Causes of misdiagnosis of superior cluneal neuralgia as lumbar disc herniation
CHENG Zishen
WANG Dihua
WANG Tianhao
REN Weina
JIN Ruina
KANG Qiangjun
Abstract：Objective To investigate the clinical characteristics of superior cluneal neuralgia misdiagnosed as lumbar disc herniation(LDH)and to analyze the causes of misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 10 patients with superior cluneal neuralgia who were misdiagnosed as LDH from January to August 2024.Results All 10 patients presented with low back pain,hip pain and lower limb pain.The lumbar magnetic resonance imaging(MRI)all showed LDH and compression of the corresponding nerve root on one side.However,the clinical symptoms did not fully match the imaging manifestations,and all were diagnosed with LDH.All 10 patients received conservative treatment including bed rest,anti-inflammatory therapy,and analgesics,but their symptoms did not improve significantly and continued to progress.One patient underwent minimally invasive endoscopic spinal surgery under local anesthesia,but the symptoms did not show significant relief.All 10 patients underwent intervertebral disc angiography and selective nerve root block examinations to preliminarily rule out LDH.Fascial cord-like structures were found approximately 3 cm lateral to the posterior superior iliac spine on the affected side in 10 patients,and there was obvious tenderness.Subsequently,acupotomy release was performed once at the cord-like structure.At 1 h after treatment,the Visual Analogue Scale pain score decreased from(5.90±0.73)points before treatment to(2.70±1.05)points.which dropped to(0.70±0.67)points and tended to stabilize at 1 week after treatment.The Oswestry Disability Index score decreased from(34.00±4.00)points before treatment to(6.60±2.98)points at 1 d after treatment,and decreased to(1.00±1.05)points at 1 week after treatment and tended to stabilize.Based on the patient's symptoms,signs,surgical outcomes,especially the cord-like structure on the lateral side of the posterior superior iliac spine,combined with the therapeutic response to acupotomy release therapy,the diagnosis was superior cluneal neuralgia.The misdiagnosis period was 2 weeks to 1 month.Conclusion The main causes of misdiagnosis of superior cluneal neuralgia include the limited diagnostic thinking of clinicians,excessive reliance on imaging examinations and incomplete physical examinations.Promoting the acupotomy technique and strengthening the education of relevant knowledge for physicians can improve the accuracy of diagnosis.
Keywords：superior cluneal neuralgiamisdiagnosislumbar disc herniationlow back painradiating painmagnetic resonance imagingOswestry disability indexacupotomy technique
Publication Date：2025-11-28
Online Publishing Date：2025-12-11(First online date of this platform, not the publication date of the document)
Pages：6( 16-21 )