intensity of his pain from 0-10, with 10 being the most intense pain. Considering that these are subjective values, additional medication is performed with the functional rating index that asks questions about the characteristics of the patient’s pain and qualifies the degree of limitation from 0 to 100%, with a higher degree of limitation due to pain values close to 100.
Results
All the patients showed a symptomatic improvement between 50 and 90% of the symptoms in the four-week control, in addition to an improvement in the functional scale of 40%, these results were similar in the ten-week control and even decreasing the scale of pain and optimizing functional performance, where in addition to the improvement described, the patients showed improvement in their daily life activities, including sports and work. No patient presented secondary events or increased pain and continued their treatment with a home rehabilitation plan focused on stretching and muscle strengthening.
Conclusions
Continuous radiofrequency for the treatment of the superior cluneal nerves as a cause of low back pain is an effective therapeutic tool that should be considered as a differential diagnosis. This case series offers a new ultrasound technique to address this pathology.
References
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Presenting Author
Jose Luis Cuervo Pulgarin
Poster Authors
Jose Luis Cuervo Pulgarin
Anesthesia and Pain medicine
Fundacion universitaria de ciencias de la salud
Lead Author
Leonardo Arce Galvez MD Physiatrist,
Hospital San Jose
Lead Author
Rafael Enrico Valencia Gómez MD
Anesthesia and Pain medicine
Hospital San Jose
Lead Author
David Hernández Abuchaibe MD Physiatrist,
Hospital San Jose
Lead Author
Christian Vladimir Guauque Marcelo MD Anesthesia and Pain medicine
Hospital San Jose
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain