Chauhan Gaurav, Levy Isaiah, DeChellis David
Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Presbyterian, Pittsburgh, USA.
Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, USA.
Cureus. 2022 Mar 31;14(3):e23711. doi: 10.7759/cureus.23711. eCollection 2022 Mar.
Superior cluneal neuralgia (SCN) can often be misdiagnosed when evaluating a patient with low back pain (LBP). The pathomechanics of SCN can range from direct injury following surgeries or trauma to myofascial compression due to abnormal muscle tone or fibrosis. The authors present a case of SCN in a 65-year-old male that persisted for three years following a laminectomy complicated by retained hardware and subsequent fibrosis. The patient's diagnosis was confirmed with a diagnostic nerve block with significant pain relief after initial misdiagnosis and unsuccessful interventions targeting other possible pain generators. He ultimately underwent a successful peripheral nerve stimulation (PNS) trial and implantation with significant long-term pain relief. This case report entails the need to consider SCN in the differential for low back pain and the successful utilization of PNS for treatment.
在评估下腰痛(LBP)患者时,臀上皮神经痛(SCN)常常会被误诊。SCN的发病机制多样,从手术或外伤后的直接损伤到因异常肌张力或纤维化导致的肌筋膜压迫。作者报告了一例65岁男性的SCN病例,该病例在椎板切除术后因内固定物残留及随后的纤维化而持续了三年。患者最初被误诊,针对其他可能的疼痛源进行的干预也未成功,后通过诊断性神经阻滞确诊,疼痛得到显著缓解。他最终成功接受了外周神经刺激(PNS)试验并植入装置,长期疼痛得到显著缓解。本病例报告强调了在鉴别下腰痛时需要考虑SCN,以及PNS在治疗中的成功应用。