Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Kamagari, 1715, Japan.
Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan.
Acta Neurochir (Wien). 2024 Feb 2;166(1):59. doi: 10.1007/s00701-024-05960-z.
Low back pain (LBP) can be attributable to entrapment of the superior cluneal nerve (SCN) around the iliac crest. Surgical decompression is a useful treatment; however, finding all entrapped SCNs involved in patients with LBP can be difficult. We performed a retrospective study to help identify entrapped SCNs in the narrow surgical field.
We enrolled 20 LBP patient (22 sides) with SCN entrapment. They were 9 males and 11 females; their mean age was 72.5 years. We developed a 3-step procedure for successful SCN decompression surgery. In step 1, the thoracolumbar fascia is exposed and the SCN penetrating the fascia is released. In step 2, the fascia is opened and the SCN is released. In step 3, the fascia above the iliac crest is opened and the SCN is released.
We successfully released 66 nerves; the average was 3.0 ± 0.8 (1-4) per patient. Step 1 detected 18 nerves (27.3%), step 2 identified 35 (53.0%), and in step 3, 13 (19.7%) were recognized. By tracing the thin nerves branching off the SCN, we found 7 nerves (10.6%). We performed 22 operations; step 1 identified 16 SCNs (72.7%), step 2 identified 21 (95.5%), and step 3 found 12 nerves (54.5%).
The SCN is most readily identified upon opening of the thoracolumbar fascia. To identify as many SCN branches as possible, our 3-step method may be useful.
下腰痛（LBP）可归因于髂嵴周围 Superior Cluneal 神经（SCN）的受压。手术减压是一种有效的治疗方法；然而，在患有 LBP 的患者中找到所有受累的 SCN 可能很困难。我们进行了一项回顾性研究，以帮助确定在狭窄的手术区域中受压的 SCN。
我们纳入了 20 例 SCN 受压的 LBP 患者（22 侧）。他们是 9 名男性和 11 名女性；平均年龄为 72.5 岁。我们开发了一种三步程序，以成功进行 SCN 减压手术。在第 1 步中，暴露胸腰筋膜并释放穿透筋膜的 SCN。在第 2 步中，打开筋膜并释放 SCN。在第 3 步中，打开髂嵴上方的筋膜并释放 SCN。
我们成功释放了 66 根神经；平均每例 3.0±0.8（1-4）根。第 1 步检测到 18 根神经（27.3%），第 2 步识别出 35 根（53.0%），第 3 步识别出 13 根（19.7%）。通过追踪 SCN 分支的细神经，我们发现了 7 根神经（10.6%）。我们进行了 22 次手术；第 1 步识别出 16 根 SCN（72.7%），第 2 步识别出 21 根（95.5%），第 3 步发现 12 根神经（54.5%）。
打开胸腰筋膜时最容易识别 SCN。为了尽可能多地识别 SCN 分支，我们的三步法可能会很有用。
