This patient had a compression of the superior cluneal nerve system. These small nerves travel from the low back and run right over the posterior pelvic bring off of the midline. Most patients have been treated for low back pain for years. The pain tends to be farther lateral than the average patient with low back pain. Cluneal nerve compression or injury is becoming more recognized as an overlooked possible diagnosis for patients with refractory low back pain.
These patients have usually been seen by pain management and a spine team who try to rule out and treat spinal stenosis, spinal arthritis or SI joint complaints.
This patient was having a hard time even standing due to the pain in his low back. Exercise and golf were out of the question due to the pain that was present when he would twist his body.
Because he had failed other treatments, we had recommended and the patient to move forward with surgical resection of these small nerves that travel just over the posterior pelvic bone into the buttock and low back.
We are delighted that he was able to return to golf, exercise, and work without pain in the low back a few months after surgery. We will “chalk this one up” in the win column.