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World Neurosurg. 2017 Feb;98:132-139. doi: 10.1016/j.wneu.2016.10.096. Epub 2016 Oct 27.

Superior Cluneal Nerve Entrapment Neuropathy and Gluteus Medius Muscle Pain: Their Effect on Very Old Patients with Low Back Pain.

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Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Japan. Electronic address:
Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Japan.
Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro City, Hokkaido Prefecture, Japan.
Department of Neurosurgery, Nippon Medical School, Bunkyo, Tokyo, Japan.
Department of Neurosurgery, Teikyo University School of Medicine, Itabashi, Tokyo, Japan.



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.


Between April 2013 and March 2015, we treated 17 consecutive elders with LBP, buttock pain, and leg pain. 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).


SCN-EN was diagnosed in 15 patients (28 sites) and GMeM pain in 14 (27 sites). In 5 patients, we obtained symptom control by local block (Numerical Rating Scale for LBP: declined from 7.8 to 0.8 [P < 0.05], Roland-Morris Disability Questionnaire 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 leg pain postoperatively, they subsequently underwent peroneal nerve neurolysis and surgery for tarsal tunnel syndrome. These treatments resulted in significantly symptom abatement (Numerical Rating Scale: from 8.2 to 1.7, Roland-Morris Disability Questionnaire score: from 12.8 to 8.6; P < 0.05).


Even very old patients with intractable LBP, buttock pain, and leg pain due to SCN-EN or GMeM pain can be treated successfully by peripheral block and less-invasive surgery under local anesthesia.


Buttock pain; Gluteus medius muscle; Leg pain; Less-invasive surgery; Low back pain; Oldest old; Peripheral neuropathy

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