Iliolumbar Ligament Research Articles

Frequency of Coexistent Spinal Segment Variants: Retrospective Analysis in Asymptomatic Young Adults.

Spinal segment variants are highly prevalent and can potentially lead to incorrect spinal enumeration and, consequently, interventions or surgeries at the wrong vertebral levels. Our aim was to assess the prevalence of spinal segment variants and to study the potential association among these variants in a population without histories of spine symptoms. Consecutive computed tomography exams of 450 young adults originally evaluated for non-spinal conditions and without a history of spinal diseases from a single institution. In addition to using descriptive statistics for reporting frequencies of spinal segment variants, the association between these variants was studied by calculating odds ratios and their 95% confidence interval. Consecutive CT exams were evaluated to determine the total number of presacral segments, presence of cervical rib, thoracolumbar transitional vertebra, iliolumbar ligament, and lumbosacral transitional vertebra. The spinal segment distribution variants (an atypical number of presacral segments or an atypical distribution of thoracolumbar vertebrae), cervical rib, thoracolumbar transitional vertebra, and lumbosacral transitional vertebra were reported in 23.8%, 4.2%, 15.3%, and 26.4% of cases in our study population. The presence of a cervical rib or a thoracolumbar transitional vertebra was associated with concurrent lumbosacral transitional vertebra (OR = 3.28; 95% CI, 1.29-8.47 and 1.87; 95% CI, 1.08-3.20, respectively). The inability to visualize the iliolumbar ligament was also associated with the presence of cervical ribs (OR = 3.06; 95% CI, 1.18-7.80). In a population of asymptomatic young adults, spinal segment variants are both highly prevalent with a high rate of coexistence. When a spinal segment variant (eg, transitional vertebra) is diagnosed, additional imaging might be considered for accurate spine enumeration before interventions or operations.

Ultrasound characteristics of soft tissues near sacroiliac joints and in the lumbar region of patients with ankylosing spondylitis.

To investigate the musculoskeletal morphomechanical properties (i.e., the thickness and elastic modulus) and the total count of power Doppler signals near the sacroiliac joints in patients with ankylosing spondylitis (AS) and non-AS individuals. Twenty participants with AS [median age (interquartile range): 31.7 (11.04) years] and 19 controls [36.3 (10.5) years] with no AS history were recruited. Bilateral ultrasound image acquisition was performed, including the short posterior sacroiliac ligament, interosseous sacroiliac ligament, long posterior sacroiliac ligament, iliolumbar ligament, proximal piriformis muscle, and sacrotuberous ligament. The intraclass correlation coefficients (ICC) of ultrasound parameters, laboratory test results of human leukocyte antigen B27, C-reactive protein, and erythrocyte sedimentation rate, and self-reported physical and disease activity scores were also obtained. The ligaments and piriformis muscle were thicker and stiffer (greater elastic modulus) in participants with AS than in non-AS participants (all p<0.01). The measurements showed good or excellent reliability (all ICC(3,1) >0.85). The numbers of power Doppler signals detected in the iliolumbar ligament, proximal piriformis muscle, and sacrotuberous ligament were higher in participants with AS than in non-AS participants (all p<0.001). A correlation was identified between disease duration and the elastic modulus of the piriformis muscle (r=0.640, p=0.003). We conclude that the ligaments and proximal piriformis muscle of AS participants have increased thickness, elastic modulus, and power Doppler signal than those of non-AS individuals. These reliable findings may serve as potential markers for the early diagnosis of AS and for assessing medication effects.

PREVALENCE OF LUMBOSACRAL TRANSITIONAL VERTEBRA IN PATIENTS PRESENTING WITH LOW BACKACHE AND IT'S ASSOCIATION WITH DEGENERATIVE SPINE CHANGES ON MRI: A STUDY IN RURAL TERTIARY CARE HOSPITAL OF SOUTH INDIA.

