1.Characteristics of Low Back Pain due to Superior Cluneal Nerve Entrapment Neuropathy
Koichi MIKI ; Kyongsong KIM ; Toyohiko ISU ; Juntaro MATSUMOTO ; Rinko KOKUBO ; Masanori ISOBE ; Tooru INOUE
Asian Spine Journal 2019;13(5):772-778
STUDY DESIGN: Retrospective analysis. PURPOSE: The present study aimed to investigate the features of low back pain (LBP) due to superior cluneal nerve (SCN) entrapment neuropathy (SCN-EN) using the Roland Morris Disability Questionnaire (RMDQ), and to analyze the differences between LBP due to SCN-EN and lumbar spinal canal stenosis (LSS). OVERVIEW OF LITERATURE: The SCN is derived from the cutaneous branches of the dorsal rami of T11–L5 and passes through the thoracolumbar fascia. LBP due to SCN-EN is exacerbated by various types of lumbar movement, and its features remain to be fully elucidated, often resulting in the misdiagnosis of lumbar spine disorder. METHODS: The present study included 35 consecutive patients with SCN-EN treated via nerve blocks or surgical release between April 2016 and August 2017 (SCN-EN group; 16 men, 19 women; mean age, 65.5±17.0 years; age range, 19–89 years). During the same period, 33 patients were surgically treated with LSS (LSS group; 19 men, 14 women; mean age, 65.3±12.0 years; age range, 35–84 years). The characteristics of LBP were then compared between patients with SCN-EN and those with LSS using the RMDQ. RESULTS: The duration of disease was significantly longer in the SCN-EN group than in the LSS group (26.0 vs. 16.0 months, p=0.012). Median RMDQ scores were significantly higher in the SCN-EN group (13 points; interquartile range, 8–15 points) than in the LSS group (7 points; interquartile range, 4–9 points; p<0.001). For seven items (question number 1, 8, 11, and 20–23), the ratio of positive responses was higher in the SCN-EN group than in the LSS group. CONCLUSIONS: Patients with SCN-EN exhibit significantly higher RMDQ scores and greater levels of disability due to LBP than patients with LSS. The findings further demonstrate that SCN-EN may affect physical and psychological function.
2.Undiagnosed Peripheral Nerve Disease in Patients with Failed Lumbar Disc Surgery
Tomohiro YAMAUCHI ; Kyongsong KIM ; Toyohiko ISU ; Naotaka IWAMOTO ; Kazuyoshi YAMAZAKI ; Juntaro MATSUMOTO ; Masanori ISOBE
Asian Spine Journal 2018;12(4):720-725
STUDY DESIGN: Retrospective study (level of evidence=3). PURPOSE: We examine the relationship between residual symptoms after discectomy for lumbar disc herniation and peripheral nerve (PN) neuropathy. OVERVIEW OF LITERATURE: Patients may report persistent or recurrent symptoms after lumbar disc herniation surgery; others fail to respond to a variety of treatments. Some PN neuropathies elicit symptoms similar to those of lumbar spine disease. METHODS: We retrospectively analyzed data for 13 patients treated for persistent (n=2) or recurrent (n=11) low back pain (LBP) and/or leg pain after primary lumbar discectomy. RESULTS: Lumbar re-operation was required for four patients (three with recurrent lumbar disc herniation and one with lumbar canal stenosis). Superior cluneal nerve (SCN) entrapment neuropathy (EN) was noted in 12 patients; SCN block improved the symptoms for eight of these patients. In total, nine patients underwent PN surgery (SCN-EN, n=4; peroneal nerve EN, n=3; tarsal tunnel syndrome, n=1). Their symptoms improved significantly. CONCLUSIONS: Concomitant PN disease should be considered for patients with failed back surgery syndrome manifesting as persistent or recurrent LBP.
