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Stéphane Ploteau, Céline Salaud, Antoine Hamel, Roger Robert
PURPOSE: The apparent failure of pudendal nerve surgery in some patients has led us to suggest the possibility of entrapment of other adjacent nerve structures, leading to the concept of inferior cluneal neuralgia. Via its numerous collateral branches, the posterior femoral cutaneous nerve innervates a very extensive territory including the posterior surface of the thigh, the infragluteal fold, the skin over the ischial tuberosity, but also the lateral anal region, scrotum or labium majus via its perineal branch...
February 24, 2017: Surgical and Radiologic Anatomy: SRA
Amelie Levesque, Thibault Riant, Jean-Jacques Labat, Stephane Ploteau
BACKGROUND: Chronic pelvic, perineal and gluteal neuralgia is often experienced in a similar way to neuropathic pain, in the territories of four nerves: ilio-inguinal, pudendal, inferior cluneal and posterior gluteal nerves. These pains are often refractory to medical treatment based on the use of systemic molecules with disabling adverse effects and surgical procedure may be necessary. OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of treatment with a high-concentration capsaicin patch in these indications...
January 2017: Pain Physician
Hirofumi Tazawa, Yuzo Hirata, Yoshio Kuga, Toshihiro Nishida, Hideto Sakimoto
BACKGROUND: Planning the surgical strategy for a gastrointestinal stromal tumor (GIST) at the posterior wall of the lower rectum is difficult, as the procedures for the lower rectum are hampered by poor visualization and may cause anal dysfunction or discomfort. We report a novel procedure to resect a submucosal tumor of the rectum. CASE PRESENTATION: A 75-year-old woman presented with metrorrhagia. Endovaginal ultrasonography showed a low echoic tumor. Computed tomography showed an enhanced tumor, measuring 5...
December 2017: Surgical Case Reports
Rinko Kokubo, Kyongsong Kim, Toyohiko Isu, Daijiro Morimoto, Naotaka Iwamoto, Shiro Kobayashi, Akio Morita
OBJECTIVE: In the very elderly, their general condition and poor compliance with drug regimens can render the treatment of low back pain (LBP) difficult. We report the effectiveness of a less-invasive treatment for intractable LBP from superior cluneal nerve entrapment neuropathy (SCN-EN) and gluteus medius muscle (GMeM) pain. PATIENTS AND METHODS: Between April 2013 and March 2015, we treated 17 consecutive elders with LBP, buttock pain, and leg pain. They were 4 men and 13 women ranging in age from 85 to 91 years (mean 86...
February 2017: World Neurosurgery
Ke-Vin Chang, Shu-Hao Hsu, Wei-Ting Wu, Levent Özçakar
No abstract text is available yet for this article.
October 13, 2016: American Journal of Physical Medicine & Rehabilitation
Morimoto Daijiro, Isu Toyohiko, Kim Kyongsong, Chiba Yasuhiro, Iwamoto Naotaka, Isobe Masanori, Morita Akio
STUDY DESIGN: Prospective observational cohort study. OBJECTIVE: The objective of this study was to present the long-term surgical outcomes of operative treatment for superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) and to analyze the causes of poor results and further treatment required. SUMMARY OF BACKGROUND DATA: There are few reports of the outcomes of surgical treatment for SCNEN, and most studies describe results for operations conducted under general anesthesia with short follow-up periods...
September 23, 2016: Spine
Vibhor Wadhwa, Kelly M Scott, Shai Rozen, Adam J Starr, Avneesh Chhabra
Chronic pelvic pain is a disabling condition that affects a large number of men and women. It may occur after a known inciting event, or it could be idiopathic. A common cause of pelvic pain syndrome is neuropathy of the pelvic nerves, including the femoral and genitofemoral nerves, ilioinguinal and iliohypogastric nerves, pudendal nerve, obturator nerve, lateral and posterior femoral cutaneous nerves, inferior cluneal nerves, inferior rectal nerve, sciatic nerve, superior gluteal nerve, and the spinal nerve roots...
