Peripheral superior cluneal nerve stimulation for intractable low back pain: Combined fluoroscopy and ultrasound technique, A case series

Interventional Pain Medicine Pub Date : 2025-02-06 DOI:10.1016/j.inpm.2025.100542

Nicolas M. Mas D Alessandro , Faria Nisar , Hesham Elsharkawy

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Abstract

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.

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周围上胫神经刺激治疗顽固性腰痛：透视和超声联合技术，一个病例系列

背景：慢性腰痛（CLBP）是一种常见且使人虚弱的疾病，通常难以诊断，而髌上神经（SCN）的卡压是一个被忽视的原因。腱鞘神经痛（CN）由腱鞘神经痛损伤引起，可显著影响患者的生活质量。目的：本病例系列旨在评估microlead - SPRINT外周神经刺激（PNS）系统（Cleveland, Ohio， USA）治疗腱鞘神经痛的有效性，该系统利用透视和超声引导来精确定位神经。方法回顾性分析2021年8月至2024年1月在MetroHealth System接受Micro Lead - SPRINT外周神经刺激（PNS）系统（Cleveland, Ohio， USA）植入治疗腱鞘神经卡压的6例非连续患者。患者选择的重点是对保守治疗难治性腱鞘神经痛患者。数据收集包括人口统计学、疼痛特征、阿片类药物使用以及术后30、60、90天和2年的随访评估。使用疼痛数值评定量表（NRS）评估结果。用NRS评分除以满分（10）再乘以100表示疼痛强度的百分比。结果6例非连续患者（83%为女性，平均年龄60岁），植入前平均疼痛评分为7.1。在随访中，5名患者报告疼痛和功能状态改善超过50%。三名既往使用阿片类药物的患者在手术后阿片类药物消费方面有不同的结果。结论：Micro Lead - SPRINT外周神经刺激（PNS）系统（Cleveland, Ohio， USA）有望有效治疗腱鞘神经痛，减少疼痛，改善日常生活活动。需要进一步的研究来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Interventional Pain Medicine

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