Posterior Superior Iliac Spine Research Articles

Three-dimensional analysis of puncture needle path through safety triangle approach PLD and design of puncture positioning guide plate.

In this study, the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process was discussed using digital technology. Additionally, the positioning guide plate was designed and 3D printed in order to simulate the surgical puncture of specimens. This plate served as an important reference for the preoperative simulation and clinical application of percutaneous laser decompression (PLD). The CT data were imported into the Mimics program, the 3D model was rebuilt, the ideal puncture line N and the associated central axis M were developed, and the required data were measured. All of these steps were completed. A total of five adult specimens were chosen for CT scanning; the data were imported into the Mimics program; positioning guide plates were generated and 3D printed; a simulated surgical puncture of the specimens was carried out; an X-ray inspection was carried out; and an analysis of the puncture accuracy was carried out. (1) The angle between line N and line M was 42o55o, and the angles between the line M and 3D plane were 1o2o, 5o12o, and 78o84o, respectively; (2) As the level of the lumbar intervertebral disc decreases, the distance from point to line and point to surface changes regularly; (3) The positioning guide was designed with the end of the lumbar spinous process and the posterior superior iliac spine on both sides as supporting points. (4) Five specimens were punctured 40 times by using the guide to simulate surgical puncture, and the success rate was 97.5% . By analyzing the three-dimensional relationship between the optimal puncture needle path and the lumbar spinous process, the guide plate was designed to simulate surgical puncture, and the individualized safety positioning of percutaneous puncture was obtained.

Sub-gluteal ligation of the internal pudendal vein for management of veno-occlusive erectile dysfunction (Shaeer's Vein Ligation-I): the cadaveric study.

Vein ligation for veno-occlusive erectile dysfunction is being abandoned due to the recurrence rate. Among the reasons for failure is inability to ligate the deep system of veins; the internal pudendal vein. The vein exits the pelvis in the gluteal region, from the lesser sciatic foramen to the greater sciatic foramen, coursing over the ischial spine and sacro-spinous ligament, under the gluteus maximus. This work aims to verify feasibility of the first surgical procedure to ligate the internal pudendal vein through the gluteal approach. This cadaveric study involved five formalin-fixed cadavers. A surface anatomical landmark was designed to identify the ischial spine, at the intersection of two lines: a vertical line from posterior superior iliac spine to ischial tuberosity, and a horizontal line extending from sacro-coccygeal joint, laterally. An incision is cut encompassing the target point. Subcutaneous fat is dissected down to the gluteus maximus, which is split along the direction of its fibers. The vein can be found crossing over the ischial spine. "Shaeer's Vein Ligation - I" appears to be surgically feasible. A protocol for a surgical study is registered at clinicaltrials.gov, and is open for participation.

Muscular Strategies for Correcting the Pelvic Position to Improve Posture-An Exploratory Study.

The correction of postural weaknesses through the better positioning of the pelvis is an important approach in sports therapy and physiotherapy. The pelvic position in the sagittal plane is largely dependent on the muscular balance of the ventral and dorsal muscle groups. The aim of this exploratory study was to examine whether healthy persons use similar muscular activation patterns to correct their pelvic position or whether there are different motor strategies. The following muscles were recorded in 41 persons using surface electromyography (EMG): M. trapezius pars ascendens, M. erector spinae pars lumbalis, M. gluteus maximus, M. biceps femoris, M. rectus abdominis, and M. obliquus externus. The participants performed 10 voluntary pelvic movements (retroversion of the pelvis). The anterior pelvic tilt was measured videographically via marker points on the anterior and posterior superior iliac spine. The EMG data were further processed and normalized to the maximum voluntary contraction. A linear regression analysis was conducted to assess the relationship between changes in the pelvic tilt and muscle activities. Subsequently, a Ward clustering analysis was applied to detect potential muscle activation patterns. The differences between the clusters and the pelvic tilt were examined using ANOVA. Cluster analysis revealed the presence of four clusters with different muscle activation patterns in which the abdominal muscles and dorsal muscle groups were differently involved. However, the gluteus maximus muscle was involved in every activation pattern. It also had the strongest correlation with the changes in pelvic tilt. Different individual muscle patterns are used by different persons to correct pelvic posture, with the gluteus maximus muscle apparently playing the most important role. This can be important for therapy, as different muscle strategies should be trained depending on the individually preferred motor patterns.

