Chronic Low Back Pain, Superior Cluneal Nerve Entrapment
Conditions
Keywords
Superior Cluneal Nerve Entrapment, Ultrasound-Guided Nerve Block, Chronic Low Back Pain
Brief summary
Superior cluneal nerve entrapment (SCNE) is an underrecognized cause of chronic low back pain and gluteal pain that may mimic lumbar spine disorders. Ultrasound-guided proximal superior cluneal nerve block has increasingly been used in routine clinical practice .Diagnostic superior cluneal nerve block is commonly used to confirm the diagnosis, whereas ultrasound-guided proximal superior cluneal nerve block has emerged as a therapeutic option. This prospective observational cohort study aims to evaluate the clinical outcomes of ultrasound-guided proximal superior cluneal nerve block in patients with clinically diagnosed superior cluneal nerve entrapment who undergo the procedure as part of routine clinical care. Pain intensity, disability, and neuropathic pain characteristics will be assessed at baseline and during follow-up to evaluate treatment outcomes.
Detailed description
Superior cluneal nerve entrapment (SCNE) is an increasingly recognized cause of chronic low back pain that may be overlooked or misdiagnosed as lumbar radiculopathy or other degenerative lumbar disorders. Accurate diagnosis is essential because patients with SCNE may benefit from targeted peripheral nerve interventions rather than treatments directed at the lumbar spine. Ultrasound-guided proximal superior cluneal nerve block has emerged as a practical technique for both diagnostic confirmation and therapeutic management of SCNE. Compared with landmark-based approaches, ultrasound guidance enables real-time visualization of relevant anatomical structures and standardized needle placement. Despite increasing clinical use, prospective evidence evaluating the clinical outcomes of this technique remains limited. This prospective observational cohort study will enroll patients with clinically diagnosed superior cluneal nerve entrapment who undergo ultrasound-guided proximal superior cluneal nerve block as part of routine clinical care. Pain intensity, disability, and neuropathic pain characteristics will be evaluated at baseline and at 1- and 3-month follow-up visits using validated clinical outcome measures. The primary objective is to evaluate changes in pain intensity following ultrasound-guided proximal superior cluneal nerve block. Secondary objectives include evaluating changes in disability and neuropathic pain characteristics after treatment and documenting the clinical outcomes of this intervention during routine practice.
Interventions
PROCEDUREUltrasound-Guided Proximal Superior Cluneal Nerve Block
Ultrasound-guided proximal superior cluneal nerve block will be performed as part of routine clinical care in patients with clinically diagnosed superior cluneal nerve entrapment. The proximal superior cluneal nerve will be targeted using a standardized ultrasound-guided interfascial technique. A standardized injectate will be administered according to the study protocol. All procedures will be performed by an experienced pain physician using the same technique for all participants.
Sponsors
Gaziosmanpasa Research and Education Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-75 years. * Chronic low back and/or gluteal pain persisting for at least 3 months. * Localized pain and/or tenderness over the posterior iliac crest. * At least 50% reduction in pain intensity following diagnostic superior cluneal nerve block. * Failure of conservative treatment. * Ability to provide written informed consent.
Exclusion criteria
* Previous superior cluneal nerve surgery. * Active local or systemic infection. * Bleeding disorders or contraindications to the procedure. * Allergy to study medications. * Pregnancy. * Severe cognitive impairment or inability to complete study assessments. * Additional interventional pain procedures involving the affected region during follow-up.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pain Intensity | Baseline, 1 month, and 3 months | Pain intensity will be assessed using the 11-point Numeric Rating Scale (NRS), a unidimensional pain assessment tool ranging from 0 (no pain) to 10 (the worst imaginable/unbearable pain). Patients will be asked to select the number that best reflects their pain intensity. The change in NRS pain score following ultrasound-guided proximal superior cluneal nerve block will be evaluated at the predefined follow-up time points. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Oswestry Disability Index (ODI) Score | Baseline, 1 month, and 3 months | Oswestry Disability Index (ODI): Change in disability related to low back pain assessed using the Oswestry Disability Index (ODI).The validated and reliability-tested Turkish version of the ODI will be used in this study.The ODI consists of 10 items, each scored from 0 to 5, yielding a maximum total raw score of 50.The total score is converted to a percentage using the following formula:ODI percentage = (Total score / 50) × 100 Higher percentage scores indicate greater disability. Disability levels are interpreted as follows: 0-20%: Minimal disability 21-40%: Moderate disability 41-60%: Severe disability 61-80%: Crippling disability 81-100%: Bed-bound or exaggerated symptoms A decrease in ODI percentage score indicates improvement in functional status. The change in ODI score following ultrasound-guided proximal superior cluneal nerve block will be evaluated at the predefined follow-up time points. |
| Douleur Neuropathique 4 (DN4) | Baseline, 1 month, and 3 months | Neuropathic pain will be assessed using the Douleur Neuropathique en 4 Questions (DN4) questionnaire, a validated 10-item screening tool with scores ranging from 0 to 10, where higher scores indicate a greater likelihood of neuropathic pain and a score of ≥4 is considered indicative of neuropathic pain. The change in DN4 score following ultrasound-guided proximal superior cluneal nerve block will be evaluated at the predefined follow-up time points. |
| Treatment Response | 1 month and 3 months | Treatment response will be defined as a ≥50% reduction in NRS pain score compared with baseline. |
Countries
Turkey (Türkiye)
Contacts
CONTACTTuğçe Yavuz Mollavelioğlu, Medical Doctor
CONTACTTuğba Bayraktar Çelebioğlu, Medical Doctor
Outcome results
None listed