Neuromodulation in Practice: Peripheral Nerve Stimulation-Superior Cluneal Nerves

Video Transcription

Video Summary

Dr. Alaa Abdel-Saeed presents peripheral nerve stimulation targeting the superior cluneal nerve branches (medial, middle, lateral) at the iliac crest, where anatomy is more predictable. Patients typically have iliac crest pain not explained by facet or other pathology. He recommends diagnostic blocks using three needles along the crest with small volumes of lidocaine or bupivacaine to confirm the pain source, accounting for variability in pain location. For lead placement under fluoroscopy, the needle contacts bone then “walks” along the top of the crest to hug it, followed by lead advancement and confirmation in multiple views. Sensory and motor testing are performed. Precautions include IV antibiotics, sterile technique, careful anchoring to prevent migration, and close follow-up for delayed infection.

Keywords

peripheral nerve stimulation

superior cluneal nerve

iliac crest pain

diagnostic nerve block

fluoroscopy-guided lead placement