Commonly Used Tests in the Assessment of Sacro-illiac Joint Dysfunction by Physiotherapists in India: A Cross-sectional Study

Introduction: Sacroiliac Joint Dysfunction (SIJD) refers to a condition that causes pain and discomfort, commonly due to dysfunction of the Sacroiliac Joint (SIJ). It is a plausible source of Low Back Pain (LBP). Static palpation tests, motion palpation, and pain provocation tests are mostly employed to check for SIJD. Aim: To determine the commonly used tests in the assessment of SIJD by physiotherapists. Materials and Methods: A cross-sectional Questionnairebased study was conducted among physiotherapists in India from November 2022 to April 2023 at the Nitte Institute of Physiotherapy, NITTE (deemed to be University), Mangalore, Karnataka, India. The study included physiotherapists specialising in orthopaedics and obstetrics and gynaecology. The practitioners’ years of experience were considered. An online survey was conducted using a questionnaire developed to determine the frequently used bony landmark for checking SIJ asymmetry, commonly affected structures, and commonly used motion palpation and pain provocation tests for examining SIJD. Questionnaires were sent to at least 100 physiotherapists, and 72 responses were included in the study. Data was collected and analysed using descriptive statistics: frequency and percentage. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 26.0. Results: Seventy-two practitioners responded to the online survey. The commonly assessed bony landmark was the Posterior Superior Iliac Spines (PSIS) with 52 responses (28%). The most frequently preferred motion palpation examination test was the compression test with 36 responses (17.2%). Tenderness or tissue texture change was mainly checked at the PSIS with 54 responses (37.8%), and the commonly used pain provocation tests were the thigh thrust test and supine SIJ springing test with 46 responses (26.6%). Conclusion: According to this study, many physiotherapists employed diagnostic techniques congruent with Mitchell’s model, but they also frequently added additional motion tests, measured tenderness, and used pain provocation techniques. Most preferred the ASIS compression and thigh thrust tests to assess SIJD.

A tailored training based on students’ and teachers’ needs to improve palpation skills: A quantitative part of a mixed-method study

BackgroundPalpation is a fundamental and complex skill for manual practitioners, it is a very difficult task to teach and to learn. Trials suggest that training might increase the reliability of palpation in detection of bony landmarks, nevertheless the poor dependability of the examined tests suggests that teaching methods must be reviewed. Different training methodologies have been implemented to improve learning experience of manual therapists, but none of them were based on students' and teachers’ suggestions. ObjectivesThis study aims to find an efficient training, tailored on students' needs, that improve students’ palpatory skills. DesignMixed-method study. Methodsthis study was divided in four phases, two quantitative and two qualitative. Pelvis asymmetries were evaluated by 112 students from the Accademia Italiana di Medicina Osteopatica osteopathic Institute using two bony landmarks: the greater trochanter (GT) and the posterior superior iliac spine. The volunteers had a hidden wedge of 2 cm under their heel using a randomization process. Nine students and three teachers were interviewed to explore their lived learning experiences. A tailored training of 1 h was implemented based on their suggestions. Students were then randomly divided into three training groups: tailored training, P.A.L.P.A.T.E. and no training. A second data collection was performed. Students were re-evaluated, asked to make another assessment on another volunteer. Two students and one teacher were then re-interviewed to assess if the tailored training met their expectations. A generalized linear model was used to analyze the data. Results76 students completed the trial. Generally, correct detections of higher landmarks increased from the first to the second data collection, except for 5th year students who decreased their performances. Tailored training achieved the best results with a correct detection of the great trochanter by 69% of students and for posterior superior iliac spine by 78% of students. The generalized linear model showed a strong association between correct detection of PSIS and training type (p-value = 0.009) and over time (p-value = 0.01) but no association with year of school (p-value = 0.434). No association between year of study (p-value = 0.228), training types (p-value = 0.267) and correct GT detection over time (p-value = 0.529) was found. ConclusionsTailored training was shown to be effective and useful in the improvement of students’ performance, especially for posterior superior iliac spine. Interest levels played an important role in correct detection.