Introduction- Lumbosacral transitional vertebra (LSTV) is a congenital spinal anomaly dened as either sacralization of lumbar segment or lumbarization of sacral segment of the spine. Identication of accurate level of pathology is of utmost importance in patients undergoing surgical intervention. Failure to do so, might result in wrong level surgery, leading to signicant morbidity. Aims and objectivesŸ To analyze the prevalence, age and sex distribution of LSTV in low back pain patients. Ÿ To analyze the various methods of identifying and numbering LSTV. Ÿ To explore the relationship between LSTV and degenerative spine changes. Materials and methods- This was a crossectional observational study done in 217 cases presented with low back pain and underwent MRI LS spine using PHILIPS Ingenia 1.5 Tesla machine in department of radio-diagnosis at MAHARAJAHS INSTITUTE OF MEDICAL SCIENCES, NELLIMARLA. LSTV prevalence was 18.8% in this study. Most of the patients Conclusion- with LSTV belonged to 4th and 5th decades. No signicant sex predilection was seen. Castellvi types II &amp; IV are the most frequent types. An association between the transitional vertebra and herniation of the disc above was found in patients with low back pain i.e., Disc herniation was always noted above the transitional vertebra and not below that level (L4/5 disc prolapse in sacralization and L5/S1 disc prolapse in lumbarization), Sacralization was common than lumbarization in LSTV, approximately in the ratio of 2.3:1. The reliability of MRI ( sagittal MRI to count from C2, axial MRI to look for iliolumbar ligaments) to identify and correctly numbering LSTV was 100 %. Severity of degenerative spine changes was slightly higher among LSTV group than 'No LSTV' group

Anatomy and morphology of iliolumbar ligament

PurposeTo address limited amount of available data and contradictory statements in published works 60 Iliolumbar ligaments extracted from 30 cadavers were examined to describe their insertions and morphology.MethodsThe ligaments were removed during the standard autopsy procedures with a use of an oscillating saw, a chisel and a scalpel. The specimens were photographed before the extraction and measured alongside their anterior margin. Next, they were preserved in formaldehyde, stripped of other soft tissues and then examined, photographed and described.ResultsThe mean length of the ligaments was 31.7 mm. 44 specimens were described as single-banded, 13 as double-banded and 3 as other. In 24 cases costal process of LV has been fixed to the iliac plate by short ligamentous bands. In 38 cases there was a thick fibrous membrane connected to the ligament. No legitimate insertions on LIV vertebra were observed.ConclusionsTypical iliolumbar ligament consists of a single ligamentous band. Most common variability of the ligament consist of two bands. In approximately 40% of cases the costal process of LV can be additionally stabilized to the iliac plate by short, strong ligamentous bands. In 63% of cases a connection between the iliolumbar ligament and a fibrous membrane placed in the frontal plane, superiorly to the ligament, has been observed. There seems to be no convincing proof of existence of the insertion of the iliolumbar ligament on the LIV vertebra.

ILIF ASSISTIDA POR ENDOSCOPIA POR VIA TRANSILÍACA: ESTUDO EM CADÁVER

ABSTRACT Objective: Demonstrate the feasibility of endoscopic assisted L5S1 intraforaminal lumbar interbody fusion (iLIF) through a transiliac approach. Methods: Ten transiliac iLIF and ten supra iliac iLIF were performed bilaterally at L5S1 in five randomly selected fresh-frozen human cadavers. The following measurements were recorded: distances from the transiliac track to the iliac crest, posterior superior iliac spine, and superior gluteal neurovascular bundle; pelvic parameters; approach angles; cage’s lateral and AP center point ratio (CPR); percentage of the cage crossing the midline in the AP and lateral views. Endplate integrity was assessed through endoscopic visualization. In addition, the facet joint, sacroiliac joint, iliolumbar ligament, and exiting and traversing nerve roots were checked for integrity through anatomic dissection. Results: In the transiliac technique, the axial and coronal approach angles were significantly decreased by 13.5º (95% CI -15.5; -11.5; p value&lt;0.001) and 13.2º (95% CI -15.3; -11.1; p value&lt;0.001), respectively, the sagittal approach angle was significantly increased by 5.4º (95% CI 1.8,8.9; p-value = 0.008), and the AP CPR was significantly higher (MD 0.16; 95% CI 0.12,0.20; p value&lt;0.001). The percentage of the cage crossing the AP view’s midline was increased by 31.6% (95% CI 19.8,43.4; p value&lt;0.001). The integrity of endplates, facet joints, sacroiliac joints, iliolumbar ligament, and exiting and traversing nerve roots was maintained. Conclusion: L5S1 transiliac iLIF is a feasible surgical technique. It allows a more centrally placed interbody cage in the coronal plane without compromising the anterior position in the lateral plane. The integrity of the major anatomic structures at risk was preserved. Evidence Level III: A case-control study.

Revisiting chronic low back pain: evidence that it is not non-specific.

