ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
FİZİKSEL TIP VE REHABİLİTASYON
BİLİMLERİ DERGİSİ
www.jpmrs.com
Kayıtlı İndexler


DERLEMELER

Bel Ağrısının Göz Ardı Edilen Nedenlerinden Biri: Superior Kluneal Sinir Tuzaklanma Nöropatisi
One of the Overlooked Causes of Low Back Pain: Superior Cluneal Nerve Entrapment Neuropathy
Received Date : 27 Nov 2019
Accepted Date : 19 Dec 2019
Available Online : 20 Jan 2020
Doi: 10.31609/jpmrs.2019-72560 - Makale Dili: TR
J PMR Sci. 2020;23(1):41-7
ÖZET
Bel ağrısı, bireylerin fonksiyonel aktivite düzeyinde büyük bir etkiye sahip önemli bir sağlık problemidir. Superior kluneal sinir tuzaklanma nöropatisi (SKSTN), bel ağrısında nedensel faktörlerden biridir. SKSTN’nin bel ağrısına yol açtığını tanımlayan çeşitli anatomik ve klinik çalışmalar mevcuttur. Bu durumun klinik özellikleri ve nedenleri iyi anlaşılmamıştır. Lomber spinal hastalık olarak yanlış tanı almaya yatkındır.Bel ağrılı hastalarda SKSTN’nin insidansı umulmadık biçimde yüksektir ve superior kluneal sinir rahatsızlığı olan hastaların takriben %50’si bacak semptomlarına sahiptir. Şiddetli semptomlara rağmen tanıları güç olabilir. Tuzaklanma bölgesinde tetik noktanın tanımlanması ve sinir bloğundan sonra semptomların kaybolması tanısal olarak önemlidir. SKSTN’ye bağlı bel ağrısı, sinir bloğu veya nöroliz ile tedavi edilebilir. Fiziyatristler ve spinal cerrahlar, bel ağrısında SKSTN’nin rolü hakkında yeteri kadar farkında olmadıklarından, biz bir literatür derlemesi sunduk ve bu genel klinik antitenin tanı ve tedavisini gözden geçirdik.
ABSTRACT
Low back pain (LBP) is a major health problem that can have a profound effect on an individual’s level of functional activity. Superior cluneal nerve entrapment neuropathy (SCNEN) is one of the causative factors in LBP. There are several anatomical and clinical studies describing that entrapment of the superior cluneal nerve produces LBP. Its clinical features and causes are poorly understood. It tends to be misdiagnosed as lumbar spine disorder. The incidence of SCNEN in patients with LBP is unexpectedly high and approximately 50% of superior cluneal nerve disorder patients had leg symptoms. Despite severe symptoms, their diagnosis can be difficult. The identification of the trigger point at the entrapment site and the disappearance of symptoms after nerve block are diagnostically important. LBP due to SCNEN can be treated by nerve block injection or neurolysis. As physiatrist and spinal surgeons are not sufficiently aware of the role SCNEN in LBP, we presented a review of the literature and reviewed the diagnosis and treatment of this common clinical entity.
REFERENCES
  1. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73:968-74. [Crossref]  [PubMed] 
  2. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354:581-5. [Crossref] 
  3. Freynhagen R, Baron R, Gockel U, et al. A new screening questionnaire to identify neuropathic components in patientswith back pain. Curr Med Res Opin. 2006;22:1911-20. [Crossref]  [PubMed] 
  4. Konno T, Aota Y, Kuniya H, et al. Anatomical etiology of "pseudo-sciatica" from superior cluneal nerve entrapment: a laboratory investigation. J Pain Res. 2017;10:2539-45. [Crossref]  [PubMed]  [PMC] 
  5. Kuniya H, Aota Y, Saito T, et al. Anatomical study of superior cluneal nerve entrapment. J Neurosurg Spine. 2013;19:76-80. [Crossref]  [PubMed] 
  6. 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. 2014;9:139. [Crossref]  [PubMed]  [PMC] 