Obturator inlet and iliac oblique technique for safe, convenient, and reliable iliac screw placement

BackgroundThere are many described techniques for the placement of posterior iliac screws for extension of lumbar posterior spinal instrumentation to the pelvis. However, each one has its limitations. We describe our technique for fluoroscopic guidance of iliac screw placement utilizing the obturator inlet (OI) and iliac oblique (IO) views as well as a detailed review of how to obtain and interpret these views for safe iliac screw placement. MethodsRetrospective chart review of patients undergoing iliac screw placement utilizing the obturator inlet (OI) and iliac oblique (IO) views as part of spine instrumentation between January 2019 and March 2022. Screw length and bony breaches are reported utilizing this technique Results12 patients underwent posterior lumbopelvic fixation with a total of 23 screws placed via either open or percutaneous technique. The mean screw length was 96.5 mm (Range 80 - 110, standard dev 7.75). There were no recorded breaches or recannulation attempts. ConclusionsWe show how this technique is a much more convenient alternative to placement of iliac screws under the obturator outlet oblique (“teardrop” view) which necessitates that the C-arm be in line with instruments being placed. These described views can be used to place screws with either open or percutaneous techniques and with either the posterior superior iliac spine (PSIS) or S2 alar iliac (S2AI) starting points.

Non-invasive assessment of sacroiliac joint and lumbar spine positioning in different unilateral sitting postures

ABSTRACT Background Sacroiliac joint (SIJ) motion has been documented using invasive and noninvasive kinematic techniques. No study has explored SIJ angular positions in functional postures using noninvasive techniques. The purpose of this study was to quantify SIJ positioning among different seated postures in a healthy population. Methods Twelve female and 11 male healthy young participants participated. Left and right anterior and posterior superior iliac spines were manually digitized during standing, neutral sitting and four different seated postures. Rigid bodies recorded the kinematics of the lumbar spine. Angles calculated included transverse sacroiliac angle, innominate sagittal angle, sacral tilt, lumbar flexion-extension, lumbar lateral bend and lumbar axial twist. Findings The observed range of angular positions was approximately 3 to 4 degrees across the SIJ-related angles. The main effect of seated posture was observed for all angles measured. The main effect of sex was observed for all angles except lumbar lateral bending. Females consistently experienced more posterior sacral tilt than males. Interaction effects between sex and posture were only observed at the right-transverse sacroiliac angle and sacral tilt. Previous sitting posture affected the subsequent neutral sitting posture for the right-transverse sacroiliac angle and lumbar spine angle. Interpretation SIJ angular position differences among the seated postures were similar in magnitude to motions previously reported in participants undergoing prone passive hip abduction and external rotation. Sex differences, including greater sacral posterior tilt observed in females, likely reflect underlying morphological and physiological differences. Future studies should explore SIJ positioning during functional tasks in pathological populations to help elucidate the underlying causes of SIJ pain and inform treatment strategies.

A retrospective CT based comparative analysis of available screw pathways to determine optimal iliac screw trajectory

