Cluneal Nerve Block

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Cluneal Nerve Block 2016-11-04T09:33:40+00:00

What is a Cluneal Nerve Block?

Cluneal Nerve Blocks performed by Las Vegas, Summerlin, and Henderson Nevada’s Top Pain Doctors

A cluneal nerve block is a minimally invasive procedure used to treat people with lower lumbar pain that radiates to the upper portion of the buttocks. Back pain is one of the most common health concerns in the United States. It affects about 80% of people at some point in their lives and is the leading cause for missed work in America.

The exact cause of chronic back pain is often difficult to diagnose. Current research has revealed that in approximately 90% of back pain cases a precise cause of pain cannot be identified. There are numerous conditions that can result in lower back, such as bulging discs, spinal stenosis, osteoarthritis and other potentially disabling conditions.

Patient history assessments regarding symptoms, radio-graphic imaging and spinal diagnostic procedures can sometimes be successful in finding the source of the pain. Nevertheless, in some cases they fail to locate the exact cause. Pain in the nerves in the upper part of the buttocks, also known as cluneal neuropathy, is an often under-diagnosed cause of lower back pain.

How is a Cluneal Nerve Performed?

Medial Cluneal NervesPrior to the procedure, the patient is positioned face down on an x-ray table. The patient’s skin is cleaned and prepped for the injection. If IV sedation is used, vital signs such as blood pressure, heart rate, and breathing are monitored. Once the skin is sterile, a local anesthetic is used as a numbing agent.

A long-lasting steroid medication is then injected into the affected cluneal nerve area. During the injection, the doctor uses a special real-time x-ray, known as a fluoroscope, to guide the needle. This helps deliver the steroid medication as closely as possible to the aggravated and inflamed nerve root. A contrast dye is injected to locate the exact area and then doctors inject the anesthetic and steroid medication. The procedure takes approximately fifteen minutes.

A recent study reported in the Journal of Back and Musculoskeletal Rehabilitation investigated the effects of cluneal nerve blocks on pain associated with cluneal nerve block entrapment. During this investigation, 25 patients with medial superior cluneal nerve entrapment received a single cluneal nerve block injection of local anesthetic and steroids. Doctors evaluated the patients one year after the injection and in all cases the pain was relieved.

Cluneal nerve blocks are considered minimally invasive procedures; however, as with all procedures, there is some risk of complications, which include nerve damage, bleeding, numbness in the extremities, and infection.

Conditions related to a Cluneal Nerve Block

Superior Cluneal NervesTo better understand what conditions a cluneal nerve block can treat, it is important to recognize the anatomy of the middle and superior cluneal nerves:

  • Medial cluneal nerves are positioned in the S1 to S3 area of the dorsal rami, which is located in the lower back. The dorsal rami transmits sensory, somatic and visceral messages in the nerves of the lower back. The middle cluneal nerves extend to the postier superior iliac spine.
  • Superior cluneal nerves are positioned at the L1 to L3 area of the dorsal rami, which is located at the top part of the buttocks. They make up the very end of the lumbar spinal nerve area. The superior cluneal nerves transmit sensory messages in that area.

Complaints of pain in the lower back that radiates into the upper gluteal area could be caused by entrapment of the cluneal nerves. This condition, known as medial superior cluneal nerve entrapment (MSCNE), has similar symptoms and clinical features as facet syndrome. However, cluneal nerve entrapment is characterized by cluneal nerves that become impinged in their tunnel against the iliac crest.

If your doctor suspects cluneal nerve entrapment as the potential source of your pain, the clinical examination will assess the following criteria:

  • Tenderness in the “trigger point” area of the buttocks
  • Intolerance to sit for extended time periods
  • Persistent pain in the lower back and on one side of the upper buttocks region

Cluneal nerve blocks can provide therapeutic benefits for medial superior cluneal nerve entrapment. Along with the known therapeutic advantages, another factor to consider regarding cluneal nerve blocks is their diagnostic capability. Pain relief from a cluneal nerve block not only alleviates pain in that area, it also helps to identify the source of the pain in the space where the injection takes place.

Current research indicates that relief can be felt as quickly as a few minutes after the injection takes place. When this happens, it confirms a positive diagnosis of medial superior cluneal nerve entrapment.  Another benefit concerning successful cluneal injections in patients is that they can significantly decrease potential premature or unwarranted lower back surgery.

Nerve BlockWhile lying face down, your skin is cleaned and prepped for the injection. If IV sedation is used, your vital signs (blood pressure, heart rate and breathing) will be monitored during the procedure. Once the skin is sterile, a local anesthetic is used to numb the skin prior to the cluneal nerve block.

A long-lasting steroid medication is then injected into the affected cluneal nerve area. During the injection, the doctor uses a special real-time X-ray, known as a fluoroscope, to guide the needle. This will help deliver the steroid medication as close as possible to the aggravated and inflamed nerve root. Once the contrast dye is injected to locate the exact area, doctors inject the anesthetic and steroid medication. The procedure takes approximately fifteen minutes.

A recent study reported in the Journal of Back and Musculoskeletal Rehabilitation investigated the effects of cluneal nerve blocks on pain associated with cluneal nerve block entrapment. During this investigation, 25 patients with medial superior cluneal nerve entrapment received a single cluneal nerve block injection of local anesthetic and steroid. Doctors evaluated the patients one year after the injection, and in all cases the pain was relieved.

Cluneal nerve blocks are considered minimally invasive procedures; however, as with all procedures, there is some risk of complications, which include: nerve damage, bleeding, numbness in the extremities, and infection.

Conclusion

If you are suffering from chronic lower back pain that radiates to one side of the buttocks, minimally invasive cluneal nerve blocks may be a viable non-surgical option to help relieve the pain. Talk to your pain specialist regarding your options, or in regard to any additional questions you may have concerning this procedure. A doctor who specializes in pain management can work with you to help determine the most suitable options concerning your specific pain.

At Nevada Pain our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 702-912-4100.

References

  1. Ermis M, Yildrum D, Duraknasa M, Tanam C, Ermis O. Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors. J Back Muscul Rehab. 2011;4:137-144.
  2. Herring A, Price D, Nagdev A, Simon B. Superior cluneal nerve block for treatment of buttock abcesses in the emergency department. JEM. 2009;39(1):83-85.
  3. Talu G, Suleyman O, talu U. Supeior cluneal nerve entrapment. Regional Anesthesia and Pain Medicine. 2000;25(6):648-650.
  4. Wisotzky E, Cocchiarella A. Cluneal neuropathy – An underdiagnosed cause of low back pain: A case series. PM&R. 2010;2(9):73-74.

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