Baltimore Peripheral Nerve Surgeon Dr. Eric H. Williams Explains How a Nerve Issue Might Be the Cause of Your Chronic Back Pain
Problems with lower back pain aren’t always the result of an issue with your spine. Superior cluneal nerve entrapment is an often overlooked cause of chronic lower back pain. Baltimore peripheral nerve surgeon Dr. Eric H. Williams has extensive experience helping people with superior cluneal nerve entrapment relieve their chronic pain—and he may be able to do the same for you.
Understanding Superior Cluneal Nerve Entrapment
The superior cluneal nerves are primarily responsible for providing sensation to the upper part of your buttocks. They are a part of the peripheral nervous system, originating from the lower thoracic and upper lumbar nerve roots.
After branching off from their respective nerve roots, the superior cluneal nerves travel across your lower back and over the top of your pelvic bone. Several of them travel through this tight fascia just to the outside of the sacroiliac joint.
Entrapment of the superior cluneal nerves can be the result of:
- Trauma or injury. Direct trauma to the lower back or repetitive strain injuries can cause inflammation or damage to the tissues surrounding the superior cluneal nerves.
- Surgical procedures. Certain surgical interventions in the lower back or hip area, such as lumbar spine surgery or procedures involving the iliac crest, can inadvertently affect the superior cluneal nerves.
- Pregnancy. The physical changes and weight gain associated with pregnancy can increase the risk of nerve compression in the lower back area.
- Degenerative spinal changes. Age-related changes in the spine, such as spinal stenosis or degenerative disc disease, can also impact the superior cluneal nerves.
- Anatomical variations. Natural variations in the anatomy of some individuals can predispose them to superior cluneal nerve entrapment.
Symptoms of Superior Cluneal Nerve Entrapment
Every patient is different, but the most common symptoms of superior cluneal nerve entrapment are as follows:
- Pain. Patients typically have severe lower back that is off to the side rather than directly over the spine. In some cases, the pain radiates into the buttocks or hip. The pain from the superior cluneal nerve seems to concentrate about one handbreadth from the midline. It also seems to be very close to the “little dimple” or small depression on a patient's lower posterior pelvis.
- Numbness or tingling. You may experience a loss of sensation or a tingling feeling in the affected area, similar to the feeling of "pins and needles” or an intense burning sensation.
- Hypersensitivity. The skin over the affected area can become extremely sensitive to touch, to the point where even light pressure from clothing can be uncomfortable.
- Limited mobility. Due to pain and discomfort, it might be difficult to perform certain movements or maintain specific postures, like standing or sitting for extended periods. Lying on your back may intensify the pain, which can make it difficult to sleep. Bending over may put traction on these nerves and cause searing pain to occur.
Related Conditions
Superior cluneal nerve entrapment is often overlooked or misdiagnosed because patients have more than one issue that is contributing to their pain. It is not uncommon for Dr. Williams to see patients who have consulted many other doctors and pain management specialists without receiving an appropriate diagnosis.
Failed Back Surgery Syndrome
Failed back surgery syndrome, sometimes called failed back syndrome, occurs when a patient continues to have lower back pain after spine surgery. This can be caused by several different factors, but may occur because a patient has both a spine problem and a peripheral nerve problem, such as superior cluneal nerve entrapment.
Back surgery may treat the issue with the spine, but the pain may continue if there is a persistent entrapment of the superior cluneal nerves and will be expected to continue until the nerve problem is addressed.
Often, these patients have a normal lumbar spine MRI and are frustrated by their continued pain despite surgery. They are often told that their spine surgery looks great, and the patient is left asking why they are in so much pain when everything with the spine looks so good.
Because superior cluneal nerve entrapments are not quite as common as lumbar facet arthritis and herniated disks, frequently, the doctors will treat the X-ray or MRI but fail to recognize that there is a completely different problem that has not been addressed.
Piriformis Syndrome
Piriformis syndrome involves irritation or compression of the sciatic nerve as it passes through or beneath the piriformis muscle in your buttocks. It’s often confused with superior cluneal nerve entrapment due to the overlap in symptoms, although it is possible to suffer from both conditions simultaneously.
Typically, superior cluneal nerve entrapment results in upper buttock pain while piriformis syndrome results in a deeper central buttock pain, often with true sciatica, or pain that radiates down into the leg.
