Wang Yu, Yang Jin, Yan Yuqing, Zhang Lifeng, Guo Chuan, Peng Zhiyu, Kong Qingquan
Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wainan Street, Wuhou District, Chengdu, 610041, Sichuan, China.
BMC Musculoskelet Disord. 2018 Jul 11;19(1):214. doi: 10.1186/s12891-018-2147-y.
Recent reported results by Fang et al. published in BMC Musculoskeletal Disorders have added to the weight of evidence supporting association between gluteal pain and lumbar disc hernia. Their clinical finding shows the L4/5 level is the main level responsible for gluteal pain in lumbar disc hernia. Indeed, many possible mechanisms may explain why patients experience pain in the gluteal area. In this Correspondence, we would like to highlight several possible mechanisms of LDH-related gluteal pain based on detailed analysis of the sensory innervation of the gluteal region. We hope this can better explain the phenomenon found by Fang et al. We believe the principle mechanism is compression/irritation of L5 or S1 dorsal rami (intraspinal portion), which produce gluteal pain by irritating superior/medial cluneal nerve and referred pain from facet joints and sacroiliac joints. In addition, the presence of proximal sciatica could also induce gluteal pain. Lastly, fibers in the superior or inferior gluteal nerve could be compressed/irritated in LDH, inducing LDH-related gluteal pain. However, additional studies are needed in the future to delineate the exact mechanism(s).
方等人近期发表于《BMC肌肉骨骼疾病》的研究结果进一步增加了支持臀痛与腰椎间盘疝之间关联的证据分量。他们的临床发现表明，L4/5节段是腰椎间盘疝中导致臀痛的主要节段。实际上，许多可能的机制可以解释患者为何会在臀区感到疼痛。在本通讯文章中，我们希望基于对臀区感觉神经支配的详细分析，着重介绍几种与腰椎间盘疝相关的臀痛可能机制。我们希望这能更好地解释方等人所发现的现象。我们认为主要机制是L5或S1背支（脊髓内部分）受到压迫/刺激，通过刺激臀上皮神经以及小关节和骶髂关节的牵涉痛而产生臀痛。此外，近端坐骨神经痛的存在也可能诱发臀痛。最后，臀上神经或臀下神经的纤维在腰椎间盘疝中可能受到压迫/刺激，从而引发与腰椎间盘疝相关的臀痛。然而，未来还需要更多研究来明确确切机制。
