Letters to the Editor

Abstract

Dear Sir: We are writing regarding the study by Lu et al.2 The authors of that study described the relationship of the nerve with the iliac crest in 15 dissections and note the presence of an entrapped nerve in two cases. They claim that "The regional anatomy of the superior cluneal nerve has not been well documented in the literature" and that "The actual lesion [of an entrapment neuropathy of this nerve] has not been identified." We think that the available literature has not been researched sufficiently. Garvey et al1 did not describe the clinical basis of superior cluneal nerve entrapment. They merely compared modalities of treating iliac crest trigger points, without going into the origins of, or mechanisms underlying, these trigger points. We were the first to describe the actual entrapment. In our paper which is quoted by the authors,5 and another article published in 1989,4 we presented a comprehensive study of the anatomy of the superior cluneal nerve, showing its distribution and iliac crest crossing patterns. To the best of our knowledge. we were the first to describe, and present photographic evidence of a superior cluneal nerve entrapment syndrome. The only difference between the study by Lu et al and ours is that we dissected 37 cadavers, whereas Lu et al2 examined 15 cadavers. Our broad based study allowed us to describe three different distribution patterns. Furthermore, we recently have published the results of surgical neurolysis in 19 patients with unilateral low back pain related to this entrapment neuropathy.3 Our findings provided evidence of the existence of this neuropathy in vivo. Therefore, the conclusions drawn by Lu et al are correct, but their article lacks originality. The study on which it is based is less extensive than the one performed by us in 1991. Because studies on this subject are few, it would not have affected the value of the paper by Lu et al if the authors had cited our work, to confirm our findings or criticize our statements, as they saw fit. We would be much obliged if you could correct the distorted impression that may have resulted from the publication of the paper by Lu et al. Jean-Yves Maigne, MD Levon Doursounian, MD Paris, France