What is a Cluneal Nerve Block?

Cluneal nerve blocks explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Medial Cluneal NervesA cluneal nerve block is a treatment for lower lumbar pain that is minimally invasive. Back pain is one of the most prevalent health conditions in the U.S. and the pain often radiates into the buttocks and lower extremities. According to reports, approximately 80% of adults will experience back pain at some point and this condition is also one of the main reasons that people miss work.

Chronic back pain is hard to diagnose because it may be caused by various factors. Research indicates that the actual cause of back pain is not determined in approximately 90% of the cases. Nonetheless, conditions that typically cause lower back pain include osteoarthritis, spinal stenosis, and bulging discs.

Reviewing a patient’s medical history and conducting an examination that involves diagnostic procedures such as radiographic imaging generally helps physicians identify the most probable source of the pain. However, this does not always guarantee that the problem will be uncovered. One particular condition that may cause lower back pain, but is often misdiagnosed, is cluneal neuropathy. This form of neuropathy results in nerve pain that is felt in the upper region of the buttocks.

How is a Cluneal Nerve Block Performed?

Superior Cluneal NervesPatients lay on their abdomens before the procedure is performed and, in some cases, a local anesthetic is administered to the skin. Furthermore, if a patient needs to be sedated, then vital signs such as heart rate, respiration, and blood pressure will be monitored.

After the needle is correctly positioned through the use of an imaging technique called fluoroscopy, a contrast dye is injected to confirm the placement. An anesthetic and steroid are then injected directly onto the cluneal nerve area. This steroid has long-lasting effects and the injection is administered as close to the nerve roots as possible. This entire procedure usually takes about 15 minutes.

A recently published study that evaluated the effectiveness of cluneal nerve blocks at treating pain that develops due to cluneal nerve block entrapment demonstrated the success of this treatment. The clinical trial involved 25 patients who were suffering from medial superior cluneal nerve entrapment and underwent a cluneal nerve block. At a one year follow-up visit, the majority of the patients still reported complete pain relief.

Although a cluneal nerve block is a safe procedure that is minimally invasive, there are certain risks that are associated with this technique such as an infection at the injection site, nerve damage, numbness, and bleeding.

Conditions Related to Cluneal Nerve Blocks

Lower Back PainA description of the anatomical structure of the middle cluneal nerves and the superior cluneal nerves helps provide an understanding of the types of conditions that can be treated with this nerve block.

  • The middle cluneal nerve bundle is in the lower region of the back between S1 and S3 of the dorsal rami. This structure transfers visceral, somatic, and sensory information.
  • The superior cluneal nerve bundle is in the upper portion of the buttocks between L1 and L3 of the dorsal rami. This structure transfers sensory information in the buttocks.

Due to the location of these nerves being in the lower back and upper buttocks region, chronic pain that radiates throughout the buttocks and even the legs may be due to what is known as medial superior cluneal nerve entrapment (MSCNE). MSCNE and facet syndrome often cause the same types of symptoms. Cluneal nerve entrapment, however, involves the impingement of cluneal nerves that causes friction between the nerves and the iliac crest. If the possible source of back pain is cluneal nerve entrapment, the presence of the following clinical criteria will be assessed:

  • Chronic lower back pain and pain that is localized to upper region of the buttocks on one side
  • Tenderness in the region of the buttocks called the trigger point
  • The inability to sit for long periods of time

A cluneal nerve block provides patients with significant pain relief from MSCNE. Although cluneal nerve blocks are effective treatments for nerve pain, they are also commonly utilized as a diagnostic technique. More specifically, nerve blocks help physicians identify regions in the spinal area that may be responsible for pain.

Reports explain that this procedure can lead to relief that starts within minutes following the injection. Furthermore, if an immediate reduction in pain occurs, it provides a physician with a confirmation that MSCNE was causing the discomfort. A successful cluneal nerve block can also help a patient avoid having to undergo back surgery.

Conclusion

A cluneal nerve block is an effective treatment option for nerve pain, especially nerve entrapment. Medical literature describes this procedure as both effective for the management of pain as well as a useful diagnostic tool.

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References

  1. Ermis M, Yildrum D, Duraknasa M, Tanam C, Ermis O. Medial superior cluneal nerve entrapment neuropathy in military personnel; diagnosis and etiologic factors. J Back Muscul Rehab. 2011;4:137-144.
  2. Herring A, Price D, Nagdev A, Simon B. Superior cluneal nerve block for treatment of buttock abcesses in the emergency department. JEM. 2009;39(1):83-85.
  3. Talu G, Suleyman O, talu U. Supeior cluneal nerve entrapment. Regional Anesthesia and Pain Medicine. 2000;25(6):648-650.
  4. Wisotzky E, Cocchiarella A. Cluneal neuropathy – An underdiagnosed cause of low back pain: A case series. PM&R. 2010;2(9):73-74.