189 Describing a Novel Diagnosis Pathway for Cluneal Neuropathy

Abstract

INTRODUCTION: Sacroiliac (SI) pain is frequently experienced by individuals who have undergone lumbosacral surgery, with a quarter of cases due to SI joint dysfunction (SIJD). Diagnosing SIJD involves following rigorous NASS guidelines. If these criteria are not met, cluneal neuropathy (CN), a rare cause of SI pain, should be considered. In this study we describe a novel diagnostic pathway for identifying CN as there are currently no formal diagnostic criteria. METHODS: A single institution’s medical records were queried for patients who underwent US testing for CN from 2018-2022. Data was extracted for the following variables: SI provocative maneuvers (PM), PSIS tenderness, SIJD injection pain relief, CN ultrasound, and CN injection pain relief. Demographic information and surgical history were recorded. SIJD negative patients were evaluated using proposed diagnostic pathway and data was analyzed using descriptive statistics. RESULTS: 24 patients (mean age 58.8 years, 62.5% female) were included. All patients presented with comorbid spinal pathology. 87% were positive for both CN (positive entrapment on ultrasound + <75% pain relief on SI injection) and Thigh Thrust, 78% for FABER, 86% for Compression, 100% for Sacral Distraction, 89% for Gaenslen’s. 79% had tenderness upon PSIS palpation. 92% of patients with >3 positive PMs had positive CN. CONCLUSIONS: This novel pathway effectively showcases cluneal neuropathy as a potential etiology for low-back-pain. Ultimately, SIJD provocative maneuvers were positive in patients with CN, likely because these maneuvers cause compression of the cluneal nerves. Thus, a diagnosis of CN should be considered, particularly in patients with PSIS tenderness or previous SI fusion.