In this video blog, Dr. Tollestrup explains how low back pain is not always caused by a spine problem. Patients with a clear MRI and pain on the side of their spine may suffer from Superior Cluneal Nerve entrapment. Luckily Dr. Tollestrup has developed a surgical solution.
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Hello again, this is Dr. Tollestrup. Today I wanted to just talk a little bit about low back pain that may not actually be coming from a spine problem. Traditionally, low back pain, or really any back pain or sacral pain has always been considered to be sort of the purview of the spine surgeon.
Now, problems with superior cluneal nerves are completely unrecognized for the most part by typical spine surgeons and pain management physicians. In fact, many of them, or maybe even most of them don’t even know what the superior cluneal nerves are.
Some people may just have a problem with their spine, and if that’s the case and they undergo spine surgery, they will typically have a very good result. Some people will have both a spine problem and a peripheral nerve problem such as a superior cluneal nerve entrapment. And that will typically result in sort of a mixed result with spine surgery.
And then some patients can have just a superior cluneal nerve problem, and if they have spine surgery in that setting, they won’t be any better at all. There’s also a group of patients who may go in with a spine problem only, and as a result of the spine surgery, not that it’s really a fault of the spine surgeon, but just given the close proximity that the superior cluneal nerves are located to the spine, very often an entrapment of these nerves can develop as a result of the swelling and inflammation.
Typically people with superior cluneal nerve pain, if that’s their only problem, will have a normal lumbar spine MRI. So people who have back pain due to a superior cluneal nerve issue tend to not localize the pain to their spine. They’ll put their hand just off to the side, over the back of their pelvic bone, and they’ll say, “This is where my pain is.”
You just have the patient lay on their stomach and you can palpate directly over these nerves. And if it produces severe pain, then you know that it’s very likely that the superior cluneal nerves are unhappy.
And if the superior cluneal nerves are the source of the back pain, the patient will typically receive very good relief of the pain for anywhere from a few hours to as long as maybe a couple of days.
The definitive treatment is to go in surgically, find these small sensory nerves which are really unimportant nerves, and actually disconnect them. And then the proximal end of these nerves are buried into muscle tissue that is nearby, and that is a very good, effective treatment for low back pain of superior cluneal nerve origin.