<b>Introduction:</b> The lumbo-sacral stabilization using iliac screw is gaining popularity in such cases of long multi segment lumbar constructs. Iliac screws help to achieve strong spinopelvic fixation, augments and protects sacral screws. However, there is a great variability found in literature for iliac screw fixation in terms of trajectory, screw length and screw diameter. Also, to the best of our knowledge, there is lacunae in current literature regarding the optimal pathway, screw length and screw diameter in the Indian population. Hence, we planned the study with the aim to analyze the available screw pathways to determine optimal iliac screw trajectory, screw length and diameter for the Indian population.<br /> <b>Material and methods:</b> This was a tertiary center-based retrospective study. One hundred pelvic CT scans of patients in 18-70 years age, who underwent abdominal CT on Siemens 256-slice dual source CT scanner for various indications were evaluated. Subsequently, 4 iliac screw trajectories were assessed by connecting the points given below using double oblique reformats on which the lengths and narrowest zones of these trajectories were measured. Path A: Posterior Superior Iliac Spine (PSIS) to Anterior Superior Iliac Spine (AIIS); Path B: point between PSIS and posterior inferior iliac spine (PIIS) to Anterior Inferior iliac spine  (AIIS); Path C: iliac crest intersection point (CLIC) point to Upper acetabulum; Path D: CLIC point to acetabular center.<br /> [p1] <b>[a2] Results:</b> Statistically significant difference was found in the lengths of various pathways. Path A (PSIS to AIIS) was found to be the longest (mean 13 cm). The second longest path in our study was path C (CLIC point to Upper acetabulum). The narrowest widths of each path were not found to have any statistically significant difference.<br /> <b>Conclusion:</b> Iliac screw fixation is of paramount importance for lumbosacral stabilization. Of the studied paths, trajectory from posterior-superior iliac spine to Antero-inferior iliac spine has the longest passage length and is the most optimal path for the Indian population. In case additional screws are required, the trajectory from CLIC point to Upper acetabulum provides the second largest screw passage.

A radiological analysis of pelvic fixation trajectories: patient series.

Three well-defined methods for pelvic fixation are used for biomechanical support in spine fusion constructs: iliac, recessed iliac, and S2-alar-iliac (S2AI) screws. The authors compared the maximum screw sizes that could be placed with these techniques by using image-guidance software and high-resolution computed tomography scans from 20 randomly selected patients. Six trajectories were plotted per side, beginning at recognized starting points (standard or recessed posterior superior iliac spine [PSIS] or S2AI screw) and ending at the anterior inferior iliac spine (AIIS) or supra-acetabular notch (SAN). The mean maximum screw length and width ranged from 80.0 ± 32.2 mm to 140.8 ± 22.6 mm and from 8.25 ± 1.2 mm to 13.0 ± 2.7 mm, respectively, depending on the trajectory. Statistically significant differences in length were found between the standard and recessed PSIS trajectories to the AIIS (p < 0.001) and between the standard PSIS-to-AIIS trajectory and the S2AI-to-AIIS (p = 0.007) or S2AI-to-SAN (p < 0.001) trajectories. The most successful trajectory was the PSIS to SAN (95%, 38/40). The traditional iliac screw trajectory enabled the longest and widest screw trajectories and highest rate of successful screw placement with the fewest theoretical breaches more reliably than recessed and S2AI trajectories. These findings may help surgeons plan for maximum screw purchase for pelvic fixation.

Superior Gluteal Nerve Anatomy and Its Injuries: Aiming for a More Secure Surgical Approach of the Pelvic Region.

Because most of the recognized causes of superior gluteal nerve (SGN) injury are iatrogenic, detailed knowledge of the anatomy of the SGN is crucial to prevent its injury associated with surgical procedures. This study aims to describe the precise location of SGN or its branches at the greater sciatic foramen, measure the distances of these neural structures to palpable bony landmarks, and evaluate the possible correlation between these parameters and pelvis size. Twenty human cadaveric hemipelvises were studied. After dissection to expose the SGN or its branches at the greater sciatic foramen, the distances from these neural structures to the greater trochanter (GT), to the anterior superior iliac spine (ASIS), to the posterior superior iliac spine (PSIS), to the ischial tuberosity (IT), and to the greater sciatic notch apex were measured. We found that at the greater sciatic foramen, the SGN emerges as a common trunk in 75% of hemipelvises, and already divided in its superior and inferior branches in 25% of hemipelvises. When the SGN exits the pelvis as a common trunk, it does so, in most cases, in contact with the bone at the apex of the greater sciatic notch or superior to the level of the apex. The median distance from the SGN at the greater sciatic notch to the PSIS, ASIS, GT and IT is 7.6 cm, 10.9 cm, 7.5 cm and 10.8 cm, respectively. We found a positive correlation between some of the analyzed parameters and the size of the pelvis. The anatomical data of this study may serve as pivotal guides during orthopedic pelvic surgery, contributing to minimize SNG iatrogenic lesions with significant implications in the patient's quality of life.