September 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Mert Akbaş, Mehmet Arif Yeğin, İrem Özdemir, Ethem Göksu, Mahmut Akyüz
Spinal cord stimulation as treatment of chronic low back pain via neuromodulation has been frequently performed in recent years. The dorsal column is stimulated by an electrode placed at the epidural region. In the case presently described, subcutaneous lead was implanted in a patient with failed back syndrome after spinal cord stimulation was inadequate to treat back and gluteal pain. A 65-year-old male had undergone surgery to treat lumbar disc herniation, after which he received physical therapy and multiple steroid injections due to unrelieved pain...
January 2016: Aǧrı: Ağrı (Algoloji) Derneği'nin Yayın Organıdır, the Journal of the Turkish Society of Algology
Gerd Bodner, Hannes Platzgummer, Stefan Meng, Peter C Brugger, Gerlinde Maria Gruber, Doris Lieba-Samal
BACKGROUND: Low back pain is a disabling and common condition, whose etiology often remains unknown. A suggested, however rarely considered, cause is neuropathy of the medial branch of the superior cluneal nerves (mSCN)-either at the level of the originating roots or at the point where it crosses the iliac crest, where it is ensheathed by an osseo-ligamentous tunnel. Diagnosis and treatment have, to date, been restricted to clinical assessment and blind infiltration with local anesthetics...
March 2016: Pain Physician
Yoichi Aota
Entrapment of middle cluneal nerves induces low back pain and leg symptoms. The middle cluneal nerves can become spontaneously entrapped where this nerve pass under the long posterior sacroiliac ligament. A case of severe low back pain, which was completely treated by release of the middle cluneal nerve, was presented. Entrapment of middle cluneal nerves is possibly underdiagnosed cause of low-back and/or leg symptoms. Spinal surgeons should be aware of this clinical entity and avoid unnecessary spinal surgeries and sacroiliac fusion...
March 18, 2016: World Journal of Orthopedics
Daijiro Morimoto, Toyohiko Isu, Kyongsong Kim, Kazuyoshi Yamazaki, Naotaka Iwamoto, Masanori Isobe, Akio Morita
A 43-year-old man with a 10-year history of low back pain (LBP) had been conservatively treated elsewhere with medications for non-specific back pain. He presented to our institute with LBP and difficulty in standing up, sitting down, and sitting for prolonged periods. His Numerical Rating Scale score, due to LBP, was 8 out of 10. He had numbness on the lateral aspect of his left thigh. A lumbar radiography and magnetic resonance imaging studies revealed mild degenerative changes and mild canal stenosis in the lumbar spine...
February 2016: No Shinkei Geka. Neurological Surgery
Naotaka Iwamoto, Toyohiko Isu, Kyongsong Kim, Yasuhiro Chiba, Rinko Kokubo, Daijiro Morimoto, Shinichi Shirai, Kazuyoshi Yamazaki, Masanori Isobe
No abstract text is available yet for this article.
March 2016: World Neurosurgery
Kyongsong Kim, Toyohiko Isu, Yasuhiro Chiba, Naotaka Iwamoto, Kazuyoshi Yamazaki, Daijiro Morimoto, Masanori Isobe, Kiyoharu Inoue
BACKGROUND: Superior cluneal nerve entrapment neuropathy (SCN-EN) may contribute to low back pain (LBP). However, it is often misdiagnosed as lumbar spine disorder and poorly understood. METHODS: Between April 2012 and September 2013, we treated 27 patients (3 men, 24 women; mean age 75.0 years) with LBP due to SCN-EN elicited by vertebral compression fractures. Symptoms were unilateral in 4 patients and bilateral in 23 patients. The interval between symptom onset and treatment averaged 10...
2015: Surgical Neurology International
Jennifer H Yanow, Luigi Di Lorenzo, Sharon C Worosilo, Marco Pappagallo
INTRODUCTION: This is a case presentation of a 45-year-old male with chronic donor site pain following autologous iliac crest bone harvest successfully treated with superior cluneal nerve blockade. Donor site pain following autologous bone harvest is a common postoperative complication of lumbar fusion procedures that can cause significant morbidity and diminish quality of life, even in the context of an otherwise successful surgery. Dysfunction of the superior cluneal nerves is an etiology of this chronic pain...
