Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, Missouri.
Department of Neurological Surgery, University of Southern California, Los Angeles, California.
Pain Physician. 2022 Aug;25(5):355-363.
The most common presentation of cluneal neuropathy is ipsilateral low back and gluteal pain. Cluneal neuralgia has been described historically in surgical contexts, with much of the description and treatment related to entrapment and decompression, respectively. Treatment options for addressing axial low back pain have evolved with advancements in the field of interventional pain medicine, though clinical results remain inconsistent. Recent attention has turned toward peripheral nerve stimulation. Nonsurgical interventions targeting the superior and medial cluneal nerve branches have been performed in cases of low back and buttock pain, but there is no known review of the resulting evidence to support these practices.
In this manuscript we provide a robust exploration and analysis of the available literature regarding treatment options for cluneal neuropathy. We provide clinical manifestations and recommendations for future study direction.
Narrative review.
This was a systematic, evidence-based narrative, performed after extensive review of the literature to identify all manuscripts associated with interventional treatment of the superior and medial cluneal nerves.
Eleven manuscripts fulfilled inclusion criteria. Interventional treatment of the superior and middle cluneal nerves includes blockade with corticosteroid, alcohol neurolysis, peripheral nerve stimulation, radiofrequency neurotomy, and surgical decompression.
The supportive evidence for interventions in cluneal neuropathy is largely lacking due to small, uncontrolled, observational studies with multiple confounding factors. There is no standardized definition of cluneal neuropathy.
Limited studies promote beneficial effects from interventions intended to target cluneal neuropathy. Despite increased emphasis and treatment options for this condition, there is little consensus on the diagnostic criteria, endpoints, and measures of therapeutics, or procedural techniques for blocks, radiofrequency, and neuromodulation. It is imperative to delineate pathology associated with the cluneal nerves and perform rigorous analysis of associated treatment options.
最常见的臀上皮神经病变表现为同侧腰痛和臀痛。臀上皮神经痛在历史上曾在外科环境中被描述，其大部分描述和治疗分别与卡压和减压有关。随着介入疼痛医学领域的进步，治疗轴性腰痛的选择也在不断发展，但临床结果仍不一致。最近，人们对周围神经刺激的关注有所增加。针对腰背和臀部疼痛，已对臀上皮神经的上支和内支进行了非手术干预，但尚无针对这些治疗方法的证据进行综述的报道。
本文旨在对臀上皮神经病变的治疗选择进行全面的文献回顾和分析，提供臀上皮神经病变的临床表现和未来研究方向的建议。
叙述性综述。
这是一项系统的、基于证据的叙述性综述，在广泛回顾文献的基础上，确定了所有与治疗上、中臀皮神经相关的介入治疗文献。
11 篇文献符合纳入标准。上、中臀皮神经的介入治疗包括：皮质类固醇阻滞、酒精神经松解术、周围神经刺激、射频神经切断术和手术减压。
由于存在多种混杂因素的小型、非对照、观察性研究，臀上皮神经病变干预措施的支持证据主要缺乏。目前还没有关于臀上皮神经病变的标准化定义。
有限的研究表明，针对臀上皮神经病变的干预措施具有有益效果。尽管人们越来越关注这种疾病并提出了更多的治疗选择，但对于诊断标准、终点、治疗学的衡量标准，以及阻滞、射频和神经调节的程序技术，尚未达成共识。明确与臀上皮神经相关的病理学，并对相关治疗方法进行严格分析至关重要。
