Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, 1715, Kamagari, Inzai-city, Chiba, Japan.
Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan.
Acta Neurochir (Wien). 2021 Mar;163(3):823-828. doi: 10.1007/s00701-020-04404-8. Epub 2020 May 15.
Middle cluneal nerve entrapment (MCN-E) around the sacroiliac joint can elicit low back pain (LBP). Pain control can be obtained with anesthetic nerve blocks; however, when their effectiveness is transient, surgical release may be necessary. We investigated the efficacy of radiofrequency thermocoagulation (RFTC) in patients with MCN-E.
Between December 2018 and August 2019, 11 consecutive patients (4 men, 7 women; mean age 76.4 years) with intractable medial buttock pain due to MCN-E underwent MCN RFTC. The mean symptom duration was 49.5 months; pre-RFTC local MCN blocks provided pain relief for a mean of 7.7 days. The severity of pain in the medial buttock due to MCN-E was recorded before and 2, 6, 12, and 24 weeks after RFTC on the numerical rating scale (NRS) and the Roland-Morris Disability Questionnaire (RDQ).
All patients reported pain alleviation; there were no complications. While there was a significant difference in the pre- and post-RFTC treatment NRS (p < 0.05), the RDQ scores were significantly lower only after 12 weeks. The duration of pain relief was significantly prolonged by RFTC (p < 0.05). Two patients suffered pain relapse 10 weeks post-RFTC; pain alleviation was obtained by re-RFTC performed 2 weeks after pain recurrence. Two other patients relapsed 20 and 21 weeks post-RFTC; their symptoms also disappeared by MCN block administered 24 weeks after they had undergone RFTC.
RFTC may safely control intractable LBP due to MCN-E.
中臀神经（MCN）在骶髂关节周围受压可引起腰痛（LBP）。通过神经阻滞麻醉可以控制疼痛；然而，当它们的效果是短暂的，可能需要手术松解。我们研究了射频热凝（RFTC）治疗 MCN-E 患者的疗效。
2018 年 12 月至 2019 年 8 月，11 例因 MCN-E 导致顽固性臀内侧疼痛的连续患者（4 名男性，7 名女性；平均年龄 76.4 岁）接受了 MCN RFTC。平均症状持续时间为 49.5 个月；术前 MCN 局部阻滞可缓解疼痛，平均持续 7.7 天。在 RFTC 前、2、6、12 和 24 周，用数字评分量表（NRS）和 Roland-Morris 残疾问卷（RDQ）记录 MCN-E 引起的臀内侧疼痛的严重程度。
所有患者均报告疼痛缓解；无并发症。虽然 RFTC 前后治疗的 NRS 评分有显著差异（p < 0.05），但仅在 12 周后 RDQ 评分显著降低。RFTC 显著延长了疼痛缓解的持续时间（p < 0.05）。2 例患者在 RFTC 后 10 周出现疼痛复发；在疼痛复发后 2 周进行再次 RFTC 后缓解了疼痛。另外 2 例患者在 RFTC 后 20 和 21 周复发；在接受 RFTC 后 24 周接受 MCN 阻滞治疗后，他们的症状也消失了。
RFTC 可安全控制 MCN-E 引起的顽固性 LBP。
