Department of Neurological Surgery, Kushiro Rosai Hospital, 13-23, Nakazonomachi, Kushiro City, Hokkaido, Japan.
Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Acta Neurochir (Wien). 2021 Mar;163(3):817-822. doi: 10.1007/s00701-020-04676-0. Epub 2021 Jan 6.
Entrapment of the middle cluneal nerve (MCN), a peripheral nerve in the buttock, can elicit low back pain (LBP). We examined the epidemiology, clinical course, and treatment of MCN entrapment (MCN-EN).
Among 383 LBP patients who visited our institute, 105 were admitted for intractable LBP. They were 42 men and 63 women; their average age was 64 years. Based on clinical symptoms, palpation, and the effects of MCN block, we suspected MCN-EN in these 105 patients, 50 of whom are our study subjects. Their treatment outcomes were assessed at the time of discharge and at follow-up visits.
MCN-EN was diagnosed in 50 of the 383 patients (13.1%) and they were hospitalized. In 43 (11.2%), MCN-EN was associated with other diseases (superior cluneal nerve entrapment, n = 21, sacroiliac joint pain, n = 9, other, n = 13). At the time of discharge, the symptoms of patients with LBP due to MCN-EN were significantly improved by repeat MCN blocks. In 7 of the 383 patients (1.8%), LBP was improved by only MCN blocks; 5 of them had reported leg symptoms in the dorsal part of the thigh. After discharge, 22 of the 50 hospitalized patients required no additional treatments after 2-5 blocks; 19 required only conservative treatment, and 9 underwent microsurgical release of the MCN.
We confirmed MCN-EN in 50 of 105 patients admitted for intractable LBP. Repeat MCN blocks were effective in 22 patients; 19 required additional conservative treatment, and 9 underwent surgery. Buttock pain radiating to the posterior thigh was an MCN-EN symptom that has been diagnosed as pseudo-sciatica. Before subjecting patients with intractable LBP to surgery, the presence of MCN-EN must be ruled out.
臀中部神经（MCN）是臀部的外周神经，受卡压可引发腰痛（LBP）。我们研究了 MCN 卡压（MCN-EN）的流行病学、临床病程和治疗方法。
在我院就诊的 383 例腰痛患者中，有 105 例因难治性腰痛住院。他们中 42 例为男性，63 例为女性；平均年龄为 64 岁。根据临床症状、触诊和 MCN 阻滞的效果，我们怀疑这 105 例患者中有 50 例患有 MCN-EN，其中 50 例为我们的研究对象。在出院时和随访时评估他们的治疗效果。
383 例患者中诊断出 50 例（13.1%）MCN-EN，他们住院治疗。其中 43 例（11.2%）MCN-EN 与其他疾病有关（臀上神经卡压 21 例、骶髂关节痛 9 例、其他 13 例）。在出院时，因 MCN-EN 而导致腰痛的患者经重复 MCN 阻滞后症状明显改善。在 383 例患者中，仅 MCN 阻滞就改善了 7 例（1.8%）LBP；其中 5 例大腿背侧有腿部症状。出院后，50 例住院患者中有 22 例在 2-5 次阻滞治疗后无需进一步治疗；19 例仅需要保守治疗，9 例接受了 MCN 显微松解术。
我们在 105 例因难治性腰痛住院的患者中证实了 50 例患有 MCN-EN。重复 MCN 阻滞对 22 例患者有效；19 例需要额外的保守治疗，9 例需要手术。放射至大腿后侧的臀部疼痛是 MCN-EN 的一种症状，已被诊断为假性坐骨神经痛。对难治性腰痛患者进行手术前，必须排除 MCN-EN 的存在。