Enhancing diagnosis and treatment of superior cluneal nerve entrapment: cadaveric, clinical, and ultrasonographic insights

ObjectivesLow back pain is a prevalent public health issue caused by superior cluneal nerve (SCN) entrapment. This study aimed to explore the course of SCN branches, cross-sectional area (CSA) of the nerves, and effects of ultrasound-guided SCN hydrodissection.MethodsSCN distance relative to the posterior superior iliac spines was measured and compared with ultrasound findings in asymptomatic volunteers. The CSA of the SCN, pressure-pain threshold, and pain measurements were obtained from asymptomatic controls and patients with SCN entrapment at various time points after hydrodissection (with 1 mL of 50% dextrose, 4 mL of 1% lidocaine, and 5 mL of 1% normal saline) in the short-axis view.ResultsTwenty sides of 10 formalin-fixed cadavers were dissected. The SCN locations on the iliac crest did not differ from the ultrasound findings in 30 asymptomatic volunteers. The average CSA of the SCN across different branches and sites ranged between 4.69–5.67 mm2 and did not vary across different segments/branches or pain statuses. Initial treatment success was observed in 77.7% (n = 28) of 36 patients receiving hydrodissection due to SCN entrapment. A group with initial treatment success experienced symptom recurrence in 25% (n = 7) of cases, and those with recurrent pain had a higher prevalence of scoliosis than those without symptom recurrence.ConclusionsUltrasonography effectively localizes SCN branches on the iliac crest, whereby increased nerve CSA is not useful for diagnosis. Most patients benefit from ultrasound-guided dextrose hydrodissection; however, those with scoliosis may experience symptom recurrence and whether structured rehabilitation can reduce recurrence post-injection should be considered as one perspective in future research.Trial registration ClinicalTrials.gov (NCT04478344). Registered on 20 July 2020, https://clinicaltrials.gov/ct2/show/NCT04478344?cond=Superior+Cluneal+Nerve&cntry=TW&draw=2&rank=1.Critical relevance statement Ultrasound imaging accurately locates SCN branches on the iliac crest, while enlargement of the CSA is not useful in diagnosing SCN entrapment; however, approximately 80% of SCN entrapment cases respond positively to ultrasound-guided dextrose hydrodissection.Graphical abstract

Guidance for dysmorphic sacrum fixation with upper sacroiliac screw based on imaging anatomy study: techniques and indications

ObjectiveThis study aimed to investigate the techniques and indications of upper sacroiliac screw fixation for the dysmorphic sacrum.MethodsThe dysmorphic sacra were selected from 267 three-dimensional pelvic models. The dysmorphic sacra which couldn’t accommodate a 7.3 mm upper trans ilio-sacroiliac screw were classified as the main dysmorphic sacra. Then, the size of the bone corridor, the length of the screw in the corridor, and the orientation of the screw were measured. The insertion point on the sacrum was identified by two bone landmarks.Resultstotally, 30.3% of sacra were identified as the main dysmorphic sacra. The inclinations of the screw oriented from posterior to anterior were (21.80 ± 3.56)° for males and (19.97 ± 3.02)° for females (p < 0.001), and from caudal to cranial were (29.97 ± 5.38)° for males and (28.15 ± 6.21)° for females (p = 0.047). The min diameters of the corridor were (16.31 ± 2.40) mm for males and (15.07 ± 1.58) mm for females (p < 0.001). The lengths of the screw in the Denis III zone were (14.41 ± 4.40) mm for males and (14.09 ± 5.04) mm for females (p = 0.665), and in the Denis II+III zones were (36.25 ± 3.40) mm for males and (38.04 ± 4.60) mm for females (p = 0.005). The rates of LP-PSIS/LAIIS-PSIS were (0.36 ± 0.04) for males and (0.32 ± 0.03) for females (t = 4.943, p < 0.001). The lengths of LPM were (8.81 ± 5.88) for males and (-4.13 ± 6.33) for females (t = 13.434, p < 0.001).ConclusionWhen the sacrum has the features of “sacrum not recessed” and/or “acute alar slope”, the conventional trans ilio-sacroiliac screw couldn’t be placed safely. The inclination oriented from posterior to anterior and from caudal to cranial are approximately 20° and 30°, respectively. The bone insertion point locates in the rear third of the anterior inferior iliac spine to the posterior superior iliac spine. The sacroiliac screw is not recommended to fix the fractures in Denis III zone.