  7. Strong EK, Davila JC. The cluneal nerve syndrome; a distinct type of low back pain. Ind Med Surg. 1957;26:417-29.
  8. 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). 1997;22:1156-9. [Crossref]  [PubMed] 
  9. Talu GK, Ozyalçin S, Talu U. Superior cluneal nerve entrapment. Reg Anesth Pain Med. 2000;25:648-50. [Crossref]  [PubMed] 
  10. Isu T, Kim K, Morimoto D, et al. Superior and middle cluneal nerve entrapment as a cause of low back pain. Neurospine. 2018;15:25-32. [Crossref]  [PubMed]  [PMC] 
  11. Kim K, Isu T, Morimoto D, et al. Common diseases mimicking lumbar disc herniation and their treatment. Mini-Invasive Surg. 2017;1:43-51. [Crossref] 
  12. Lu J, Ebraheim NA, Huntoon M, et al. Anatomic considerations of superior cluneal nerve at posterior iliac crest region. Clin Orthop Relat Res. 1998;1:224-8. [Crossref] 
  13. 13. Iwamoto N, Isu T, Kim K, et al. Treatment of low back pain elicited by superior cluneal nerve entrapment neuropathy after lumbar fusion surgery. Spine Surg Relat Res. 2017;1:152-7. [Crossref]  [PubMed]  [PMC] 
  14. Loubsera L, Raathb RP, Van Schoora AN. Clinical anatomy of the superior cluneal nerve in relation to easily identifiable bony landmarks. South Afr J Anaesth Analg. 2015;21:77-80. [Crossref] 
  15. Maigne JY, Lazareth JP, Guérin Surville H, et al. The lateral cutaneous branches of the dorsal rami of the thoracolumbar junction. An anatomical study on 37 dissections. Surg Radiol Anat. 1989;11:289-93. [Crossref]  [PubMed] 
  16. Xu R, Ebraheim NA, Yeasting RA, et al. Anatomic considerations for posterior iliac bone harvesting. Spine (Phila Pa 1976). 1996;21:1017-20. [Crossref]  [PubMed] 
  17. Takayama T, Utsumi T. Superior cluneal syndrome as a cause of low back pain. Surgery. 1961;23:885-900.
  18. Morimoto D, Isu T, Kim K, et al. Surgical treatment of superior cluneal nerve entrapment neuropathy. J Neurosurg Spine. 2013;19:71-5. [Crossref]  [PubMed] 
  19. Ermis MN, Yildirim D, Durakbasa MO, et al. Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors. J Back Musculoskelet Rehabil. 2011;24:137-44. [Crossref]  [PubMed] 
  20. Aly TA, Tanaka Y, Aizawa T, et al. Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases. Tohoku J Exp Med. 2002;197:229-31. [Crossref]  [PubMed] 
  21. Speed S, Sims K, Weinrauch P. Entrapment of the medial branch of the superior cluneal nevre-a previously unrec¬ognized cause of low back pain in cricket fast bowlers. J Med Cases. 2011;2:101-3. [Crossref] 
  22. Iwamoto N, Isu T, Kim K, et al. Low back pain caused by superior cluneal nerve entrapment neuropathy in patients with Parkinson disease. World Neurosurg. 2016;87:250-4. [Crossref]  [PubMed] 
  23. Kim K, Isu T, Chiba Y, et al. Treatment of low back pain in patients with vertebral compression fractures and superior cluneal nerve entrapment neuropathies. Surg Neurol Int. 2015;6:S619-21. [Crossref]  [PubMed]  [PMC] 
  24. Sittitavornwong S, Falconer DS, Shah R, et al. Anatomic considerations for posterior iliac crest bone procurement. J Oral Maxillofac Surg. 2013;71:1777-88. [Crossref]  [PubMed] 
  25. Yanow JH, Lorenzo LD, Worosilo SC, et al. Successful treatment of chronic donor site pain. Anesth Pain Med. 2015;10;5:e18777. [Crossref]  [PubMed]  [PMC] 
  26. Trescot AM. Cryoanalgesia in interventional pain management. Pain Physician. 2003;6:345-60.
  27. Akbas M, Yegin A, Karsli B. Superior cluneal nerve entrap¬ment eight years after decubitus surgery. Pain Pract 2005;5:364-6. [Crossref]  [PubMed] 
  28. Miki K, Kim K, Isu T, et al. Characteristics of low back pain due to superior cluneal nerve entrapment neuropathy. Asian Spine J. 2019;13:772-8. [Crossref]  [PubMed]  [PMC] 
  29. Iwanaga J, Simonds E, Schumacher M, et al. Anatomic study of the superior cluneal nerve and its related groove on the iliac crest. World Neurosurg. 2019;125:e925-8. [Crossref]  [PubMed] 
  30. Bodner G, Platzgummer H, Meng S, et al. Successful identification and assessment of the superior cluneal nerves with high-resolution sonography. Pain Physician. 2016;19:197-202.
  31. DiMond ME. Rehabilitative principles in the management of thoracolumbar syndrome: a case report. J Chiropr Med. 2017;16:331-9. [Crossref]  [PubMed]  [PMC] 
  32. Kokubo R, Kim K, Isu T, et al. Superior cluneal nerve entrapment neuropathy and gluteus medius muscle pain: their effect on very old patients with low back pain. World Neurosurg. 2017;98:132-9. [Crossref]  [PubMed]