Keywords
sciatica
clunealgia
cluneal nerves
cluneal syndrome.
Abstract
Introduction: Due to the clinical interest in the study of cluneal nerves (CN) as a differential diagnosis of low back pain and the limited scientific literature available, a narrative review was conducted.
Objectives: To analyze the scientific literature on CN anatomy, function, associated pathologies, diagnosis, and therapeutic alternatives.
Materials and methods: A bibliographic search was conducted in MEDLINE/PubMed using the terms “cluneal nerves” and “clunealgia”. The Revista Española de Anestesiología y Reanimación and the Revista de la Sociedad Española del Dolor were also consulted using the terms “nervios cluneales”, “clunealgia”, and “nervios clúneos”.
Results: The superior cluneal nerves (SCN) are cutaneous branches of the dorsal rami from T11 to L3 or L5. They usually emerge above the iliac crest, piercing the thoracolumbar fascia, and may become entrapped in an osteofibrous tunnel. The middle cluneal nerves (MCN) arise from the lateral branches of the sacral dorsal rami from L5 to S4 and innervate the skin below the posterior superior iliac spine. The inferior cluneal nerves (ICN) are sensory branches of the posterior femoral cutaneous nerve and innervate the lower gluteal and perineal regions. Their main entrapment site is beneath a fibrous tissue expansion near the ischial tuberosity. The most common presentation is low back and/or gluteal pain accompanied by sensory disturbances. Diagnosis is primarily clinical, and imaging studies help rule out other causes. Treatment begins with conservative measures and nerve blocks, followed by nerve lesion techniques, such as radiofrequency (RF) or cryoablation. Surgery is the final therapeutic option.
Conclusions: The SCN have the most extensive literature available, followed by the MCN; the ICN are less well described. Treatments are poorly standardized, making it difficult to compare results. Further studies on RF and cryoablation are needed. Peripheral nerve stimulation may be an area of interest in the coming years for refractory cases.
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