Posterior Sacroiliac Ligaments Research Articles

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.

Numerical analysis of the effects of padded pelvic belts as a treatment for sacroiliac joint dysfunction.

Pain related to the sacroiliac joint (SIJ) accounts for low back pain in 15%-30% of patients. One of the most common treatment options is the use of pelvic belts. Various types of pelvic belts exist; however, the mechanisms underlying treatment and their effectiveness remain unclear to date. To analyze stress distribution in the pelvis when a pelvic rubber belt or a padded pelvic belt is applied, to assess the effectiveness of treatment from a numerical biomechanical perspective. The pressure distribution at the pelvic belts was measured using a device and subsequently modeled with the finite element method of a pelvis with soft tissues. The stress environment when wearing a pelvic belt in a double-leg stance was simulated. With the application of pelvic belts, the innominate bone rotated outward, which was termed an out-flare. This caused the SIJ to compress and cause reduction in sacrotuberous, sacrospinous, interosseous, and posterior sacroiliac ligament loading. Padded pelvic belts decreased the SIJ displacement to a greater extent than in pelvic rubber belts. Pelvic belts aid in compressing the SIJ and reduce its mobility.

A cadaveric biomechanical evaluation of anterior posterior compression II injuries

Pelvic fractures are associated with high morbidity and often require surgical intervention. An Anterior Posterior Compression (APC) II injury consists of disruption at the pubic symphysis and anterior sacroiliac joint. Studies investigating specific ligamentous contributions would aid in development of novel fixation techniques. The objective of this study is to determine the level of pelvic destabilization from progressive soft tissue disruptions associated with APC II injuries. Six fresh-frozen cadaveric pelvises were dissected of soft tissues, preserving joint capsules and ligaments. Each pelvis was secured in a double-leg stance and joint motion was tracked with the specimens cyclically loaded to 60% body weight. Each specimen was measured in the intact state and again following stepwise destabilization to an APC II injury model (PS: sectioned pubic symphysis, IPS JOINT: PS+ipsilateral anterior sacroiliac, sacrotuberous, sacrospinous ligaments sectioned, IPS LIGS: IPS JOINT+ipsilateral interosseous ligaments sectioned, IPS JOINT+CONT ASI: IPS LIGS+contralateral anterior sacroiliac ligament disruption). Compared to the intact state, there was a statistically significant increase in movement in the IPS JOINT (ipsilateral 177%, p<0.001; contralateral 46%, p<0.005) and IPS JOINT+CONT ASI (ipsilateral 184%, p<0.002; and contralateral 62%, p<0.002) states bilaterally. No significant change was demonstrated in the PS or IPS LIGS state. Disruption of ipsilateral ligamentous structures destabilized both sacroiliac joints. The interosseous and posterior sacroiliac ligaments provide the majority of stability of the sacroiliac joint and will likely benefit most from surgical stabilization. mechanism-based reasoning.

Sacroiliac innervation

PurposeTo investigate the innervation pattern of the sacroiliac region, especially with regard to the sacroiliac joint (SIJ). Dorsal SIJ innervation was analyzed and described. Our main hypothesis was that nerves reach the SIJ dorsally, passing ligamental compartments, as this would explain dorsal SIJ pain.MethodsTo examine sacroiliac innervation, we followed the nerves in over 50 specimens over several years. Plastinated slices were evaluated, nerves in the region were stained histologically, and the data were summarized as 3D models.ResultsThe Rami communicans and posterior branches of the spinal nerves and their branches that form a dorsal sacral plexus and communicating branches, together with corresponding vessels, were observed to form neurovascular bundles embedded by tiny fatty connectives in gaps and tunnels. Branches of L5-S1 pass the inner sacroiliac ligaments (the interosseous sacroiliac ligament and axial interosseous ligament). The outer sacroiliac ligaments (posterior sacroiliac ligaments, long posterior sacroiliac ligament, sacrotuberal ligament, thoracolumbar fascia) are passed by the S1-S4 branches. However, although the paths of these nerves are in the direction of the SIJ, they do not reach it. It is possible that impingement of the neurovascular bundles may result in pain. Moreover, the gaps and tunnels connect to the open dorsal SIJ.ConclusionOur findings suggest that Bogduk’s term “sacroiliac pain” correlates to “sacroiliac innervation”, which consists of “inner-” and “outer sacroiliac ligament innervation”, and to ventral “SIJ pain”. The watery gaps and tunnels observed could play a significant role in innervation and thus in the origins of SIJ pain.Level of evidenceIndividual cross-sectional studies with consistently applied reference standard and blinding.