There is a common symptom pattern with most chronic low back pain (CLBP), suggesting that there is a common underlying etiology, belying the term "nonspecific." Many studies of CLBP and its treatment have been conducted with the assumption of nonspecificity, and as a result, treatment has not been focused, thus there has not been a significant change in CLBP prevalence over the past several decades. It is the thesis of this study to show that there is an underlying, specific cause of CLBP and that the presumption that CLBP is nonspecific is misdirected. The lumbosacropelvic (LSP) region, including the sacroiliac joint (SIJ), is part of a neuromusculoskeletal (NMSK) feedback system, and it is proposed here that CLBP is the result of a change in the feedback (afferent) aspect in that system. The objectives of this study are to show that CLBP presents as a pattern of symptoms that actually represents the final common pathway for a dysfunctional LSP joint system. Rather than being "nonspecific," the majority of CLBP has an underlying cause that is quite specific and predictable. A total of 252 patients were seen for CLBP, 67% of whom were diagnosed with an SIJ dysfunction. The presence of pain was recorded from seven structures most closely associated with CLBP. The conditional probabilities of having each pain generator given a SIJ dysfunction and an SIJ dysfunction given the presence of the pain generator were estimated, and associations were analyzed utilizing chi-square tests. Phi coefficients and odds ratios were utilized to quantify the strength of the association. The multivariable logistic regression model was fit to relate thepresence or absence of the SIJ dysfunction to the seven pain generators. The associations between SIJ dysfunction and each pain generator were statistically significant. Phi coefficients indicated moderate strengths of these bivariate associations. Iliolumbar ligament (ILL) and psoas muscle (PSM) were significant predictors of SIJ dysfunction in the multivariable model. Seven pain generators had a strong association with SIJ dysfunction. This empirical clinical evidence supports our hypothesis that LSP system dysfunction, as evidenced by SIJ dysfunction, is a common source of symptom patterning associated with CLBP and is most likely the causal element. This is evidence that most CLBP is not "nonspecific" but rather the result of changes made by the NMSK control system for the LSP region.

Deferent Anatomical Presentations of Iliolumbar Ligament: A Cadaveric Study.

This work was carried out to describe the detailed gross anatomy of the iliolumbar ligaments in human cadavers and to shed more light on these disputes regarding the configuration and direction of these ligaments. Twenty partially dissected human formalin-preserved cadavers originating from North America and Europe were investigated in this study. Blunt dissection was made through the ventral and dorsal aspects of the pelvic area of the cadavers. According to the current study, the anterior and posterior portions of the iliolumbar ligament most frequently attached to the 5th lumbar vertebra's transverse process (70% and 80%, respectively). The body of the 4th lumbar vertebra with the 5th lumbar vertebra' transverse process was the attachment of the anterior part (30%). The attachment of the posterior part was the body of the 5th lumbar vertebra (20%). The anterior and posterior parts of the iliolumbar ligament were inserted into the anterior tip of the iliac crest. There is an obvious variation in the morphological appearance of the iliolumbar ligament distinguished in attachments, length, width, thickness, number of bands, and the presence of accessory bands in the anterior part of the ligament. In addition, a new attachment for the anterior band was revealed in one-third of the specimens (body of the 4th lumbar vertebra) which have not been described before. Also, in one-fifth of the specimens, there was a new attachment for the posterior band (body of the 5th lumbar vertebra).

STUDY OF RESULTS OF TRANSFORAMINAL LUMBAR INTERBODY FUSION (TLIF) IN SPONDYLOLISTHESIS IN CIVIL HOSPITAL AHMEDABAD, GUJARAT,INDIA