Effects of Slide Sheet Use and Bed Position on Muscle Activities in the Low Back and Extremities: A Pilot Experimental Simulation Study.

Low-friction slide sheets (SS) are designed to reduce compression loads on the body during manual handling tasks, such as boosting patients. Using SS has been shown to decrease muscle activity in the lower back and upper extremities. However, it is unclear if this effect varies with different bed positions. To investigate this, we studied the effects of SS use, bed height, and their combination on muscle activity during a simulated patient boost. Thirty-three Japanese undergraduate students (age 21.0 ± 1.1 years; 14 men, 19 women) participated. Participants were asked to boost a dummy figure on the bed three times each using four conditions. During the repositioning task, electromyography of eight muscles of the lower back and upper and lower extremities, hip and knee joint flexion angles, pelvic forward tilt angle, and position of the center of mass based on the posterior superior iliac spine were evaluated. Electrophysiological activities of muscles of lower back and upper extremities were significantly lower with SS than without it in both bed positions (30% and 40% of body height); the reduction in muscle activities with SS use was 20% to 40%. Lowering the bed did not affect the SS effect magnitude on reducing muscle activities, although postural changes, including hip and knee joint flexion, were observed. SS reduced muscle activities in the back, upper, and lower extremities when the bed was in the low position, and this effect persisted at a bed height of ≥30% of the participant's height.

Osteosarcopenia in the Spine Beyond Bone Mineral Density: Association Between Paraspinal Muscle Impairment and Advanced Glycation Endproducts.

Prospective cross-sectional study. To determine if an accumulation of advanced glycation endproducts (AGEs) is associated with impaired paraspinal muscle composition. Impaired bone integrity and muscle function are described as osteosarcopenia. Osteosarcopenia is associated with falls, fragility fractures, and reduced quality of life. Bone integrity is influenced by bone quantity (bone mineral density) and quality (microarchitecture and collagen). The accumulation of AGEs stiffens collagen fibers and increases bone fragility. The relationship between paraspinal muscle composition and bone collagen properties has not been evaluated. Intraoperative bone biopsies from the posterior superior iliac spine were obtained and evaluated with multiphoton microscopy for fluorescent AGE cross-link density (fAGEs). Preoperative magnetic resonance imaging measurements at level L4 included the musculus (m.) psoas and combined m. multifidus and m. erector spinae (posterior paraspinal musculature, PPM). Muscle segmentation on axial images (cross-sectional area, CSA) and calculation of a pixel intensity threshold method to differentiate muscle (functional cross-sectional area, fCSA) and intramuscular fat (FAT). Quantitative computed tomography was performed at the lumbar spine. Univariate and multivariable regression models were used to investigate associations between fAGEs and paraspinal musculature. One hundred seven prospectively enrolled patients (50.5% female, age 60.7y, BMI 28.9kg/m 2 ) were analyzed. In all, 41.1% and 15.0% of the patients demonstrated osteopenia and osteoporosis, respectively. Univariate linear regression analysis demonstrated a significant association between cortical fAGEs and CSA in the psoas (ρ=0.220, P =0.039) but not in the PPM. Trabecular fAGEs revealed no significant associations to PPM or psoas musculature. In the multivariable analysis, higher cortical fAGEs were associated with increased FAT (β=1.556; P =0.002) and CSA (β=1.305; P =0.005) in the PPM after adjusting for covariates. This is the first investigation demonstrating that an accumulation of nonenzymatic collagen cross-linking product fAGEs in cortical bone is associated with increased intramuscular fat in the lumbar paraspinal musculature.