An ultrasound study of the long posterior sacroiliac ligament in healthy volunteers and in patients with noninflammatory sacroiliac joint pain.

To describe the sonoanatomy of the long posterior sacroiliac ligament (LPSL) in healthy volunteers and to assessby ultrasound the LPSL in patients with noninflammatory sacroiliac joint pain (SIP). We assessed 64LPSLs of 32 healthy controls and 40 LPSLs of 40 patients with unilateral noninflammatory SIP and a positive Fortin fingertest. LPSLs in both groups were assessed for the presence of alterations in their structure, continuity and echogenicity andtheir thickness was measured in three predefined points. All patients were examined in prone position following a strict scanningprotocol. Detailed sonoanatomy description and measurement of the LPSL in healthy volunteers are provided(length: 31.32±4.79 mm, width: 8.14±1.28 mm, thickness: 2.05±0.55 mm; 1.64±0.41 mm and 1.51±0.42 mm at the iliac andsacral entheses and in its middle part, respectively). The LPSLs were found to be significantly thicker in the SIP group, withan optimum criterion value of >2.0 mm in its middle part to identify pathologically thickened ligaments. In addition, LPSLs inthe SIP group presented significantly more often hypoechogenicity/altered fibrillar structure (57.5% vs.16%) and/or periligamentousedema (72.8% vs 28%). The combination of either altered structure or periligamentous edema, with thickening of theligament's body showed the best diagnostic accuracy (sensitivity and specificity 83.9% and 94.7% for the first combinationand 100% and 84.6% for the second combination) to identify LPSL pathology in noninflammatory SIP. LPSLcould be assessed by ultrasound and sonopathological lesions could be identified in patients with SIP.

Radiofrequency Ablation for Chronic Posterior Sacroiliac Joint Complex Pain: A Comprehensive Review.

Radiofrequency ablation of the sacral lateral branches targets the innervation of the posterior sacroiliac ligaments and posterior portion of the sacroiliac joint. These structures are also collectively referred to as the posterior sacroiliac joint complex. This review will discuss current diagnostic block paradigms and selection criteria for sacral lateral branch radiofrequency ablation, varying techniques and technologies utilized for sacral lateral branch radiofrequency ablation, and updates on the clinical outcome literature. The current evidence suggests that sacral lateral branch radiofrequency ablation can provide relief for posterior sacroiliac joint complex pain, but the literature is limited by variability in selection criteria, the specific nerves targeted by radiofrequency ablation, and the types of radiofrequency ablation technology and techniques utilized in clinical outcome studies.

Chondrosarcoma Arising from the Posterior Iliac Crest Extending into the Spinal Canal

Chondrosarcoma is a malignant tumor characterized by the production of a cartilage matrix. Extension into the spinal canal from the extracannular space is seen mainly for neurogenic tumors, but it is rare in nonneurogenic tumors. A 75-year-old woman suffered from sciatic pain and numbness in her lower left extremity. The diagnosis was of a low-grade conventional chondrosarcoma, which originated from the posterior ilium with an intraspinal extension at the level of the sacrum, compressing the cauda equina. The tumor extended further into the S1 sacral anterior foramen, in the shape of a dumbbell. The tumor was resected in several blocks posteriorly, and the dumbbell-shaped tumor in the S1 foramen was resected by widening the S1 foramen from behind. The posterior extension of the iliac tumor seemed prevented by the posterior sacroiliac ligament, and the tumor extended into the canal. Here, we report that the iliac chondrosarcoma extending into the spinal canal is rare for this tumor type. An understating of the tumor extension is important for planning the surgical strategy.