Introduction: Spondylolisthesis is a descriptive term derived from the Greek word spondylo (spine) and olisthesis (slip). spondylolisthesis is anterior translation of the cephalad vertebra relative to the adjacent caudal segment. For spondylolisthesis to occur there must be a failure of anatomic structures that normally resist this anteriorly directed force. These structures include the facets, annulus brosus, posterior bony arch, and pedicles. Radiological investigations are done for diagnosis and planning of treatment. Treatment includes conservative management and surgical management using different techniques. 1) To Estimate the clinical outcom Aim And Objective: e of patients who underwent Transforaminal lumbar interbody fusion (TLIF) in terms of symptoms and signs. This is a Prospecti Materials And Methods: ve Study, Sample size of 25 in which 18 were female and 7 males. After Institutional Ethics Committee approval, Study was conducted from September 2019 to December 2021 at a tertiary care Hospital. Consecutive patients with spondylolisthesis and planned for TLIF. Informed written consent was taken from all the patients. Observation And Results: Total 25 patients were included in the study out of that 7(28) % men and 18(72%) women. Majority of the study patients 16(64%) were belong to above 45 years age group. Preoperative minimum VAS scoring of back pain was 6 while the maximum was 8, with a mean of 6.8. The mean VAS scoring at 6 months follow up was 1.08 with a minimum of 0 while a maximum of 3, which is statistically signicant. In our study slip grade was reduced by 1 in 19 patients and by grade 2 in 5 patient and there was no improvement of grade in 1 patient. Out of 25 study patients, 1(4%) patient had supercial wound infection and only 1(4%) patient had complication of screw loosening. In our study Conclusion: 18(72%) patients were female while 7(28%) patients were male, with mean age of 47 years. showing that degenerative spondylolisthesis is common in females as compared to male, in age group more than 40 years. level of spondylolisthesis is L4-L5 while L5-S1 in 10(40%), indicating that L4-L5 is the more commonly involved as compared to L5-S1 due to sagittal inclination of the lower vertebra and relative stability of L5-S1 between the stout iliolumbar ligaments in the sacral ala and the L5 transverse process. Transforaminal lumbar interbody fusion is a safe and effective option to achieve circumferential fusion without sever complications. TLIF has been established as one of the most successful surgery for reducing pain and enhancing physical function in spondylolisthesis.

Biomechanical analysis of sacroiliac joint motion following oblique-pulling manipulation with or without pubic symphysis injury

Background: Oblique-pulling manipulation has been widely applied in treating sacroiliac joint (SIJ) dysfunction. However, little is known about the biomechanical mechanism of the manipulation. This study aims to analyze the SIJ motion under oblique-pulling manipulation, in comparison with compression and traction loads. Methods/Study Design: A total of six specimens of embalmed human pelvis cadavers were dissected to expose the SIJ and surrounding ligaments. Through a servo-hydraulic testing system, biomechanical tests were performed on the stable pelvis and the unstable pelvis with pubic symphysis injury (PSI). A three-dimensional (3D) photogrammetry system was employed to determine the separation and nutation in three tests: axial compression (test A), axial traction (test B), and oblique-pulling manipulation (test C). Results: After applying the testing loads, the range of nutation was no more than 0.3° (without PSI) and 0.5°(with PSI), separately. Except for test B, a greater nutation was found with PSI (p < 0.05). Under both conditions, nutation following test A was significantly greater than that of other tests (p < 0.05). SIJ narrowed in test A and separated in tests B and C, where the range of motion did not exceed 0.1 mm (without PSI) or 0.3 mm (with PSI) separately. Under both conditions, the separation of SIJ in test C was not as apparent as the narrowness of SIJ in test A (p < 0.05). Compared to SIJ, a more significant increasing displacement was found at the site of the iliolumbar ligament (p < 0.05). Nevertheless, when the force was withdrawn in all tests, the range of nutation and separation of SIJ nearly decreased to the origin. Conclusion: Pubic symphysis is essential to restrict SIJ motion, and the oblique-pulling manipulation could cause a weak nutation and separation of SIJ. However, the resulting SIJ motion might be neutralized by regular standing and weight-bearing load. Also, the effect on SIJ seems to disappear at the end of manipulation. Therefore, the stretching and loosening of surrounding ligaments need to be paid more attention to.

Identifying the relationship between lumbar sacralization and adjacent ligamentous anatomy in patients with Bertolotti syndrome and healthy controls.

