Alcohol neurolysis for persistent pain caused by superior cluneal nerves injury after iliac crest bone graft harvesting in orthopedic surgery: report of four cases and review of the literature.

Abstract

Harvesting of autologous bone graft from the posterior iliac crest for lumbar spinal fusions is a frequently performed procedure in orthopedic surgery. The most common complication associated with this procedure is an alteration in sensation over the donor site manifested as chronic pain, hyperesthesia, dysesthesia, or diminished sensitivity resulting from superior cluneal nerve (SCN) injury. To predict the effectiveness of alcohol neurolysis in the treatment of persistent pain caused by the entrapment of superior cluneal nerves. The subjects of this study were patients with intractable pain in donor area after conventional treatments using a transverse incision, which is parallel to posterior iliac crest. The study group was composed of four patients who underwent surgery in a 1-year period and experienced chronic pain resulting from superior cluneal nerve injury. No reports describing alcohol neurolysis of the superior cluneal nerve exist in the relevant literature. All four patients in this study were treated with alcohol neurolysis of the superior cluneal nerves. The study patients were observed up to 4 years, and none of them reported any problems. The authors suggest that conventional treatments be limited to a 2-month period, and that alcohol neurolysis be applied as soon as possible to prevent lengthy pain experiences.