Proximal Versus Distal Superior Cluneal Nerve Block in Entrapment Neuropathy

Superior cluneal nerve (SCN) entrapment is an underdiagnosed cause of chronic low back and gluteal pain. Although diagnostic nerve block is considered the gold standard for confirming SCN entrapment, there is no consensus regarding the optimal injection approach. This prospective observational study aims to compare the clinical effectiveness of proximal and distal ultrasound-guided SCN block techniques in patients diagnosed with SCN entrapment. Pain intensity and functional outcomes will be evaluated over the follow-up period to assess differences between the two approaches.

Inclusion Criteria: * Age between 18 and 75 years * Chronic low back and/or gluteal pain lasting longer than 3 months * Localized point tenderness and/or paresthesia on palpation over the unilateral posterior iliac crest * Clinical suspicion of superior cluneal nerve entrapment based on physical examination * Failure to respond to conservative treatment * Ability and willingness to provide written informed consent Exclusion Criteria: * Active local or systemic infection * Cognitive impairment or psychiatric disorders interfering with study participation * History of malignancy or cancer-related pain * Uncontrolled diabetes mellitus or severe comorbid conditions adversely affecting general health * Pregnancy * Known allergy to the medications used in the injection * Prominent radicular pain associated with neurological deficit * History of interventional procedures applied to the lumbar region within the last 6 months * Initiation of another lumbar interventional or medical treatment during the follow-up period * Suspected bilateral superior cluneal nerve entrapment * Sphincter dysfunction related to neurological disease * Bleeding diathesis or coagulation disorders