Bertolotti syndrome is a diagnosis given to patients experiencing low-back pain due to a lumbosacral transitional vertebra (LSTV). LSTVs cause altered biomechanics at the lumbosacral junction, predisposing these patients to degenerative disease. It has been proposed that these patients have additional non-osseous variation such as ligamentous differences in the lumbar spine. The iliolumbar ligament, which attaches from the iliac crest to the transverse process of L4 and L5, plays a significant role in reducing lumbar motion in all six degrees of freedom; therefore, altered ligament anatomy can have a significant impact on stability. The purpose of this study was to examine the iliolumbar ligament complex in patients with Bertolotti syndrome and anatomically normal controls to determine if underdevelopment of the iliolumbar ligament complex is seen in Bertolotti syndrome. This is a retrospective analysis of patients with Bertolotti syndrome and anatomically normal controls who received care at the authors' institution between 2010 and 2020. Axial thickness of the iliolumbar ligament at the L5 vertebral level was assessed via MRI. Results were compared between the defective and normal side within unilaterally affected (Castellvi types IIa and IIIa) Bertolotti syndrome patients, between defective sides in bilaterally affected Bertolotti syndrome patients (Castellvi types IIb, IIIb, and IV), and between the affected side in Bertolotti syndrome patients and the corresponding location in normal controls. A total of 173 patients were included in the study, 102 with Bertolotti syndrome and 71 controls. Among the Bertolotti patients, 49 had left LSTVs, 29 had right LSTVs, and 24 had bilateral LSTVs. For patients with unilateral defects, defective side ligaments were thinner than ligaments on the normal side (p < 0.05). For bilateral LSTVs, ligament thickness on each side was considered statistically equivalent (p < 0.05) and not significantly different from that in controls. Bertolotti syndrome correlates to significant underdevelopment of the iliolumbar ligament corresponding to the side of the LSTV as compared to the ligament on the contralateral side. In patients with bilateral LSTVs, no difference in the iliolumbar ligament compared to that in controls was seen. Developmental changes in the iliolumbar ligament may further exacerbate the altered lumbosacral biomechanics seen in patients with unilateral LSTV, whereas bilateral LSTVs may still allow normal development of the ligament complex. Further research should be done to examine the discrepancies seen in this study.

Quantitative measurements at the lumbosacral junction are more reliable parameters for identifying and numbering lumbosacral transitional vertebrae.

To evaluate quantitative parameters to identify the anatomic variation lumbosacral transitional vertebrae (LSTV) and compare them with the landmarks commonly used at present. A total of 2,845 PET/CT scans were reviewed, and the patients with 23 and 25 presacral vertebrae were included. The quantitative parameters, including the anterior-edge vertebral angle (AVA) of the lowest lumbar-type vertebra, the ratio of the length of the inferior endplate to that of the superior endplate (RISE) of the uppermost sacral-type vertebra and the lumbosacral intervertebral disc angle (LSIVDA), and the anatomical landmarks, including the iliac crest tangent (ICT) level, the iliolumbar ligament (ILL) origin level and psoas proximal insertion, were all evaluated to determine their ability to identify LSTV. The values of AVA and RISE were significantly different between the LSTV group and the control group, and between subgroups of LSTV. The cutoff value for AVA was 73.0°, with an accuracy, sensitivity, and specificity of 91.1%, 77.5%, and 88.3%, and that for RISE was 0.79, with an accuracy, sensitivity, and specificity of 90.3%, 77.5%, and 94.2%, while that for LSIVDA was 14.15°, with an accuracy, sensitivity, and specificity of 75.9%, 65.7%, and 78.3%, to differentiate L5 sacralization from S1 lumbarization. For differentiating the controls from LSTV, the accuracy, sensitivity, and specificity of the ICT level and proximal psoas insertion were 78.0%, 70.2%, and 95.0%, versus 71.7%, 61.7%, and 94.0%. Compared with the anatomical landmarks, the quantitative measurements at the lumbosacral junction, including AVA and RISE, may be more helpful for differentiating subgroups of LSTV especially if only lumbar spine imaging is available. • The quantitative parameters, the anterior-edge vertebral angle (AVA) of the lowest lumbar-type vertebra and the ratio of the length of the inferior endplate to that of the superior endplate (RISE) of the uppermost sacral-type vertebra, are more helpful for distinguishing L5 sacralization from S1 lumbarization than the previously proposed anatomic landmarks. • AVA and RISE represent relevant changes in the curvature at the lumbosacral region and the shape of the transitional vertebral body, respectively. • AVA and RISE are easily assessed, with high intra- and inter-reader reliability.

A novel anatomo-physiologic high-grade spondylolisthesis model to evaluate L5 nerve stretch injury after spondylolisthesis reduction

L5 nerve palsy is a well-known complication following reduction of high-grade spondylolisthesis. While several mechanisms for its occurrence have been proposed, the hypothesis of L5 nerve root strain or displacement secondary to mechanical reduction remains poorly studied. The aim of this cadaveric study is to determine changes in morphologic parameters of the L5 nerve root during simulated intraoperative reduction of high-grade spondylolisthesis. A standard posterior approach to the lumbosacral junction was performed in eight fresh-frozen cadavers with lumbosacral or lumbopelvic screw fixation. Wide decompressions of the spinal canal and L5 nerve roots with complete facetectomies were accomplished with full exposure of the L5 nerve roots. A 100% translational slip was provoked by release of the iliolumbar ligaments and cutting the disc with the attached anterior longitudinal ligament. To evaluate the path of the L5 nerves during reduction maneuvers, metal bars were inserted bilaterally at the inferomedial aspects of the L5 pedicle at a distance of 10 mm from the midpoint of the L5 pedicle screws. There was no measurable change in length of the L5 nerve roots after 50% and 100% reduction of spondylolisthesis. Mechanical strain or displacement during reduction is an unlikely cause of L5 nerve root injury. Further anatomical or physiological studies are necessary to explore alternative mechanisms of L5 nerve palsy in the setting of high-grade spondylolisthesis correction, and surgeons should favor extensive surgical decompression of the L5 nerve roots when feasible.

