Superior Cluneal Nerve Entrapment Neuropathy and Gluteus Medius Muscle Pain: Their Effect on Very Old Patients with Low Back Pain.

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 86.6 years). We carefully ascertained that their symptoms were attributable to SCN-EN and GMeM pain. The median follow-up period was 21.5 ± 12.2 months (range 2-35 months).

RESULTS: SCN-EN was diagnosed in 15 patients (28 sites) and GMeM pain in 14 (27 sites). In 5 patients, we obtained symptom control by local block (Numerical Rating Scale for LBP: declined from 7.8 to 0.8 [P < 0.05], Roland-Morris Disability Questionnaire score: declined from 16.5 to 5.2). The other 12 were operated under local anesthesia (SCN neurolysis, GMeM decompression). As 3 patients reported the persistence of leg pain postoperatively, they subsequently underwent peroneal nerve neurolysis and surgery for tarsal tunnel syndrome. These treatments resulted in significantly symptom abatement (Numerical Rating Scale: from 8.2 to 1.7, Roland-Morris Disability Questionnaire score: from 12.8 to 8.6; P < 0.05).

CONCLUSIONS: Even very old patients with intractable LBP, buttock pain, and leg pain due to SCN-EN or GMeM pain can be treated successfully by peripheral block and less-invasive surgery under local anesthesia.