October 2015: Anesthesiology and Pain Medicine
Yasuhiro Chiba, Toyohiko Isu, Kyongsong Kim, Naotaka Iwamoto, Daijiro Morimoto, Kazuyoshi Yamazaki, Masaaki Hokari, Masanori Isobe, Mitsuo Kusano
OBJECT Superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) is a cause of low-back pain (LBP) that can be misdiagnosed as a lumbar spine disorder. The clinical features and etiology of LBP remain poorly understood. In this study, 5 patients with intermittent LBP due to SCNEN who had previously received conservative treatment underwent surgery. The findings are reported and the etiology of LBP is discussed to determine whether it is attributable to SCNEN. METHODS Intermittent LBP is defined as a clinical condition in which pain is induced by standing or walking but is absent at rest...
October 13, 2015: Journal of Neurosurgery. Spine
A Lee Dellon
PURPOSE: The ischial tuberosity, referred to as the "sit bone" by patients with pain, is surrounded by critical nerves. This research relates, for the first time, the involvement of the posterior femoral cutaneous nerve (PFCN), including its perineal and inferior cluneal branches to the symptom of "sitting pain." An experience with PFCN resection for treatment of pain with sitting is reported. PATIENTS AND METHODS: The computer records were searched from 2010 through August of 2013, identifying 17 patients who had surgery on PFCN...
September 2015: Microsurgery
Hiroshi Kuniya, Yoichi Aota, Takuya Kawai, Kan-ichiro Kaneko, Tomoyuki Konno, Tomoyuki Saito
BACKGROUND: Entrapment of the superior cluneal nerve (SCN) in an osteofibrous tunnel has been reported as a cause of low back pain (LBP). However, there are few reports on the prevalence of SCN disorder and there are several reports only on favorable outcomes of treatment of SCN disorder on LBP. The purposes of this prospective study were to investigate the prevalence of SCN disorder and to characterize clinical manifestations of this clinical entity. METHODS: A total of 834 patients suffering from LBP and/or leg symptoms were enrolled in this study...
2014: Journal of Orthopaedic Surgery and Research
Jared M Kasper, Vibhor Wadhwa, Kelly M Scott, Avneesh Chhabra
Clunealgia is caused by neuropathy of inferior cluneal branches of the posterior femoral cutaneous nerve resulting in pain in the inferior gluteal region. Image-guided anesthetic nerve injections are a viable and safe therapeutic option in sensory peripheral neuropathies that provides significant pain relief when conservative therapy fails and surgery is not desired or contemplated. The authors describe two cases of clunealgia, where computed-tomography-guided technique for nerve blocks of the posterior femoral cutaneous nerve and its branches was used as a cheaper, more convenient, and faster alternative with similar face validity as the previously described magnetic-resonance-guided injection...
July 2014: Clinical Imaging
Khalid Azzam, Justin Siebler, Karl Bergmann, Miguel Daccarett, Matthew Mormino
OBJECTIVES: The purpose of this cadaveric study was to determine the proximity of the neurologic structures to the path of the screw inserted percutaneously into the ischial tuberosity. DESIGN: Cadaver study. INTERVENTION: Ten screws were inserted in 10 limbs (5 cadavers) under fluoroscopic guidance. Dissection was then performed to expose the head of the screw and was extended laterally to expose the sciatic nerve, the posterior cutaneous nerve of the thigh, and its inferior cluneal branches...
January 2014: Journal of Orthopaedic Trauma
Kyongsong Kim, Toyohiko Isu, Yasuhiro Chiba, Daijiro Morimoto, Seiji Ohtsubo, Mitsuo Kusano, Shiro Kobayashi, Akio Morita
Superior cluneal nerve (SCN) entrapment neuropathy is a known cause of low back pain. Although surgical release at the entrapment point of the osteofibrous orifice is effective, intraoperative identification of the thin SCN in thick fat tissue and confirmation of sufficient decompression are difficult. Intraoperative indocyanine green video angiography (ICG-VA) is simple, clearly demonstrates the vascular flow dynamics, and provides real-time information on vascular patency and flow. The peripheral nerve is supplied from epineurial vessels around the nerve (vasa nervorum), and the authors now present the first ICG-VA documentation of the technique and usefulness of peripheral nerve neurolysis surgery to treat SCN entrapment neuropathy in 16 locally anesthetized patients...
November 2013: Journal of Neurosurgery. Spine
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