Long-term Outcome of Surgical Treatment for Superior Cluneal Nerve Entrapment Neuropathy.

Abstract

Prospective observational cohort study. The objective of this study was to present the long-term surgical outcomes of operative treatment for superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) and to analyze the causes of poor results and further treatment required. There are a few reports of the outcomes of surgical treatment for SCNEN, and most studies describe results for operations conducted under general anesthesia with short follow-up periods. Surgery was performed for SCNEN in 52 consecutive patients on 79 sides, excluding patients who had undergone previous surgery on the lumbar spine. Entrapment was unilateral in 25 patients and bilateral in 27. The mean postoperative follow-up period was 41.3 months (range, 29-58 months). All patients had received conservative treatment without improvements, and operations were performed under local anesthesia. Twenty-three cases (44%) involved only low-back pain (LBP), and 31 cases (60%) involved LBP associated with leg numbness or pain. The mean number of SCN branches decompressed in the operative field at the first operation was 1.4 (range, 1-4 branches). There were no local or systemic complications during or after the operation. All patients reported symptom improvement, but LBP caused by SCNEN recurrence was reported for 10 sides (13%) in seven patients who subsequently underwent repeat surgery. In the second surgery, the number of additionally treated SCN branches was 2.0 (range, 1-5). Additional surgeries were performed in two cases for lumbar disorders. All patients showed significant improvement at the last follow-up visit (P < 0.05), including those who developed recurrence. Long-term outcomes of surgical treatment for SCNEN were satisfactory. For prevention of recurrence, as many SCN branches as possible should be decompressed in the operation field during the first operation. 4.