Informative value of physical provocative tests and treatment-diagnostic blocks for differentiation of iliolumbar ligament syndrome

Informative value of provocative tests and a treatment-diagnostic block for differentiation of iliolumbar ligament syndrome was determined. Results of diagnostic examination of 174 patients with ligamentogenic lumbopelvic pain, where 97 cases revealed iliolumbar ligament syndrome and 77 patients had pathology of the sacrotuberous and/or sacrospinal ligaments, were analysed. It was found out that adduction of the hip, flexed at the right angle, with a subsequent pressure along its axis resulted in the largest sensitivity (Se=70.09%) and specificity (Sp=73.68%) for differential diagnosis of the source of ligamentogenic lumbopelvic pain in patients with iliolumbar ligament syndrome. This finding makes it possible to consider the above test as pathognomic, even in conditions of negative results of other provocative tests, and the one that substantiates a treatment-diagnostic block as the next diagnostic step. A combination of the test (adduction of the hip, flexed at the right angle, with a subsequent pressure along its axis), pathognomic for iliolumbar ligament syndrome, with a rotation test had a high sensitivity (Se=73.17%) and specificity (Sp=86.27%), thereby being a more valuable informative index for differential diagnosis of this ligamentosis. A combination with a diagnostic block increased diagnostic accuracy up to 98%. Keywords: lumbopelvic pain, iliolumbar ligament, provocative tests, treatment-diagnostic block.

ANATOMICAL-BIOMECHANICAL PECULIARITIES, PATHOGENESIS, CLINICAL FEDATURES AND DIAGNOSIS OF ILIOLUMBAR LIGAMENT SYNDROME (LITERATURE REVIEW)

Low back pain is the most widespread manifestation of pathology in the locomotor system. This pain has a multifactorial nature and in a number of cases can be caused by ligament defects in the lumbosacral region, particularly in the iliolumbar ligaments. Objective. To find out the modern trends in the development, clinical manifestation and diagnosis of iliolumbar ligament (ILL) syndrome based on the analysis of scientific-medical information. Results. ILL syndrome is characterized by variability of its form, attachment sites and even number. It has been revealed that ILL’s play an important biomechanical role in providing of stability in the frontal plane on the level of LV vertebra, and in the horizontal plane they restrict rotation of LІV with respect to the pelvis. Asymmetry of the spatial orientation of ILL causes an increased risk of formation of disc herniation in LІV–SІ. Under the effect of overloads ILL’s developstructural changes or damages, whose risk increases with age. Diagnostic algorithms usually provide use of physical and radial techniques for revealing of ILL damages. Difficulties in physical diagnosis and blocking of ILL syndrome are caused by their insufficient specificity. Also rather weak is an association between pain manifestations in the low back and results of radiological examinations. CT and MRI make it possible to visualize ILL’s, but so far these opportunities do not give too much for practice because of absence of any signs, whose relationship with the appearance and dynamics of low back pain would be doubtless. Ultrasound examination is a more informative method for instrumental diagnosis of ILL syndrome. Conclusions. Development of provocative tests and therapeutic-diagnostic blocks, which hold on the principles of evidence-based medicine, is a promising trend in improving diagnosisof ILL syndrome. Biochemical criteria for revealing and monitoring ILL pathology and their correlation with sonographic characteristics of different stages in the development of ligamentopathy require specification.

Novel Regional Nerve Blocks in Clinical Practice: Evolving Techniques for Pain Management.

This review examines the use of novel US-guided nerve blocks in clinical practice. Erector spinae block is a regional anesthesia technique doing by injecting a local anesthetic among the erector spinae muscle group and transverse processes. The phrenic nerve is a branch of the cervical plexus, arising from the anterior rami of cervical nerves C3, C4, and C5. The quadratus lumborum muscle is located along the posterior abdominal wall. It originates from the transverse process of the L5 vertebral body, the iliolumbar ligament, and the iliac crest. US-guided peripheral nerve procedures have a considerable scope of use, including treating headaches and hiccups to abdominal surgical pain, cesarean sections, musculoskeletal pathologies. These nerve blocks have been an effective addition to clinical anesthesia practice. The use of peripheral nerve blocks has improved postoperative pain, lessened the use of opioids and their potential side effects, and decreased the incidence of sleep disturbance in patients. More research should be done to further delineate the potential benefits of these blocks.

