BACKGROUND: Low back pain is a leading cause of disability; superior cluneal nerve entrapment (SCN-E) is an underdiagnosed etiology. SCN-E mimics common pain generators such as lumbar radiculopathy, facet joint dysfunction, and sacroiliac joint pain, thus leading to diagnostic challenges and delayed treatment.

CASE REPORTS: We describe 2 cases of SCN-E with distinct predisposing factors, including spinal scoliosis. A 74-year-old woman with a history of polymyalgia rheumatica presented with persistent low back pain and buttock pain despite standard treatments. A 77-year-old man with prior lumbar laminectomies reported chronic low back pain and right hip pain refractory to previous interventions. Both patients underwent ultrasound-guided superior cluneal nerve blocks, resulting in significant pain relief, thereby confirming SCN-E as the pain generator.

CONCLUSION: These cases highlight the importance of recognizing SCN-E in patients with refractory low back pain, particularly in those with altered spinal biomechanics. Ultrasound-guided SCN blocks serve as both a diagnostic tool and a therapeutic intervention, facilitating targeted pain management.

KEYWORDS: Superior cluneal nerve entrapment, altered spinal biomechanics, case series, spinal scoliosis, superior cluneal nerve block