Research Article
Volume 11 Issue 3 - 2020
A Radiofrequency Treatment Pathway for Cluneal Nerve Disorders
Martin Knight1*, Indu Karangoda2, Rahim Nadeem Ahmed3, Thomas D’Angelo4, James Inklebarger5, Babar Abbas6 and Jamshid Dehmeshki7
1Consultant Endoscopic Spine Surgeon, Senior Lecturer Manchester University, The Medical Director, The Spinal Foundation, The Weymouth Hospital, London, UK
2Consultant in Anaesthesia and Intensive Care Medicine, Lewisham and Greenwich NHS Trust, University Hospital Lewisham, London, UK
3College Tutor (RCoA UK), Consultant Anaesthesia and Intensive Care Medicine, Croydon University Hospital, London, UK
44Radiology Department, Fawkham Manor Hospital, UK
5Faculty of the London College of Osteopathic Medicine, London, UK
6Senior Lecturer, Faculty of Science, School of Life Sciences, Kingston University, UK
7Professor of Medical Image Computing and Image Analysis, Faculty of Science, Engineering and Computing, School of Computer Science and Mathematics, Department of Computer Science, Kingston University, UK
*Corresponding Author: Martin Knight, Consultant Endoscopic Spine Surgeon, Senior Lecturer Manchester University, The Medical Director, The Spinal Foundation, The Weymouth Hospital, London, UK.
Received: January 22, 2020; Published: February 17, 2020




Abstract

The Cluneal cutaneous nerves suffer an entrapment syndrome presenting as Trigger Points along the iliac crest. The clinical “tell-tale” is the replication of the predominant presenting symptoms by provocation of these Trigger Points where the Cluneal nerves cross the pelvic rim thus reproducing symptoms of low back pain radiating into the buttock, groin or thigh or as “sciatica”.

Cluneal nerve irritation may arise from spinal malposture and malrotation of the of the pelvis and irritant angulation of the Cluneal nerves as they pass over the iliac crest or from the irritation of their nerve roots.

The diagnosis of the source can be refined by injecting provocative trigger points with local anaesthetic and steroids.  Where the injection effectively reduces the predominant presenting symptom, then we recommend an immediate course of correction of spinal malposture, pelvic alignment and core muscle hardening with Muscle Balance Physiotherapy and Reformer Pilates.

Where the symptoms recur, long-term relief may accrue from radiofrequency ablation of the irritated Cluneal Nerves (CRFA) as they pass over the iliac crest. This study is the first provide a Radiofrequency based treatment protocol and technique to comprehensively treat the entrapment trigger points.

Failure to appreciate their role as a symptom generator may lead to inappropriate spinal surgery.

The treatment of the Cluneal Nerve trigger points and Muscle Balance Physiotherapy reversed the symptoms in 5/33 cases over a prolonged period. Where a marked but transient reduction in symptoms occurred, treatment with impedance guided aware state Cluneal Nerve Radiofrequency Ablation provided excellent or good results in 26/28 (93%) patients during their follow-up period of 12 - 42 months.

During the same period 8 patients presented with similar symptoms but failed to respond to Cluneal Nerve injection but did respond to CT Guided Nerve Root Blocks and successfully underwent Transforaminal Endoscopic Lumbar Decompression and Foraminoplasty at pain provocative segments L3 - S1 with excellent or good outcomes.

A comprehensive treatment protocol has been derived for the holistic treatment of Cluneal nerve trigger points  together with a clinically derived classification of the Cluneal nerve Trigger Points.

Keywords: Cluneal Nerve Trigger Points; Low Back Pain; Sciatica; Failed Back Surgery; Radiofrequency Ablation

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Citation: Martin Knight., et al. “A Radiofrequency Treatment Pathway for Cluneal Nerve Disorders”. EC Orthopaedics 11.3 (2020): 01-19.

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