title: Superior Cluneal Nerve Entrapment Neuropathy and Gluteus Medius Muscle Pain: Their Effect on Very Old Patients with Low Back Pain.
abstract: OBJECTIVE
  In the very elderly, their general condition and poor compliance with drug regimens can render the treatment of low back pain (LBP) difficult. We report the effectiveness of a less-invasive treatment for intractable LBP from superior cluneal nerve entrapment neuropathy (SCN-EN) and gluteus medius muscle (GMeM) pain.
  
  
  METHODS
  Between April 2013 and March 2015, we treated 17 consecutive elders with LBP, buttock pain, and leg pain. They were 4 men and 13 women ranging in age from 85 to 91 years (mean 86.6 years). We carefully ascertained that their symptoms were attributable to SCN-EN and GMeM pain. The median follow-up period was 21.5 ± 12.2 months (range 2-35 months).
  
  
  RESULTS
  SCN-EN was diagnosed in 15 patients (28 sites) and GMeM pain in 14 (27 sites). In 5 patients, we obtained symptom control by local block (Numerical Rating Scale for LBP: declined from 7.8 to 0.8 [P < 0.05], Roland-Morris Disability Questionnaire score: declined from 16.5 to 5.2). The other 12 were operated under local anesthesia (SCN neurolysis, GMeM decompression). As 3 patients reported the persistence of leg pain postoperatively, they subsequently underwent peroneal nerve neurolysis and surgery for tarsal tunnel syndrome. These treatments resulted in significantly symptom abatement (Numerical Rating Scale: from 8.2 to 1.7, Roland-Morris Disability Questionnaire score: from 12.8 to 8.6; P < 0.05).
  
  
  CONCLUSIONS
  Even very old patients with intractable LBP, buttock pain, and leg pain due to SCN-EN or GMeM pain can be treated successfully by peripheral block and less-invasive surgery under local anesthesia.
authors.affiliation: Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Japan. Electronic address: rin-ko927@nms.ac.jp.
authors.forename: Rinko
authors.initials: R
authors.lastname: Kokubo
authors.affiliation: Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Japan.
authors.forename: Kyongsong
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro City, Hokkaido Prefecture, Japan.
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Isu
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Bunkyo, Tokyo, Japan.
authors.forename: Daijiro
authors.initials: D
authors.lastname: Morimoto
authors.affiliation: Department of Neurosurgery, Teikyo University School of Medicine, Itabashi, Tokyo, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Iwamoto
authors.affiliation: Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai City, Chiba, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Bunkyo, Tokyo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Morita
mesh_terms: D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D063806:Myalgia / Q000209:etiology* / Q000601:surgery*; D009408:Nerve Compression Syndromes / Q000209:etiology* / Q000601:surgery*; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Buttock pain; Gluteus medius muscle; Leg pain; Less-invasive surgery; Low back pain; Oldest old; Peripheral neuropathy