Department of Orthopaedic Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
J Neurosurg Spine. 2013 Jul;19(1):76-80. doi: 10.3171/2013.4.SPINE12683. Epub 2013 May 3.
Entrapment of the superior cluneal nerve (SCN) in an osteofibrous tunnel in the space surrounded by the iliac crest and the thoracolumbar fascia is a cause of low-back pain (LBP). Several anatomical and surgical reports describe SCN entrapment as a cause of LBP, and a recent clinical study reported that patients with suspected SCN disorder constitute approximately 10% of the patients suffering from LBP and/or leg symptoms. However, a detailed anatomical study of SCN entrapment is rare. The purpose of this study was to investigate the courses of SCN branches and to ascertain the frequency of SCN entrapment.
Branches of the SCN were dissected in 109 usable specimens (54 on the right side and 55 on the left side) obtained in 59 formalin-preserved cadavers (average age at death 84.8 years old). All branches were exposed at the points where they perforated the thoracolumbar fascia. The presence or absence of an osteofibrous tunnel was ascertained and, if present, the entrapment of the branches in the tunnel was determined.
Of 109 specimens, 61 (56%) had at least 1 branch running through an osteofibrous tunnel. Forty-two medial (39%), 30 intermediate (28%), and 14 lateral (13%) SCN branches passed through such a tunnel. Of these, only 2 medial branches had obvious entrapment in an osteofibrous tunnel. There were several patterns for the SCN course through the tunnel: medial branch only (n = 25), intermediate branch only (n = 11), lateral branch only (n = 4), medial and intermediate branches (n = 11), medial and lateral branches (n = 2), intermediate and lateral branches (n = 4), and all branches (n = 4).
Several anatomical variations of the running patterns of SCN branches were detected. Entrapment was seen only in the medial branches. Although obvious entrapment of the SCN is rare, it may cause LBP.
在由髂嵴和胸腰筋膜围绕的空间中，坐骨神经上支（SCN）被纤维骨性隧道所卡压是导致下腰痛（LBP）的一个原因。一些解剖学和外科报告描述了 SCN 卡压是 LBP 的一个原因，最近的一项临床研究报告称，疑似 SCN 障碍的患者约占 LBP 和/或腿部症状患者的 10%。然而，对 SCN 卡压的详细解剖学研究却很少。本研究旨在探讨 SCN 分支的走行，并确定 SCN 卡压的发生率。
在 59 具福尔马林固定的尸体（平均死亡年龄 84.8 岁）中获得的 109 个可用标本（右侧 54 个，左侧 55 个）中解剖了 SCN 分支。所有分支均在穿过胸腰筋膜处暴露。确定是否存在纤维骨性隧道，并确定分支是否在隧道中卡压。
在 109 个标本中，有 61 个（56%）至少有 1 个分支穿过纤维骨性隧道。42 个内侧（39%）、30 个中间（28%）和 14 个外侧（13%）SCN 分支穿过这样的隧道。其中，只有 2 个内侧分支在纤维骨性隧道中有明显的卡压。SCN 通过隧道的走行有几种模式：仅内侧分支（n=25）、仅中间分支（n=11）、仅外侧分支（n=4）、内侧和中间分支（n=11）、内侧和外侧分支（n=2）、中间和外侧分支（n=4）以及所有分支（n=4）。
检测到 SCN 分支的几种解剖学变异。仅在内侧分支中观察到卡压。尽管 SCN 的明显卡压很少见，但它可能导致 LBP。
