Superior Cluneal Nerve Block

The superior cluneal nerves (SCN) are sensory nerves derived from the lateral branches of the dorsal rami of T12-L4. They innervate the skin and tissues over the lateral buttock and hip, and irritation of these nerves can lead to a pain pattern similar to SI joint pain, L5 radiculopathy, and lumbar facet arthropathy. As much as 14% of back pain can be from pathology of these nerves. Pain can result from nerve entrapment within an osteofibrous tunnel or from irritation due to repeated mechanical motion from the quadratus lumborum and erector spinae. Injection of local anesthetic or steroid may provide significant long-term relief in some patients and should be considered in patients with intractable low back and buttock pain not responding to other measures.