Superior Cluneal Neuralgia

Superior Cluneal Neuralgia: Treatment in Palm Beach

Superior cluneal neuralgia is a frequently misdiagnosed cause of low back and buttock pain, caused by entrapment or irritation of the superior cluneal nerves as they cross the iliac crest from the lumbar region into the buttock. It is often confused with lumbar disc disease, facet pain, or SI joint dysfunction.

Accurate diagnosis of superior cluneal neuralgia is an important competency at Palm Beach Regenerative, where Dr. Ghattas's comprehensive approach to back pain evaluation ensures this condition is not missed. Give us a call to schedule a consultation.

What Is Superior Cluneal Neuralgia?

The superior cluneal nerves are sensory nerves that originate from the lateral branches of the posterior rami at L1-L3 and travel over the iliac crest to supply sensation to the upper buttock and lower back. They can become entrapped as they pass through the osseofibrous tunnel at the iliac crest, producing a distinct pattern of localized low back and buttock pain.

Signs and Symptoms

• Localized pain at the posterior iliac crest and upper buttock
• A tender, often reproducible trigger point just below or at the posterior iliac crest
• Pain that radiates into the buttock and may extend into the upper thigh
• Symptoms that can mimic lumbar radiculopathy but without true leg radiation below the knee
• Pain worsened by prolonged standing, walking, or lumbar extension

Common Causes and Risk Factors

• Entrapment of the nerve at the iliac crest fascia
• Prior lumbar or pelvic surgery
• Weight gain or iliac crest prominence
• Trauma to the posterior iliac region

How It Is Diagnosed

The diagnosis is confirmed by a positive response to a diagnostic nerve block at the point of nerve entrapment at the iliac crest, administered under ultrasound guidance.

A careful clinical examination identifies the characteristic tender point and differentiates this condition from lumbar disc, facet, and SI joint pathology.

Conventional Treatment Options

• Diagnostic and therapeutic nerve block at the iliac crest entrapment point
• Physical therapy for lumbar and hip flexor stretching
• Nerve hydrodissection to release entrapment
• Surgical nerve decompression in refractory cases

The Palm Beach Regenerative Approach

Dr. Ghattas uses real-time ultrasound guidance to identify the entrapment point of the superior cluneal nerves at the iliac crest and deliver targeted nerve hydrodissection with platelet preparations to reduce perineural inflammation and free the nerve from its constriction.

Accurately identifying and treating this condition when it is the true pain source avoids unnecessary lumbar procedures and provides targeted relief.

The BioMod Advantage: MLS Robotic Laser Therapy to the posterior iliac and lumbar region reduces neurogenic inflammation at the superior cluneal nerve entrapment site. Xymogen anti-inflammatory and nerve support protocols provide systemic support, helping the nerve recover from chronic compression.

Like all medical procedures, orthobiologic treatments have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.