Superior Cluneal Nerve Entrapment as a Cause of Low Back Pain Refractory to Sacroiliac Joint Fusion: A Case Report

Low back pain (LBP) is a common complaint that can be nonspecific. Superior cluneal nerve entrapment should be included in the differential for LBP because, without a precise diagnosis, treatment may be less effective. A 61-year-old female with a history of chronic LBP and sacroiliac (SI) pain requiring opioids for pain control presented with minimal relief following SI joint fusion. Physical exam showed tenderness over the iliac crest with burning, radicular pain into the buttock. The patient received a superior cluneal nerve injection of local anesthetic that provided 100% pain relief for 72 hours without the use of opioids and no complaints of burning or radicular pain. This confirmed the diagnosis of superior cluneal nerve entrapment syndrome causing superior cluneal neuralgia. Superior cluneal nerve entrapment syndrome should be considered when evaluating causes of LBP to avoid unnecessary procedures and reduce the use of opioids.