Reliability and Accuracy of Three Anatomical Landmarks for Spinal Level Estimations

Background: Three anatomical landmarks are used to identify a suitable vertebral level for spinal anesthesia: a) Tuffier line (TL), b) tenth rib line (TRL) and c) posterior superior iliac spine (PSIS). We aim to determine reliability and accuracy of these landmarks compared to radiologic landmark.

Effect of Intradermal Sterile Water Injection on Labor Experiences: A Randomized Controlled Study

Background: Sterile water injection is rapidly gaining popularity as a method of pain relief in labor. The purpose of this single-blinded randomized controlled study is to investigate the effect of intradermal sterile water injection (ISWI) on labor experiences of women who experience low-back pain during labor. Methods: The sample group of the study was 120 pregnant women with severe low-back pain during labor (30-sterile water, 30-saline solution, 60-control). In the study, the baseline low back pain score (&gt;7) was determined with Visual Analogue Scale (VAS) in the ISWI group and then 0.1 mL sterile water made to form 4 small blebs 1 over each posterior superior iliac spine and 2 others placed 3 cm below and 1 cm medial to each of the first sites (Michaelis Rhomboid). The VAS scoring were repeated at 10–30–60–90 and 120th minutes after the injections. In the saline solution group, injection of 0.1 mL saline solution was made with the same procedure. Childbirth Experience Questionnaire (CEQ) were utilized to determine the effect of injections on participants’ labor experiences. Also participants’ satisfaction with the method was evaluated via Intradermal injections assessment form. Results: There was a significant difference between the mean VAS scores in favor of the ISWI group (p &lt; 0.05). Also comparisons indicated significant differences in favor of the ISWI group in terms of both CEQ total mean score and women’s thoughts about injections (p &lt; 0.05). Conclusions: The findings of this study showed that ISWI was effective in relieving low-back pain during labor and the technique had positive effects on labor experiences.

Bone marrow infiltration by Non-Hodgkin lymphoma: An experience in a tertiary care centre.

To determine the frequency and patterns of bone marrow infiltration in non-Hodgkin lymphoma patients. The cross-sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from April to October 2021, and comprised patients of either gender aged 20-80 years who had been diagnosed with non-Hodgkin lymphoma. Following assessment and as per standard protocol, bone marrow aspirate and trephine biopsy were done on all patients from the posterior superior iliac spine, and slides were prepared and assessed. Data was analysed using SPSS 25. Of the 100 patients, 67(67%) were males and 33(33%) were females. The overall mean age was 54.99±12 years, and mean duration of symptoms was 11.7±1.5 months. Diffuse large B-cell lymphoma was the commonest type 43(43%). Infiltration of marrow occurred in 38(38%) patients, with 12(12%) of them being cases of mantle cell lymphoma. The commonest infiltration pattern was diffuse in 17(17%) cases, followed by focal/nodular in 10(10%). Diffuse large B-cell lymphoma was found to be the commonest type of non-Hodgkin lymphoma, and marrow infiltration occurred most frequently in cases of mantle cell lymphoma.

Assessing the Usefulness of Testing Standing Flexion in the Posterior Superior Iliac Spines for Functional Diagnostics of the Sacroiliac Joints

Introduction: Sacroiliac joint dysfunctions are common among patients visiting physiotherapy offices. The main symptom of these dysfunctions is pain in the lumbosacral region of the spine. Taking the frequency of its occurrence into account, it is important to conduct an appropriate diagnosis that enables the implementation of proper treatment.

Acupuncture relieves pain by inhibiting expression of Cx43 in astrocytes and release of interfe-ron-γ in neurons of trigeminal spinal nucleus in rats with migraine