Sciatica
Superior cluneal nerve entrapment is often misdiagnosed as sciatica. Sciatica refers to pain that radiates along the path of the sciatic nerve, which is the longest and largest nerve in the body. This nerve begins in the lower back, running through the buttocks and down the back of each leg.
The primary difference between the two conditions is that sciatica generally involves pain starting in the lower back or buttock that radiates down the back of the leg, often to the foot, while superior cluneal nerve entrapment involves pain in the lower back through the upper buttock—but not into the leg.
Sacroiliac Joint Disease
The sacroiliac joint is also in the same region as the superior cluneal nerve and can, therefore, also cause some diagnostic challenges. The SI joint can be evaluated with an X-ray, MRI, and CT scan to determine if there is severe arthritis or misalignment.
Also, it may be necessary to see an orthopedic surgeon and/or pain management team who specializes in pelvic stability and SI disease to help tease this out. Often, steroid injections performed in the SI joint can be a diagnostic and therapeutic tool to help tease out these two different problems.
Confirming the Diagnosis of Superior Cluneal Nerve Pain With a Nerve Block
With so many different factors to consider, how does a peripheral nerve surgeon determine if you are suffering from superior cluneal nerve entrapment? After examining you and taking note of your symptoms, Dr. Williams will inject pain-relieving medication near the superior cluneal nerves. If this nerve block succeeds in taking away your pain for several hours, it provides good evidence that you have a nerve issue that can be surgically treated. If the nerve block does not provide any pain relief, this suggests your pain is not related to the superior cluneal nerve, and nerve surgery will not be an effective solution. The medical team will need to continue to look for other causes as mentioned above.
Surgical Treatment
Even though a nerve block can temporarily take away the symptoms of superior cluneal nerve entrapment, medication isn’t always a viable long-term option. Medication masks the symptoms, but it doesn’t treat the underlying cause of the pain or prevent further damage to the nerve. For long-term relief, surgical treatment may be the best course of action.
Surgical treatment for superior cluneal nerve entrapment typically involves decompressing the nerve or removing the nerve. Also known as neurolysis or resection, this might involve cutting through tight bands of tissue, removing a portion of a bone that is pressing on the nerve, or clearing away any scar tissue that may be causing the entrapment. It may also involve steps to prevent future entrapment, such as repositioning the nerve or surrounding tissues to reduce the likelihood of recurrence.
In some cases, a neurectomy may be a better course of action. This surgery involves identifying and then cutting or removing the affected portion to disrupt the pain signals transmitted by the nerve. The superior cluneal nerves do not control motor function, so muscle movement is not affected. The area would be numb, but there is generally much less pain in the area, a trade-off most patients will gladly accept.
If you are a candidate for surgery, Dr. Williams will explain the process and answer any questions that you might have about what to expect during the recovery period. His goal as a peripheral nerve surgeon is to determine what may be causing your pain, create a plan to address the cause of your pain, and then execute that plan to improve your health, quality of life, and function.
Don’t Give Up Hope
Cynthia Baker’s story illustrates the importance of persistence when it comes to finding a solution for neuropathic pain. Cynthia had visited 28 doctors in the three years before her first appointment with Dr. Williams. She was unable to walk, drive, or play with her grandchildren without pain. Every day was a struggle.
Cynthia found relief with three different surgical procedures:
- Releasing the common peroneal nerve, superficial peroneal nerve, and sural nerves, which are often injured in ankle sprains
- Correcting a piriformis muscle release done by another surgeon by removing the piriformis muscle entirely
- Removing the superior cluneal nerves
After her second surgery, Cynthia had complete relief from her buttock, leg, and ankle pain. However, she continued to have low back pain in the posterior pelvis. She could have accepted the improvement in her pain as sufficient, but she continued to work with Dr. Williams to find a solution that would allow her to lead an active, fulfilling life.
Today, Cynthia wakes up excited to see what each day will bring. “Being able to sit in my recliner, kick back, be pain-free, and fall asleep—I forgot how nice it was to do that. The last time I could comfortably do that was in 2013. Driving, grabbing my camera and heading out, or even just being with my grandkids—it's all SO much better,” she said.
If you’d like to learn more about the results Dr. Williams has been able to achieve with his patients, refer to the testimonials section of our website.
