Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine
The cluneal nerves are a group of nerves that were first described by Dr. Robert Maigne as a potential source of low back pain. In this article, we discuss the anatomy of this nerve, and the clinical implication for those who suffer from back pain or leg pain.
Contents
Definition and anatomy
The cluneal nerves (separated into inferior, middle cluneal nerve and superior) are cutaneous nerves, that is, they provide sensation to the skin surrounding the buttocks. Specifically, the inferior cluneal nerve innervates the lower part of the buttocks, the middle cluneal nerve innervates the middle part, and the superior cluneal nerve is responsible for providing sensation to the upper part of the buttocks.
It should be noted that these nerves do not have a motor role (they do not allow movement) despite the fact that they cross multiple layers of muscles.
Le superior cluneal nerve most often originates from the dorsal ramifications (dorsal rami) of the L1, L2 and L3 lumbar nerve roots. It then goes through the erector spinae muscles, the psoas major, the paraspinal muscles, then the latissimus dorsi to reach the iliac crest following a diagonal path (from superior-medial to inferior-lateral).
An osteofibrous tunnel created by the thoracolumbar fascia and the rim of the superior iliac crest allows passage of the nerve at the level of the iliac crest. The superior cluneal nerve finally terminates at the level of the gluteal fascia.
Le middle cluneal nerve, meanwhile, origin of the sacral nerve roots S1 to S4. It passes under the long posterior sacroiliac ligament in an almost horizontal course, and sandwiches it between the postero-superior iliac spine (PSIS) and the postero-inferior iliac spine (IPIS). It then goes to the buttock through the iliac crest.
Le inferior cluneal nerve arises from the posterior femoral cutaneous nerve of the thigh, which itself arises from the sacral nerve roots S1 to S3. He walks with the sciatic nerve et pudendal passing through the indentation sciatica. It also has some branches joining the perineum.
Clinical implication (Pathologies)
Any irritation or compression of the cluneal nerve in its nerve path can cause pain. This compression is usually done at the level of the iliac crest (upper branch), or sometimes at the level of the long posterior sacroiliac ligament. We then speak of cluneal neuralgia.
To learn all about cluneal neuralgia (including diagnosis and management), see the following article.
References
- https://en.wikipedia.org/wiki/Superior_cluneal_nerves
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944640/
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