The presence of inclusion of the cluneal nerve (MCN), a neuropathy characterized by buttock pain radiating to the back of the thigh, should be considered before recommending surgery to patients with persistent lower back pain (LBP) becomes. This emerges from the study results published in Acta Neurochirurgica.
The aim of the current study was to evaluate the incidence of LBP due to the inclusion of MCN, its clinical course, and the response to treatment.
The retrospective single-center study included 383 patients (63 women; mean age 64 years) who were examined for LBP between May 2016 and August 2017.
After excluding 278 patients with LBP who were controlled by oral medication or diagnosed with radiological findings, 105 patients were admitted for LBP that is difficult to treat. After additional exclusion of subjects without pain or sensitivity in the MCN area, the diagnosis of MCN inclusion was made in 50 patients (13.1%) who reported a reduced LBP in the MCN after an MCN block.
In 43 patients, inclusion of MCN was associated with other diseases, most commonly with inclusion of the superior cluneal nerve (21 patients), sacroiliac joint pain (9 patients), radiculopathy (5 patients), or other diseases (8 patients).
During the hospital stay, several MCN blocks (2 ml 1% lidocaine) were administered to treat LBP from MCN inclusion. After discharge, the patients were observed on an outpatient basis for a median of 18.4 months.
Of the 50 patients with MCN inclusion who reported reduced LBP after MCN blockade, 22 patients required no additional treatment, while 19 only required conservative treatment. Only 9 patients whose MCN entrapment pain recurred after temporary relief from MCN blocks were considered candidates for microsurgical release of the MCN.
The study had several limitations including retrospective design, single center study, lack of a control group, relatively small sample size, inclusion limited to hospital patients, diagnosis of MCN inclusion based on the effect of the MCN block, and the brief post-treatment follow-up.
“Before operating on patients with difficult-to-treat LBP, a differential diagnosis and the presence of MCN EN must be established [entrapment] needs to be assessed, ”concluded the researchers.
Fujihara F., Isu T., Kim K. et al. Clinical features of neuropathy of clunal middle nerve inclusion. Acta Neurochir (Vienna). Published online January 6, 2021. doi: 10.1007 / s00701-020-04676-0
This article originally appeared on Clinical Pain Advisor