Superior cluneal nerve entrapment neuropathy and gluteus medius muscle pain: Their effect on very old patients with low back pain

Abstract Objective In the very elderly, their general condition and poor compliance with drug regimens can render the treatment of low back pain (LBP) difficult. We report the effectiveness of a less invasive treatment for intractable LBP from superior cluneal nerve entrapment neuropathy (SCN-EN) and gluteus medius muscle (GMeM) pain. Patients and Methods Between April 2013 and March 2015, we treated 17 consecutive elders with LBP and buttock- and leg pain (BuP, LP). They were 4 men and 13 women ranging in age from 85 to 91 years (mean 86.6 years). We carefully ascertained that their symptoms were attributable to SCN-EN and GMeM pain. The median follow-up period was 21.5 ±12.2 months (range 2 - 35 months). Results SCN-EN was diagnosed in 15 patients (28 sites), GMeM pain in 14 (27 sites). In 5 patients we obtained symptom control by local block [numerical rating scale (NRS) for LBP: declined from 7.8 to 0.8 (p < 0.05), Roland-Morris Disability Questionnaire (RDQ) score: declined from 16.5 to 5.2]. The other 12 were operated under local anesthesia (SCN neurolysis, GMeM decompression). As 3 patients reported the persistence of LP postoperatively, they subsequently underwent peroneal nerve neurolysis and surgery for tarsal tunnel syndrome. These treatments resulted in significantly symptom abatement [NRS: from 8.2 to 1.7, RDQ score: from 12.8 to 8.6 (p < 0.05)]. Conclusion Even very old patients with intractable LBP, BuP, and LP due to SCN-EN or GMeM pain can be successfully treated by peripheral block and less invasive surgery under local anesthesia.