Quantitative study on the biomechanical mechanism of sacroiliac joint subluxation: A finite element study.

The biomechanical mechanism of sacroiliac joint pain caused by sacroiliac joint subluxation is still unclear. And the purpose of this study is to elucidate the mechanism. In the present study, a finite element model of female lumbar spine-pelvis-femur was established. To simulate the sacroiliac joint subluxation quantitatively, the left ilium was shifted ±1, ±2, and ±3 mm along each axis, respectively. The stress and strain of articular surfaces and ligaments between the sacroiliac joint subluxation model and the normal model were compared. When the left ilium shifted along the positive direction of the X/Y/Z axis, the stress on most articular surfaces of the sacroiliac joint increased, of which the stress on the iliac surface of the right sacroiliac joint increased most obviously. The stress and strain of the ligaments increased most obviously when the left ilium shifted along the Y-axis, of which the left sacrospinous ligament increased the most, followed by the right sacrospinous ligament and right long posterior sacroiliac ligament. While the left long posterior sacroiliac ligament decreased the most, followed by the left short posterior sacroiliac ligament. The present study suggests that when the sacroiliac joint subluxation happens, even a slight shift, different biomechanical changes of different ligaments around the sacroiliac joint will happen. This may lead to an abnormal proprioceptive sensation of the ligaments, resulting in stress imbalance of the sacroiliac joint, and finally resulting in sacroiliac joint pain.

Middle cluneal nerve entrapment neuropathy attributable to lumbar disc herniation

Background: Middle cluneal nerve entrapment neuropathy (MCN-EN) is a known cause of low back pain (LBP). Here, we succeeded in treating a patient with a lumbar disc herniation who actually had MCN-EN with a nerve block and neurolysis.Case Description: A 52-year-old female presented with severe left lower back and lateral thigh pain making it difficult to walk. The lumbar MRI revealed a disc herniation on the left at the L5/S1 level. On palpation, we identified a trigger point on the buttock where the MCN penetrates the long posterior sacroiliac ligament between the posterior superior and inferior iliac spine. Two left-sided MCN blocks, followed by the left MCN neurolysis procedure, were performed under local anesthesia. At the last follow-up, 10 months after surgery, the LBP has not recurred, and she requires no medications for pain control.Conclusion: Here, a patient with a left-sided L5S1 disc herniation and low back/leg pain was successfully treated for MCN-EN with nerve block followed by neurolysis.

A biomechanics study on ligamentous injury in anterior-posterior compression type II pelvic injury

