Radiofrequency ablation of the superior cluneal nerves to treat chronic low back pain: a description of a novel technique

Superior cluneal nerve (SCN) entrapment is an often-overlooked cause of chronic axial low back and gluteal pain. Recent cadaveric findings demonstrate that the SCN originates from T11-L5 with variable branching across the posterior iliac crest. This technical report describes a method for treating low back and gluteal pain using fluoroscopy-guided radiofrequency ablation (RFA) for SCN pain and summarizes the relevant anatomical sites. For the RFA procedure, under a combination of fluoroscopic and ultrasound-guided imaging, an 18-22-gauge cannula is advanced to the osseoaponeurotic orifice 6-8 cm lateral to the midline. Sensory stimulation is utilized to confirm pain reproduction, while motor testing verifies the absence of distal activation. RFA is performed at 80 °C for 90 seconds, and additional lesions are added as needed due to anatomical variability. With minimal complications, peer-reviewed studies show significant but preliminary pain reduction and improved function after SCN-targeted RFA. Accuracy in probe placement, achieved through the use of fluoroscopic and ultrasound-guided imaging and stimulation testing, enhances both reproducibility and safety. SCN-targeted RFA offers a minimally invasive treatment for patients with refractory axial low back pain. Moderate-quality evidence suggests a therapeutic benefit, although current data are obtained from observational studies. Detailed attention to anatomic variability and technique is crucial for achieving consistent outcomes and ensuring patient safety.