Cluneal nerve entrapment decompression: a systematic review of 236 surgical cases.

PURPOSE: Superior (SCN) and middle cluneal nerve (MCN) entrapments are underdiagnosed causes of chronic low back pain (LBP), accounting for 1.6-14% of cases. Targeted nerve blocks that provide at least 50% pain reduction are used to confirm the diagnosis of cluneal nerve entrapment. This systematic review aims to address the clinicopathological features, diagnosis, surgical management, outcomes, and prognosis of patients with cluneal nerve entrapment.

METHOD: This study was a systematic review of the literature. A thorough search of PubMed, MEDLINE, Embase, and CENTRAL was performed. Studies on surgically treated cluneal nerve entrapment were included with the exception of case reports. Descriptive categorical and numerical statistical analyses were used to analyze the data.

RESULT: Fourteen articles involving 236 patients met the inclusion criteria. The average age was 64.68 years, with bilateral involvement in 38.98% of the cases and unilateral involvement in 59.75%. Low back pain (LBP) was reported in all 236 patients (100%). In addition, 209 (88.56%) patients experienced radiating pain in the buttocks. The results showed a significant improvement after surgery: the Visual Analog Scale (VAS) score dropped from 73.63 to 33.31, the Roland-Morris Disability Questionnaire (RDQ) score decreased from 12.49 to 2.52, the Japanese Orthopaedic Association (JOA) score increased from 11.62 to 23.39, and the Numerical Rating Scale (NRS) score decreased from 7.61 to 1.06. Surgical complications were not encountered in any patient; however, 11 (4.6%) patients required a second operation.

CONCLUSION

Cluneal nerve entrapment is a well-established yet underdiagnosed cause of LBP. In this systematic review, surgical decompression offered effective and safe pain relief and functional improvement, with no reported complications and a low reoperation rate. Choosing the right patient and management plan for each case is necessary. Additional research is required to optimize the surgical procedures and evaluate the long-term outcomes.