BackgroundAnterior-posterior compression (APC) type II pelvis fracture is caused by the destruction of pelvic ligaments. This study aims to explore ligaments injury in APC type II pelvic injury.MethodFourteen human cadaveric pelvis samples with sacrospinous ligament (SPL), sacrotuberous ligament (SBL), anterior sacroiliac ligament (ASL), and partial bone retaining unilaterally were acquired for this study. They were randomly divided into hemipelvis restricted and unrestricted groups. We recorded the separation distance of the pubic symphysis and anterior sacroiliac joint, external rotation angle, and force when ASL ruptured. We observed the external rotation damage to the pelvic bone and ligaments.ResultWhen ASL failed, there was no significant difference in pubic symphysis separation (28.6 ± 8.4 mm to 23.6 ± 8.2 mm, P = 0.11) and anterior sacroiliac joint separation (11.4 ± 3.8 mm to 9.7 ± 3.9 mm, P = 0.30) between restricted and unrestricted groups. The external rotation angle (33.9 ± 5.5° to 48.9 ± 5.2°, P < 0.01) and force (553.9 ± 82.6 N to 756.6 ± 41.4 N, P < 0.01) were significantly different. Pubic symphysis separation between two groups ranged from 14 to 40 mm. In the restricted group, both SBL and SPL were injured. SPL ruptured first, and then SBL and the interosseous sacroiliac ligament were damaged while the posterior ligament remained unharmed. In the unrestricted group, interosseous sacroiliac ligament and posterior sacroiliac ligaments were damaged, while SBL and SPL were not. When the ASL, SBL, and SPL all failed, pubic symphysis and anterior sacroiliac joint separation between two groups increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05).ConclusionPelvic external rotation injury is either hemipelvic restricted or unrestricted, which can result in different outcomes. When the ASL ruptures, the unrestricted group needs greater external rotation angle and force, without SBL or SPL injury, while both SBL and SPL were injured in another group. When ASL fails in two groups, pubic symphysis separation fluctuates considerably. Finally, when the ASL ruptures, SBL and SPL may be undamaged.

БИША МАРИ ФРАНСУА КСАВЬЕ (1771-1802)

The article tells about the great French surgeon, anatomist and physiologist Marie-François Xavier Bichat, the founder of science about tissues – histology, discoverer in an anatomy and creator of such medical disciplines, as a thanatology (science about death) and pathoanatomy. The most essential moments and facts from biography of scientist are described, his basic scientific insights are briefly expounded. Main scientific works and publications, and also described by Bichat anatomic structures and formations are enumerated. His name is carried on by several eponyms in anatomy fossa (pterygopalatine fossa), Bichat’s protuberance (buccal fat pad), Bichat’s foramen (cistern of the vena magna of Galen), Bichat’s ligament (lower fasciculus of the posterior sacroiliac ligament), Bichat’s fissure (transverse fissure of the brain) and Bichat’s tunic (tunica intima vasorum). The substantive provisions of the scientific conceptions offered to them in morphology and pathoanatomy are expounded. The critical importance of scientific works and discoveries of Marie-François Xavier Bichat for modern science and practical medicine is emphasized

To Study the Effect of Mulligan Mobilization Versus Conventional Therapy in Sacroiliac Joint Pain

Background: Sacroiliac Joint Pain (SIJP) is a pain arising from SIJ structures such as anterior sacroiliac ligament, posterior sacroiliac ligament, interosseous ligaments or articular cartilage. The treatment of sacroiliac joint pain is quite challenging. The standard physical therapy (PT) interventions include repetitive exercises, manual joint mobilization, manipulation, bracing, massage, patient education, aerobic conditioning, general therapeutic exercise and electrotherapeutic modalities. Objectives: To compare the effect of mulligan mobilization versus conventional therapy on pain on VAS, Lumbar Range of motion and functional disability in patients with sacroiliac joint pain. Material and Method: A total 93 patients were screened as per the inclusion and exclusion criteria. Patients were randomly allocated in two groups. Group A received mulligan mobilization and Ultrasound therapy and group B received Conventional therapy i.e Ultrasound therapy. Outcome measures assessed were VAS for pain, Lumbar flexion by modified schober’s test and MODQ for functional Disability. Result: Mean difference of Pain on VAS 4.41±1.04 in group A and in group B 3.63±1.27. Mean difference in Lumbar flexion ROM in group A it was 1.30 ± 0.67 and in group B it was 0.98 ±0.55 Mean difference in MODI Score in group A was 34.67 ± 10.84 and in group B it was 13.50 ± 6.45. Conclusion: In the present study, we found that both the techniques Mulligan mobilization and Conventional therapy are effective in the subjects with Sacroiliac joint pain but Mulligan mobilization was found to be more effective than conventional therapy.

