RECRUITINGOBSERVATIONAL

Proximal Versus Distal Superior Cluneal Nerve Block in Entrapment Neuropathy

Proximal Versus Distal Superior Cluneal Nerve Block in Superior Cluneal Nerve Entrapment: A Prospective, Randomized, Single-Blind Trial

About This Trial

Superior cluneal nerve (SCN) entrapment is an underdiagnosed cause of chronic low back and gluteal pain. Although diagnostic nerve block is considered the gold standard for confirming SCN entrapment, there is no consensus regarding the optimal injection approach. This prospective observational study aims to compare the clinical effectiveness of proximal and distal ultrasound-guided SCN block techniques in patients diagnosed with SCN entrapment. Pain intensity and functional outcomes will be evaluated over the follow-up period to assess differences between the two approaches.

Who May Be Eligible (Plain English)

Who May Qualify: - Age between 18 and 75 years - Chronic low back and/or gluteal pain lasting longer than 3 months - Localized point tenderness and/or paresthesia on palpation over the unilateral posterior iliac crest - Clinical suspicion of superior cluneal nerve entrapment based on physical examination - Failure to respond to conservative treatment - Ability and willingness to provide written willing to sign a consent form Who Should NOT Join This Trial: - Active local or systemic infection - Cognitive impairment or psychiatric disorders interfering with study participation - History of malignancy or cancer-related pain - Uncontrolled diabetes mellitus or severe comorbid conditions adversely affecting general health - Pregnancy - Known allergy to the medications used in the injection - Prominent radicular pain associated with neurological deficit - History of interventional procedures applied to the lumbar region within the last 6 months - Initiation of another lumbar interventional or medical treatment during the follow-up period - Suspected bilateral superior cluneal nerve entrapment - Sphincter dysfunction related to neurological disease - Bleeding diathesis or coagulation disorders Always talk to your doctor about whether this trial is right for you.

Original Eligibility Criteria

View original clinical language

Inclusion Criteria: * Age between 18 and 75 years * Chronic low back and/or gluteal pain lasting longer than 3 months * Localized point tenderness and/or paresthesia on palpation over the unilateral posterior iliac crest * Clinical suspicion of superior cluneal nerve entrapment based on physical examination * Failure to respond to conservative treatment * Ability and willingness to provide written informed consent Exclusion Criteria: * Active local or systemic infection * Cognitive impairment or psychiatric disorders interfering with study participation * History of malignancy or cancer-related pain * Uncontrolled diabetes mellitus or severe comorbid conditions adversely affecting general health * Pregnancy * Known allergy to the medications used in the injection * Prominent radicular pain associated with neurological deficit * History of interventional procedures applied to the lumbar region within the last 6 months * Initiation of another lumbar interventional or medical treatment during the follow-up period * Suspected bilateral superior cluneal nerve entrapment * Sphincter dysfunction related to neurological disease * Bleeding diathesis or coagulation disorders

Treatments Being Tested

PROCEDURE

Ultrasound-guided distal superior cluneal nerve injection

The ultrasound probe will be placed over the posterior superior iliac crest to visualize the fibro-osseous tunnel where the superior cluneal nerve passes. Using an in-plane approach, the needle will be advanced toward the target area, and the injection will be administered at the fascial exit point of the nerve. A total injectate volume of 5 cc (2 cc bupivacaine, 2 cc dexamethasone, and 1 cc normal saline) will be administered. All procedures will be performed in the prone position under standard aseptic conditions.

PROCEDURE

Ultrasound-guided proximal superior cluneal nerve injection

Patients randomized to the proximal injection group will undergo ultrasound-guided injection above the iliac crest level. The target will be the plane beneath the posterior layer of the thoracolumbar fascia. Using an in-plane approach, the injectate will be delivered into the interfascial plane. A total injectate volume of 5 cc (2 cc bupivacaine, 2 cc dexamethasone, and 1 cc normal saline) will be administered under ultrasound guidance. Patient positioning and aseptic conditions will be identical to those used in the distal perineural injection group.

Locations (1)

Health Sciences University Gaziosmanpaşa Physical Medicine and Rehabilitation Training and Research Hospita

Istanbul, Turkey (Türkiye)