Precise Ultrasound Localization and Guided Injection for Superior Cluneal Nerve Entrapment
试验速览
- 阶段
- 不适用
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Visual analogue scale
研究概览
简要总结
Low back pain (LBP) is a common complaint in the clinical setting. Among all the differential diagnosis for LBP, superior cluneal nerve (SCN) entrapment is the commonly omitted one. The superior cluneal nerve is the terminal branch of the lateral branches of the posterior rami of the L1-L3 spinal nerves, which passes through the osseous tunnel interposed between the thoracolumbar fascia and iliac crest. This nerve can be entrapped due to poor posture, trauma or stretching of the surrounding thoracolumbar fascia and osseous membrane. The cardinal symptom of the superior cluneal nerve entrapment is buttock pain. Sometimes the pain may radiate to the lower limb, which mimics sciatica, and makes the diagnosis difficult. Early diagnosis and treatment of SCN entrapment is crucial, which can facilitate the improvement of health related quality of life and decrement the socioeconomic loss due to disability.
The study aims is (1) to scan the SCN and thoracolumbar fascia by ultrasound in patients with LBP and normal subjects. The transcutaneous electrical stimulation will be used to confirm the location of SCN by asking the subject to depict the sensory distribution after stimulation; (2) to analyze the related factors of LBP with SCN entrapment, which may help in setting up the diagnostic criteria of SCN entrapment; (3) to analyze the therapeutic effect of perineural injection to SCN in SCN entrapment, and to find the factors that related responsiveness.
详细描述
Introduction:
Superior cluneal nerve (SCN) entrapment is the commonly omitted diagnosis in chronic low back pain. The superior cluneal nerve is the terminal branch of the lateral branches of the posterior rami of the L1-L3 spinal nerves, which passes through the osseous tunnel interposed between the thoracolumbar fascia and iliac crest. This nerve can be entrapped due to poor posture, trauma or stretching of the surrounding thoracolumbar fascia and osseous membrane. The cardinal symptom of the superior cluneal nerve entrapment is buttock pain. Sometimes the pain may radiate to the lower limb, which mimics sciatica, and makes the diagnosis difficult. Early diagnosis and treatment of SCN entrapment is crucial, which can facilitate the improvement of health related quality of life and decrement the socioeconomic loss due to disability.
Material and methods:
Participants: Adult patients (>20 year old) with low back/buttock pain. The pain consists area of iliac crest.
Control : healthy adult subjects (>20 year old) without low back
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 20 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Participants:
- •Adult patients (>20 year old) with low back/buttock pain.
- •The pain consists area of iliac crest Control : healthy adult subjects (>20 year old) without low back
排除标准
- •non-mechanical low back pain
- •referred low back pain (tumor, infection, inflammatory arthritis, Scheuermann disease,Paget disease, herpetic neuralgia)
- •acute compression fracture
- •acute herniated disc
- •underwent lumbar region nerve block within 3 months
研究组 & 干预措施
Ultrasound guided hydrodissection to superior cluneal nerve
Patients with superior cluneal nerve enttrappment given by ultrasound guided perineural injection with a mixture of 1 mL of 50% dextrose, 4 mL of 1% lidocaine, and 5 mL of 0.9% normal saline to superior cluneal nerve of affected side.
干预措施: Ultrasound guided hydrodissection of superior cluneal nerve (Other)
Control arm
Patients without superior cluneal nerve entrappment
结局指标
主要结局
Visual analogue scale
时间窗: Change of the score between one month and baseline, and change of the score between three months and baseline
The pain scale to evaluate pain, from 0 to 10. The lower means less pain.
Short Form-36 Questionnaire
时间窗: Change of the score between one month and baseline, and change of the score between three month and baseline
Reflect 8 domains of health, including physical functioning, physical role, pain, general health, vitality, social func-tion, emotional role, and mental health. The categories of physical role and emotional role reflect performance at the activity and participation levels. The score will be transformed between 0 to 100. The higher score means better health condition in each domain.
Oswestry Disability Questionnaire
时间窗: Change of the score between one month and baseline, and change of the score between three months and baseline
Oswestry Disability Questionnaire, A 10 item questionnaire, score ranges from 0 to 100, and a higher score indicates worse function.
次要结局
- Ultrasound evaluation of SCN (Grey scale)(Measurement change between one month and baseline and between three months and baseline)