MRI Evaluation of the Posterior Pelvic Bony and Soft Tissue Injuries With Tile C Displaced Pelvic Fractures in Young Children.

Disruption through the weak iliac apophysis growth plate is characteristic in unstable pediatric posterior pelvic injuries. Magnetic resonance imaging (MRI) scans would help in the assessment of bony injuries in addition to the trunk and abdominal wall muscles and the posterior sacroiliac and pelvic floor ligaments. All children with displaced pelvic fractures Tile C and open triradiate cartilage between September 2010 and December 2017 who had computed tomography evidence of iliac apophysis avulsion and available MRI scans were reviewed. The paravertebral, anterior abdominal wall and iliacus muscles, and the sacroiliac and pelvic floor ligaments were evaluated. Eight patients had pelvic MRI scans in addition to the standard computed tomography. All were males and the average age was 7.5 years (4 to 14 y). The iliac apophysis was attached posteriorly to the quadratus lumborum and erector spinae muscles and to the posterior sacroiliac complex. The bony iliac wing lost its connection to the axial skeleton and its muscular attachment to the erector spinae and quadratus lumborum. The iliacus muscle was elevated of the iliac fossa in all cases. The anterior sacroiliac ligaments were disrupted in all while the pelvic floor ligaments were disrupted in 5 patients, intact in 2 and could not be clearly visualized in 1 patient. In 2 patients, anterior abdominal wall muscles were split in 2 layers, the external oblique attached to the displaced bony ilium and the internal oblique and transversus abdominis attached to the iliac crest apophysis. This deep layer was continuous distally with the iliacus muscle. This could be explained by the anatomic arrangement of the thoracolumbar fascia and its middle layer. The posterior pelvic ring would be disrupted through the weak chondro-osseous connection between the bony ilium and its well-fixed iliac crest apophysis which is attached to the posterior sacroiliac complex, paravertebral muscles, and the posterior and middle layers of the thoracolumbar fascia. This is central to our understanding for the pathomechanics of those injuries and for operative fixation.

Radiofrequency Ablation for Posterior Sacroiliac Joint Complex Pain: A Narrative Review.

Radiofrequency ablation (RFA) of the sacral lateral branches targets the innervation of the posterior sacroiliac ligaments and posterior portion of the sacroiliac joint, also referred to as the posterior sacroiliac joint complex. This review assesses the published evidence on local anesthetic blocks for the diagnosis of posterior sacroiliac joint complex pain and the efficacy of RFA of the sacral lateral branches as a treatment. The current evidence suggests that RFA can provide relief of pain that originates from the posterior sacroiliac joint complex, but interpretation of this literature is limited by variability in patient selection criteria, the specific nerves targeted for ablation, and the types of RFA technology and technique utilized.

Endoscopic Radiofrequency Treatment of the Sacroiliac Joint Complex for Low Back Pain: A Prospective Study with a 2-Year Follow-Up

Background: The sacroiliac joint complex (SIJC) is considered a major sources of chronic low back pain. Interventional procedures for sacroiliac (SI) joint pain tend to be short-lived and surgical treatment usually involves a fusion procedure. Objectives: To determine the clinical efficacy of endoscopically visualized radiofrequency treatment of the SIJC in the treatment of low back pain. Study Design: Retrospective chart review. Setting: This study took place in a single-center, orthopedic specialty hospital. Methods: Patients received general anesthesia and under endoscopic visualization, radiofrequency ablation was performed on 1) the perforating branches that innervate the posterior capsule of the SI joint capsule, 2) along the course of the long posterior SI ligament, 3) the lateral edges of the S1, S2, and S3 foramen, and 4) the L4, L5, and S1 medial marginal nerve branches along the lateral facet margins. Results: From January 2015 to June 2016, a total of 30 patients who met the precise inclusion criteria were treated with the endoscopic SIJC radiofrequency treatment for low back pain. The average patient was aged 56 years (19 women and 11 men), the average preoperative visual analog scale (VAS) score was 7.23, and the average Oswestry disability index (ODI) score was 44.8. VAS and ODI were measured at 3, 6, 9, 12, 15, 21 and 24 months: VAS was reduced from 7.23 at baseline to 2.82 at 24 months (61% reduction), and ODI was improved from 44.8 at baseline to 22.2 at 24 months (50% reduction). Limitations: Small retrospective case series. Conclusions: Full-endoscopic radiofrequency ablation of the large sensory SI joint innervation complex, that includes the sensory nerve branches along the lateral S1-3 foramina and the L4-S1 medial branches, is perhaps a minimally invasive surgical procedure that could provide significant relief of lumbar back pain in the carefully selected patient. Key words: Endoscopic spine surgery, minimally invasive, low back pain, sacroiliac joint, radiofrequency treatment

