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Superior Cluneal Nerve Schwannoma as a Cause of Intractable Ipsilateral Low Back Pain: A Case Report
Siddartha Simha1, Trishul Kapoor1, Ryan M Meral1
1Department of Anesthesiology, University of Michigan, Michigan Medicine, Ann Arbor, MI.
Background:
Superior cluneal nerve (SCN) entrapment is an infrequent, yet commonly missed etiology of low back pain (LBP). The SCN is prone to entrapment as it travels through the iliocostalis muscle and exits thoracolumbar fascia via an osseofibrous tunnel as it courses over the iliac crest.
Case Report:
A patient with chronic LBP exhibited new provocative sacroiliac joint testing not responsive to injections. Subsequent pelvis magnetic resonance imaging revealed a peripheral nerve sheath tumor of the right SCN. Although she exhibited an excellent response to therapeutic nerve blocks, her silicone allergy excluded her from peripheral nerve stimulation as a treatment option. She underwent SCN neurolysis and tumor resection by the neurosurgery department resulting in symptom resolution.
Conclusion:
Interventional pain physicians should consider SCN entrapment when diagnosing intractable LBP. In the event of rare etiologies of SCN entrapment, such as neurogenic tumors, a multidisciplinary patient-centered care approach should be sought for symptom management.