Pathologic continuum in lumbosacral ligamentosis: comparison of sonographic and histologic data

Objective:to establish sonographic criteria allowing determining the stage of the pathologic continuum in lumbosacral ligamentosis.Material and methods.The sonographic data were compared with the results of the morphological studies of the samples of the iliolumbar ligaments, long dorsal sacroiliac ligaments, and sacrotuberous ligaments in 100 corpses. The age range of the studied subjects was 25–90 years. Among them, there were 64 men (average age 62.4 ± 11.8 years) and 36 women (average age 58.8 ± 15.1 years). Sonography of the ligament samples was performed in Bmode and using Multi-Slice View technology (Voluson 730 Expert and Toshiba Aplio XG ultrasound scanner, scanning frequency — 16–18 MHz).Results.A sonographic pattern inherent in the stage of adaptive changes, the stage of potentially reversible changes, and the stage of irreversible changes has been determined.Conclusion.Sonography can be used for a sufficiently accurate assessment of the stage of the pathologic continuum in lumbosacral ligamentosis.

Recovering from nonspecific low back pain despair: Ultrasound-guided intervention in iliolumbar syndrome.

Background:Iliolumbar syndrome is a frequent cause of chronic nonspecific low back pain. The cornerstone of its treatment lies upon the specific diagnosis of the iliolumbar syndrome. The ultrasound guided interventions have the potential for the specific diagnosis and treatment of the iliolumbar syndrome.Objective:To assess the role of ultrasound-guided intervention for the diagnosis and treatment of the iliolumbar syndrome.Materials and Methods:The study comprised of fifty-seven patients of nonspecific low back pain with the clinically suspected iliolumbar syndrome. Two-staged ultrasound-guided interventions were performed: Primary diagnostic and secondary therapeutic interventions. Favorable response after the injection of local anesthetic agent in iliolumbar ligament (defined as VAS score to ≥3) was classified as confirmed Ilio-lumbar syndrome. Clinico radiological efficacy after platelet-rich plasma (PRP) injection in confirmed iliolumbar syndrome patients was done.Results:Out of 57 patients, 45 (78.95%) were diagnosed with confirmed Iliolumbar syndrome after primary diagnostic intervention. The mean value of VAS at presentation was 8.02 ± 0.72 which was decreased to 3.16 ± 1.63; P < 0.0001. All 45 patients underwent PRP injection in iliolumbar ligament and 42 patients (93.33%) showed reduction in mean VAS score from 8 ± 0.67 (at presentation) to 0.89 ± 1.23 after 6 weeks follow up; P < 0.0001. Iliolumbar ligament thickness was decreased from the day of presentation (2.66 ± 0.22) to 6 weeks after therapeutic intervention (0.91 ± 0.42); P < 0.0001.Conclusion:The ultrasound guided diagnostic and therapeutic intervention were found to result in a specific diagnosis and remarkable recovery in the iliolumbar syndrome group of nonspecific low back pain patients.

Effects of myofascial techniques on pain, mobility and function in patients with low back pain: a double-blind, controlled and randomized trial

Introduction: Low back pain is one of the most frequent causes of disability, with several associated etiologies. Osteopathic manipulative treatment is widely used to evaluate and manage musculoskeletal disorders. The aim of the study was to evaluate the immediate and late effects of 3 sessions of myofascial osteopathic techniques on pain intensity, posterior chain flexibility, lumbar mobility and level of disability in patients with chronic low back pain. Methods: 60 subjects of both genders, randomly divided into 3 experimental groups: healthy control (HC n = 20), low back pain control group (CG, n = 20) and treated low back pain group (TG, n = 20). Initially, the 3 groups were evaluated using the Visual Analogue Scale (VAS), Oswestry questionnaire, Wells bench and measurement of lateral spine tilt and fingertip-to-floor test. The TG was submitted to 3 sessions of myofascial techniques (lasting 40 minutes), 1x / week. The session consisted of the application of 6 myofascial techniques (thoracolumbar fascia, quadratus lumborum fascia, iliopsoas muscle stretching, quadratus lumborum stretching and iliolumbar ligaments). Subjects were reevaluated immediately after the first session, 7 days after the last session and one month after treatment completion (follow up). Results: There was an improvement in posterior chain flexibility (20.3 ± 7.4 cm pre to 26.3 ± 8 cm after 3 sessions), spinal mobility (fingertip-to-floor: 13.3 ± 11.33 cm pre to 4.8 ± 10.5 cm after 3 sessions), as well as pain intensity reduction (3.3 ± 1.9 cm pre to 1 ± 1.7 after 3 sessions) and reduction in the level of lumbar disability (15.8 ± 7.3 in the pre to 9.2 ± 8.6 after 3 sessions) for TG. In HC and CG there was no change in any of the variables. The results shown for TG remained even one month after the intervention. Conclusion: The osteopathic treatment protocol with myofascial techniques was effective for the treatment of low back pain.