Diskectomy
;
Failed Back Surgery Syndrome
;
Humans
;
Leg
;
Low Back Pain
;
Lumbosacral Region
;
Nerve Compression Syndromes
;
Peripheral Nerves
;
Peripheral Nervous System Diseases
;
Peroneal Nerve
;
Retrospective Studies
;
Spine
;
Tarsal Tunnel Syndrome
3.Therapeutic Effect of Mirogabalin on Peripheral Neuropathic Pain due to Lumbar Spine Disease
Kyongsong KIM ; Toyohiko ISU ; Rinko KOKUBO ; Naotaka IWAMOTO ; Daijiro MORIMOTO ; Masaaki KAWAUCHI ; Akio MORITA
Asian Spine Journal 2021;15(3):349-356
Retrospective study. This study aims to evaluate the effectiveness of mirogabalin in treatment of peripheral neuropathic pain due to lumbar spine disease. Mirogabalin is a novel selective ligand for the α2δ subunit of voltage-gated Ca channels. Between April and December 2019, we used mirogabalin to treat 60 consecutive patients (mean age, 67.6 years) with leg symptoms due to lumbar disease. The treatment outcome after 8 weeks of mirogabalin therapy was evaluated by comparing the preand post-administration Numerical Rating Scale (NRS) for leg symptoms and sleep disturbance, the NRS and Roland–Morris Disability Questionnaire for low back pain (LBP), and the quality of life (QOL) score (based on EuroQol five-dimension five-level scale). Mirogabalin treatment was stopped at less than eight weeks in eight patients. The remaining 52 patients for evaluation were divided as group 1 (17 patients who presented with leg symptoms that lasted for less than 3 months) and group 2 (35 patients with leg symptoms that lasted longer than 3 months). The leg symptoms and LBP in both groups significantly improved at 4 and 8 weeks of treatment, and sleep disturbance and QOL were improved at 8 weeks as well. Compared to group 2, the pretreatment leg symptoms and QOL were significantly worse in group 1, and their improvement after 8 weeks of mirogabalin treatment was significantly better ( We have validated the effect of mirogabalin on neuropathic pain due to lumbar spine disease, which has effectively addressed the associated leg symptoms, LBP, and sleep disturbance.
4.Therapeutic Effect of Mirogabalin on Peripheral Neuropathic Pain due to Lumbar Spine Disease
Kyongsong KIM ; Toyohiko ISU ; Rinko KOKUBO ; Naotaka IWAMOTO ; Daijiro MORIMOTO ; Masaaki KAWAUCHI ; Akio MORITA
Asian Spine Journal 2021;15(3):349-356
Retrospective study. This study aims to evaluate the effectiveness of mirogabalin in treatment of peripheral neuropathic pain due to lumbar spine disease. Mirogabalin is a novel selective ligand for the α2δ subunit of voltage-gated Ca channels. Between April and December 2019, we used mirogabalin to treat 60 consecutive patients (mean age, 67.6 years) with leg symptoms due to lumbar disease. The treatment outcome after 8 weeks of mirogabalin therapy was evaluated by comparing the preand post-administration Numerical Rating Scale (NRS) for leg symptoms and sleep disturbance, the NRS and Roland–Morris Disability Questionnaire for low back pain (LBP), and the quality of life (QOL) score (based on EuroQol five-dimension five-level scale). Mirogabalin treatment was stopped at less than eight weeks in eight patients. The remaining 52 patients for evaluation were divided as group 1 (17 patients who presented with leg symptoms that lasted for less than 3 months) and group 2 (35 patients with leg symptoms that lasted longer than 3 months). The leg symptoms and LBP in both groups significantly improved at 4 and 8 weeks of treatment, and sleep disturbance and QOL were improved at 8 weeks as well. Compared to group 2, the pretreatment leg symptoms and QOL were significantly worse in group 1, and their improvement after 8 weeks of mirogabalin treatment was significantly better ( We have validated the effect of mirogabalin on neuropathic pain due to lumbar spine disease, which has effectively addressed the associated leg symptoms, LBP, and sleep disturbance.
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