Branch Blockade of the Dorsal Sacral Rami

Abstract

The recent original research article by Dreyfuss and colleagues [1], presents an interesting perspective on a potential technique to diagnose sacroiliac joint pain of extra-articular origin. However, some questions arise out of the described methodology, which we believe may merit further discussion. Recent morphological and histological study of the posterior sacroiliac region [2] indicate a specialized and metameric arrangement of a deep fascial layer that is related to a number of adjacent structures in the region. These include the individual dorsal sacral foramen, the associated lateral and medial branches of the dorsal sacral rami, and the long posterior sacroiliac ligament. The delicate neurovascular lateral branches of the dorsal sacral rami form a variable network of interconnected lateral branches from L5 to S4 dorsal rami [2–4], which lie immediately posterior to the dorsal sacral surface. Significantly, the lateral branches lie within a protective and continuous layer of loose connective and adipose tissue, as they wend their variable path between the …