Treatment outcomes for cluneal neuropathy: a systematic review and meta-analysis

Cluneal nerve entrapment is an increasingly recognized but often overlooked cause of chronic low back pain. Various treatment strategies have been described, including surgical decompression, injection therapy, radiofrequency ablation (RFA), and peripheral nerve stimulation (PNS). However, pooled evidence on treatment outcomes remains limited.

This systematic review and meta-analysis aimed to evaluate pooled responder rates following different treatment modalities for cluneal nerve-related pain.

A systematic review and meta-analysis was performed of studies reporting dichotomous responder outcomes after treatment of superior or middle cluneal nerve entrapment. Responder status was defined as ≥50% pain reduction or study-defined clinical improvement. Random-effects meta-analysis of proportions with logit transformation was used to pool responder rates. The primary analysis included treatment arms with follow-up of ≥3 months, and a predefined sensitivity analysis was restricted to studies with follow-up of ≥6 months. Subgroup analyses were performed by treatment modality and by surgical versus non-surgical treatment strategy.

A total of 26 treatment arms including 628 patients were analyzed. The pooled responder rate was 78.3% (95% CI 72.9-82.9) at ≥3 months and 82.9% (95% CI 75.3-88.6) at ≥6 months. Stratified by treatment modality, pooled responder rates were 93.1% (95% CI 84.9-97.0) for surgical decompression, 72.4% (95% CI 65.9-78.1) for injection therapy, 75.1% (95% CI 62.1-84.7) for radiofrequency ablation, and 80.1% (95% CI 58.5-92.0) for peripheral nerve stimulation.

Targeted treatment of cluneal nerve entrapment was associated with high pooled responder rates at both ≥3 and ≥ 6 months of follow-up. Surgical decompression was associated with the highest pooled responder proportion; however, differences between treatment modalities should be interpreted cautiously given the predominantly observational, non-comparative nature of the available evidence, heterogeneity in diagnostic criteria and outcome definitions, and the potential for confounding by indication. Prospective comparative studies using standardized diagnostic and outcome measures are needed.