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Peripheral superior cluneal nerve stimulation for intractable low back pain: Combined fluoroscopy and ultrasound
Nicolas M Mas D Alessandro1,2, Faria Nisar1,2, Hesham Elsharkawy1,2,3,4
1The MetroHealth System, Case Western Reserve University School of Medicine, United States.
Background:
Chronic low back pain (CLBP) is a common and debilitating condition often difficult to diagnose, with entrapment of the superior cluneal nerves (SCN) being a overlooked cause. Cluneal neuralgia (CN) arises from injury to the SCN and can significantly impact patients' quality of life.
Objectives:
This case series aims to evaluate the effectiveness of the Micro Lead - SPRINT Peripheral Nerve Stimulation (PNS) System, (Cleveland, Ohio, USA) for treating cluneal neuralgia, utilizing both fluoroscopic and ultrasound guidance for accurate nerve localization.
Methods:
A retrospective review was conducted on six nonconsecutive patients who underwent Micro Lead - SPRINT Peripheral Nerve Stimulation (PNS) System, (Cleveland, Ohio, USA) implantation for cluneal nerve entrapment at MetroHealth System between August 2021 and January 2024. Patient selection focused on individuals with cluneal neuralgia refractory to conservative treatments. Data collection included demographics, pain characteristics, opioid usage, and follow-up evaluations at 30, 60, 90 days, and 2 years post-procedure. Outcomes were assessed using the Numerical Rating Scale (NRS) for pain. Dividing the NRS score by the maximum score (10) and multiplying by 100 expresses pain intensity as a percentage.
Results:
Among the six nonconsecutive patients (83 % female, mean age 60 years), the mean pain score prior to implantation was 7.1. At follow-up, five patients reported over 50 % improvement in pain and functional status. Three patients with prior opioid use had varying outcomes regarding opioid consumption post-procedure.
Conclusion:
The Micro Lead - SPRINT Peripheral Nerve Stimulation (PNS) System, (Cleveland, Ohio, USA) demonstrates promise as an effective treatment for cluneal neuralgia, leading to reductions in pain and improvements in daily living activities. Further studies are warranted to validate these findings.