Algorithm of Radiological Diagnostics of Dystrophic Damage to Ligaments of the Lumbosacral Spine in the Lower Back Pain Syndrome: the Potential of Sonography

Objective: to formulate the main points of the diagnostic algorithm in the lower back pain syndrome caused by pathology of the ilio-lumbar, posterior long sacroiliac, and sacrotuberal ligaments based on the limits and potential of visualization methods. Material. Data of X-ray, multispiral computer tomography (MSCT), magnetic resonance imaging (MRI) and sonography of 184 patients aged 19-79 with clinical manifestations of the lower back pain syndrome caused by pathology of the ilio-lumbar, posterior long sacroiliac, and sacrotuberal ligaments were analyzed. Results. The potential of the visualization methods in the assessment of structural changes of the ilio-lumbar, posterior long sacroiliac, and sacrotuberal ligaments has been identified. The main points of the algorithm which makes it possible to diagnose the lower back pain syndrome, caused by pathology of ilio-lumbar, posterior long sacroiliac and sacrotuberal ligaments have been formulated. Conclusion. The choice of the visualization method in the lower back pain syndrome, caused by ligamentosis of the ilio-lumbar, posterior long sacroiliac, and sacrotuberal ligaments must be made taking into account the limits and potential of MSCT, MRI and sonography, which will shorten the time of diagnostic search and reduce the risk of diagnostic errors.

Groin pain associated with sacroiliac joint dysfunction and lumbar disorders

ObjectiveWe investigated the prevalence of groin pain in patients with sacroiliac joint (SIJ) dysfunction, lumbar spinal canal stenosis (LSS), and lumbar disc herniation (LDH) who did not have hip disorders, and evaluated the clinical features that distinguished SIJ dysfunction from LSS and LDH. Patient and methodsWe evaluated 127 patients (57 men, 70 women, average age 55 years) with SIJ dysfunction, 146 (98 men, 48 women, average age 71 years) with LSS, and 124 (83 men, 41 women, average age 50 years) with LDH. The following data were retrospectively collected from the patients’ medical charts: (1) the prevalence of groin pain for each pathology; (2) corresponding spinal level of LSS and LDH in the patients with groin pain; (3) the pain areas in the buttocks and back; pain increase while in positions such as sitting, lying supine, and side-lying; an SIJ shear test; and four tender points composed of the posterior superior iliac spine (PSIS), long posterior sacroiliac ligament (LPSL), sacrotuberous ligament (STL), and iliac muscle. ResultsFifty-nine (46.5%) patients with SIJ dysfunction, 10 (6.8%) with LSS, and 10 (8.1%) with LDH reported groin pain. Of the 10 patients with LSS, five presented with cauda equina symptoms, two had stenosis of L2-L3, and three had stenosis below L3-L4. The other five presented with radiculopathy: the corresponding nerve root was L2, L3, and L4 in one patient each, and L5 in two. Of the 10 patients with LDH, eight presented with radiculopathy: the corresponding nerve root was L2 and L4 in three patients each, and L5 in two. Two patients presented with L4-L5 discogenic pain without radiculopathy. In patients with groin pain, pain provoked by the SIJ shear test and the tenderness of the PSIS and LPSL were significant physical signs that differentiated SIJ dysfunction from LSS and LDH. (Fisher’s exact test, P<0.05) ConclusionThe prevalence of groin pain in patients with SIJ dysfunction was higher than in those with LSS or LDH. When patients who do not have hip disorders complain of groin and lumbogluteal pain, not only lumbar disorders but also SIJ dysfunction should be considered.