Progressive instability of bilateral sacral fragility fractures in osteoporotic bone: a retrospective analysis of X-ray, CT, and MRI datasets from 78 cases.

The pathogenetic mechanism, progression, and instability in geriatric bilateral fragility fractures of the sacrum (BFFSs) remain poorly understood. This study investigated the hypothesis of sequential BFFS progression by analysing X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) datasets. Imaging data from 78 cases were retrospectively analysed. Fractures were categorized using the CT-based Fragility Fractures of the Pelvis classification. MRI datasets were analysed to detect relevant fracture location information. The longitudinal sacral fracture was graded as stage 1 (bone oedema) on MRI, stage 2 (recent fracture), stage 3 (healing fracture), or stage 4 (non-union) on CT. Ligamentous avulsions at the L5 transverse process and iliac crest were also captured. Contralateral sacral lesions were only recognized by initial bone oedema on MRI in 17/78 (22%) cases. There were 22 cases without and 56 cases with an interconnecting transverse fracture component (TFC) [between S1/S2 (n = 39) or between S2/S3 (n = 17)]. With 30/78 patients showing bilateral fracture lines at different stages (1/2: n = 13, 2/3: n = 13, 1/3: n = 4) and 38 at similar stages, Wilcoxon tests showed a significant stage difference (p < 0.001). Forty cases had a coexistent L5 transverse process avulsion, consistent with a failing iliolumbar ligament. Analysis of variance revealed significant increases in ligamentous avulsions with higher fracture stages (p < 0.001). Our results support the hypothesis of stagewise BFFS progression starting with unilateral sacral disruption followed by a contralateral lesion. Loss of sacral alar support leads to a TFC. Subsequent bone disruption causes iliolumbar ligament avulsion. MRI is recommended to detect bone oedema.

Evaluation of the Frequency of Pain Occurrence of the Lumbar Spine Measured in the Employees of Szczecin’s Universities Depending on Age and Pathomechanisms

Introduction: With age, there are many pathologies in the organs of our body. The sedentary lifestyle in specific professional groups cause the emergence and intensification of functional and structural defects of the spine. Aim: The aim of the study was to examine the frequency of pelvic and lumbar spine disorders (measured using functional tests and imaging tests) affecting the frequency of pain. Material and Methods: The study involved 114 patients with lumbosacral pain (75 women, 39 men, 24-85 years of age, average age of the respondent 53 years). It was carried out between July 2017 and September 2019 at SP ZOZ SW in Szczecin. In the study group, the author’s questionnaire was used, functional tests were carried out and imaging analysis was performed. Results: The frequency of occurrence of pain episodes depends statistically significantly on the age (p &lt;0.05). The highest percentage of frequent pain occurs in people over 65 years of age (70.83%). Over half (57.02%, n = 65) of respondents struggle with pain in the ilio-lumbar and / or sacro-tumor ligaments. Strong pain in the ilium-lumbar ligament is statistically significant in people with lumbar hyperlordosis (84.62%, n = 22). This relationship was also observed during the lifting of hands. For 6 people declaring the pain while doing this - 4 of them also show severe pain in the ilio-lumbar ligaments. The pain of the cruciate ligament alleviates the standing position, which is also statistically significant. In the employees of the Szczecin universities, the disc herniation of the intervertebral disc was most often found in people between the 4th and 6th decade of life. Pain discomfort associated with discopathy accompany patients throughout all day (p &lt;0.05). Conclusions: The degree of advancement of changes in the lumbar-sacral spine increases with age. The type of lumbar lordosis affects pain in the ilium-lumbar ligament.