They travel inferiorly through multiple layers of muscles, then traverse osteofibrous tunnels between the thoracolumbar fascia and iliac crest.

[5] The nerves then pass through an osteofibrous tunnel created by the thoracolumbar fascia and rim of the superior iliac crest.

[6] Cadaver studies have noted that some patients have boney grooves along the rim that house the superior cluneal nerves.

[citation needed] Damage to the cluneal nerves can be from direct injury or from entrapment between the muscles or in the osteofibrous tunnel.

Direct injury to the cluneal nerves can happen during posterior iliac crest harvest to obtain bone mineral for other surgeries, such as spinal arthrodesis.

[citation needed] Dysfunction of the superior cluneal nerves lead to many different neuropathic symptoms such as burning pain, numbness, tingling, and dysesthesia around the low back and upper gluteal area.

[1] Manual compression over the posterior superior iliac crest, such as with wearing tight clothing and belts, can also reproduce symptoms.

[5][14] On physical exam, the pain can be reproduced by the excessive motions listed above or by tapping along the posterior superior iliac crest, which would be a positive Tinel-like sign.

[1][5] The treatment for superior cluneal nerve dysfunction can vary based on the clinician and severity of symptoms.

[1] Other treatments of superior cluneal nerve dysfunction include both minimally invasive interventions and surgical options.

[11] These injections can be performed with or without image modalities, though the use of ultrasound guidance may help optimize medication delivery [11][8][15] These procedures can also be done under fluoroscopy.