DYSTROPHIC CHANGES OF ILIOLUMBAR, LONG DORSAL, SACROILIAC, AND SACROTUBEROUS LIGAMENTS IN PATIENTS WITH SECONDARY AMYLOIDOSIS

Objective: to assess the nature of morphological and sonographic changes in the iliac-lumbar ligament, posterior long sacroiliac ligament, and sacroiliac ligament in amyloidosis. Material of research . Sectional data of a subject with secondary amyloidosis. Results. We have revealed some dystrophic changes in the iliac-lumbar, posterior long sacroiliac ligament, and sacro-ligamentous ligaments, the severity of which was significantly higher than the average values characteristic of that age period. Conclusion. Secondary amyloidosis is a pathological state that significantly affects the severity of dystrophic changes in ligaments and, accordingly, the character of the sonographic pattern.

LIGAMENTOSIS OF THE LONG DORSAL SACROILIAC LIGAMENT: OUTSTANDING ISSUES OF RADIOTHERAPY

Objective: to systematize the data on the possibility of application of imaging techniques for the diagnosis of ligamentosis of the long dorsal sacroiliac ligament. Materials. Publications containing information about the use of imaging techniques for the diagnosis of ligamentosis of the long dorsal sacroiliac ligament deposited in PubMed resources and information portal eLIBRARY.RU. Results. The work has sorted out the most important aspects regarding the possibility of application of imaging techniques for the diagnosis of ligamentosis of the long dorsal sacroiliac ligament. Conclusion. Modern methods of X-ray diagnostics are able to provide visualization of the posterior long sacroiliac ligaments, but the absence of reliable diagnostic criteria does not make it possible to diagnose degenerative changes (ligamentosis) confidently and, accordingly, to verify the related cases of lower back pain syndrome.

Anatomical study of middle cluneal nerve entrapment.

ObjectEntrapment of the middle cluneal nerve (MCN) under the long posterior sacroiliac ligament (LPSL) is a possible, and underdiagnosed, cause of low-back and/or leg symptoms. To date, detailed anatomical studies of MCN entrapment are few. The purpose of this study was to ascertain, using cadavers, the relationship between the MCN and LPSL and to investigate MCN entrapment.MethodsA total of 30 hemipelves from 20 cadaveric donors (15 female, 5 male) designated for education or research, were studied by gross anatomical dissection. The age range of the donors at death was 71–101 years with a mean of 88 years. Branches of the MCN were identified under or over the gluteus maximus fascia caudal to the posterior superior iliac spine (PSIS) and traced laterally as far as their finest ramification. Special attention was paid to the relationship between the MCN and LPSL. The distance from the branch of the MCN to the PSIS and to the midline and the diameter of the MCN were measured.ResultsA total of 64 MCN branches were identified in the 30 hemipelves. Of 64 branches, 10 (16%) penetrated the LPSL. The average cephalocaudal distance from the PSIS to where the MCN penetrated the LPSL was 28.5±11.2 mm (9.1–53.7 mm). The distance from the midline was 36.0±6.4 mm (23.5–45.2 mm). The diameter of the MCN branch traversing the LPSL averaged 1.6±0.5 mm (0.5–3.1 mm). Four of the 10 branches penetrating the LPSL had obvious constriction under the ligament.ConclusionThis is the first anatomical study illustrating MCN entrapment. It is likely that MCN entrapment is not a rare clinical entity.