Ultrasonographic Imaging and Guided Intervention for the Superior Cluneal Nerve: A Narrative Pictorial Review.

BACKGROUND

Ultrasound (US) has been widely used for the diagnosis and guided interventions of peripheral nerve disorders. Although superior cluneal nerve (SCN) entrapment is an important cause of lower back pain, a relevant review as to how US can be used for imaging and guided intervention for cases of SCN entrapment is still lacking.

OBJECTIVES

This review aims to revisit the anatomy and pertinent clinical issues of SCN entrapment, as well as the role of US regarding the diagnosis and subsequent management of relevant clinical scenarios.

STUDY

DESIGN

A narrative review.

METHODS

Although the present article is a narrative review, we used a systematic approach to search the relevant literature. The combinations of key words, including SCN, ultrasound, and sonography, were used to search PubMed and Medline without restriction of languages or article types. The search period was from the earliest record through November 2021.

RESULTS

Our included studies showed that high-resolution US and knowledge of sonoanatomy facilitated the visualization of individual branches of the SCN after emerging from the erector spinae muscles. However, the diagnostic block was needed for confirmation of SCN entrapment. Perineural US-guided injection was helpful in relieving the complaints of SCN entrapment; whereas, hydrodissection underneath the thoracolumbar fascia over the iliac crest seems to be a feasible approach for postsurgical analgesia.

LIMITATIONS: There was no clinical trial comparing the efficacy of different injection techniques and regimens.

CONCLUSIONS

US imaging is helpful for guiding injections of SCN entrapment and related clinical conditions. The evidence of US imaging in diagnosing SCN disorders remains insufficient, which requires more prospective studies to validate.