400 Section - Therapeutic Potentials of Superior Cluneal Nerve Interventions for Low Back Pain: A Scoping Review

Objectives : Superior cluneal nerve (SCN) entrapment is an underrecognized cause of low back and gluteal pain, often mimicking radiculopathy or sacroiliac joint pain. This scoping review aimed to map and synthesize current evidence on SCN anatomy, entrapment mechanisms, and therapeutic interventions for low back pain and related symptoms.

Design: We conducted a PRISMA scoping review of the last 10 years of English-language publications focused specifically on the SCN. PubMed, Embase, Cochrane Library, and Google Scholar were searched using the terms “superior cluneal nerve” and “superior cluneus nerve.” From 215 records identified, 68 studies met inclusion criteria.

Results: The superior cluneal nerve (SCN) is a purely sensory nerve, most commonly arising from the dorsal rami of T11–L5 and innervating the posterior lumbar region, iliac crest, and upper medial gluteal area. The medial branch, crossing an osteofibrous tunnel over the iliac crest, was consistently identified as the main entrapment site, causing cluneal neuralgia and “pseudo-sciatica” that may mimic radiculopathy or sacroiliac joint pain.
First-line interventions consisted of image-guided SCN nerve blocks with local anesthetic, with or without corticosteroids, which provided clinically meaningful pain reduction in most reported series and were frequently used as both diagnostic and therapeutic tools. In refractory cases, thermal radiofrequency, radiofrequency ablation, and peripheral nerve stimulation targeting the SCN yielded prolonged pain relief, while open or endoscopic surgical decompression of the entrapment tunnel demonstrated high rates of sustained symptom improvement in carefully selected patients.

Conclusion: SCN entrapment is an important and frequently overlooked contributor to low back pain. Targeted SCN interventions—from diagnostic–therapeutic nerve blocks to radiofrequency procedures, neuromodulation, and decompression surgery—appear effective in selected patients and should be considered within stepwise low back pain management algorithms. Future high-quality comparative studies are needed to refine patient selection and standardize techniques.