Radiofrequency Ablation of the Superior Cluneal Nerve
Condition: Nerve Entrapment Syndrome; Radiofrequency Ablation; Low Back Pain
MeSH terms: Nerve Compression Syndromes; Charcot-Marie-Tooth Disease; Hereditary Sensory and Motor Neuropathy; Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      Low back pain is one of the most common musculoskeletal disorders affects individuals at
      least one during lifetime. Chronic low back pain (CLBP) lasts more than 3 months and
      decreases quality of life and causes work loss all over the world. Most common causes of
      Chronic Low back pain (CLBP) are lumbar disc herniation and/or degeneration, degenerative
      facet joints and sacroiliac joint pathologies, However, superior cluneal nerve (SCN)
      entrapment is another cause of CLBP that is ignored. It was reported that Superior cluneal
      nerve entrapment prevalence is % 1,6 - % 14 in CLBP patients. The Cluneal Nerves originate
      from the cutaneous branches of the dorsal ramus at T11-L4 and SCN innervates the skin of the
      upper part of the gluteal region. The nerves pass over the iliac crest through a tunnel
      formed by the thoracolumbar fascia and the upper edge of the iliac crest, that is the
      entrapment area. There are methods such as nerve blocks, neuromodulations and surgery in
      resistant cases. However, SCN entrapment is an overlooked diagnosis that should be considered
      in differential diagnosis.

      Recently, radiofrequency ablation (RFA) of the SCN was performed under fluoroscopic guidance,
      total of 78% of patients reported nearly full analgesia for an average of 3 months. Although
      ultrasound-guided imaging and blocking of SCN is well described, there was not enough study
      that shows the effectiveness of ultrasound-guided SCN RFA and compares it to conventional
      physical therapy (CPT) in the treatment of CLBP.
    


Intervention name(s): Radiofrequency ablation
Intervention type(s): Procedure
Intervention description(s): Firstly, the posterior superior iliac spine was showed in the transverse plane, and it was gradually moved proximally until gluteus maximus muscle disappears and gluteus medius arises. Medial branch of the SCN is seen between iliac crest and thoracolumbar fascia as an ovoid structure. Radiofrequency device was utilized with 22-gauge 10-cm, 5 mm RF cannulas for all procedures. Cannula was placed thorough the SCN area and Sensory fiber stimulation was started between 0.3 and 0.5 V. The patient was asked for feedback on symptoms such as numbness, paresthesia or pain. If the patient did not report any sensory symptoms within the specified sensory stimulation range, the cannula was repositioned. Motor stimulation was given up to 1.5 V and it was checked whether there was any contraction or not. If there is no contraction detected, the SCN was ablated at 42° degrees centigrade for 240 seconds.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This current prospective randomized study was carried out in Ankara Bilkent City Hospital, Department of Physical Therapy and Rehabilitation. Total of 25 CLBP patients (12 patients underwent SCN RFA, 13 patients participated CPT) were enrolled. Patients who admitted to outpatient clinics with low back pain that lasts more than 3 months, aged ≥ 18 year-old and detected positive 'iliac crest sign' included in the study. Patients have pain score <3 according to the Visual Analog Scale (VAS), INR >1.2 in blood samples were excluded from the study.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Nerve Entrapment Syndrome; Radiofrequency Ablation; Low back pain