To observe the effect of acupuncture on the expression of connexin 43 (Cx43), glial fibrillary acidic protein (GFAP), interferon-γ (IFN-γ) in the trigeminal spinal nucleus (TNC) of rats with migraine, so as to explore its mechanisms underlying amelioration of migraine. A total of 44 SD rats were randomly divided into control, model, acu-puncture, and sham acupuncture groups (n=11 in each group). Acupuncture was applied to bilateral "Shuaigu"(GB8) and "Yanglingquan"(GB34) or non-acupoint Ⅰ (the spot about 10 mm superior to the iliac spine and 20 mm lateral to the post-median line) and non-acupoint Ⅱ (behind the iliac spine, the ending-spot of the posterior superior iliac spine at the muscles) on both sides for 20 min, once daily for 9 days. Paw withdrawal latency (mechanical pain threshold,PWMT) and thermal tail flick latency (TFL) were measured using a VonFrey detector and photothermal tail pain meter, respectively. The content of IFN-γ of TNC tissue was detected by ELISA. The expression levels of Cx43 and IFN-γ proteins of TNC tissue were detected by Western blot. The immunofluorescence dual labeling method was used to detect the positive expression of GFAP and Cx43, IFN-γR and NeuN in TNC tissue, for displaying the activity of Cx43 in astrocytes and IFN-γ in neurons, respectively. Compared with the control group, both PWMT and TFL at 3, 5, 7 and 9 days after modeling were significantly decreased (P<0.01), while the expression of Cx43 and IFN-γ proteins, the immunofluorescence intensity of GFAP, Cx43, IFN-γR, and the content of IFN-γ were considerably up-regulated in the model group (P<0.01). In comparison with the model group, both PWMT and TFL at 3, 5, 7 and 9 days after modeling were obviously increased (P<0.01), whereas the expression of Cx43 and IFN-γ proteins, the immunofluorescence intensity of GFAP, Cx43, IFN-γR, and the content of IFN-γ in the acupuncture group, as well as the protein expression of IFN-γR in the sham acupuncture group were also remarkably decreased (P<0.05, P<0.01). The effect of acupuncture was significantly superior to that of sham acupuncture in down-regulating the expression of Cx43 and IFN-γ proteins, and the immunofluorescence intensity of GFAP, Cx43, and IFN-γR (P<0.05, P<0.01). Immunofluorescence dual labeling outcomes showed that in the model group, a large number of GFAP and Cx43 co-expressed astrocytes were found, and the cell body and protrusion of GFAP-labelled astrocytes were evidently increased, and Cx43 was mainly expressed on the surface of astrocyte membrane and the protrusion site, and the proportion of IFN-γR and NeuN co-expressing neurons in the model group was significantly increased, suggesting an activation of astrocytes and neurons after modeling. Whereas in the acupuncture group, the bright green clustered particles on the cell membrane and protrusion of astrocytes, and the proportion of IFN-γR and NeuN co-expressing neurons were significantly reduced, suggesting a suppression of activities of Cx43, astrocytes and neurons and IFN-γ release from TNC after acupuncture intervention. Acupuncture can relieve the pain response in rats with migraine, which may be associa-ted with its functions in inhibiting the expression of Cx43 and activation of astrocytes and neurons, and reducing release of pro-inflammatory factor IFN-γ in TNC.

Modified Iliac Screw in Lumbopelvic Fixation After Sacral Tumor Resection: A Single-Center Case Series.

Traditional iliac screw, S2-alar iliac screw, and modified iliac screw are the 3 common techniques for lumbopelvic fixation. The application of the modified iliac technique in sacral spinal tumors has been rarely reported. To report the feasibility and safety of modified iliac screws after sacral tumor resection and their preliminary clinical outcomes. Twenty-seven patients who underwent sacral tumor resection with modified iliac screw fixation between August 2017 and August 2021 at our center were clinically and radiographically evaluated. A total of 59 iliac screws were inserted by freehand according to the anatomic landmarks. The mean operation time was 207 minutes (range, 140-435 minutes). The average estimated blood loss was 1396 mL (300-4200 mL). Computed tomography scans showed that 2 (3.4%) screws penetrated the iliac cortex, indicating a 96.6% implantation accuracy rate. There were no iatrogenic neurovascular or visceral structure complications observed. The mean minimal distances from the screw head to the skin were 24.9 and 25.8 mm on the left and right sides, respectively. The mean minimal distances from the screw head to the horizontal level of the posterior superior iliac spine were 7.9 and 8.3 mm on the left and right sides, respectively. Two patients (7.4%) underwent reoperation for wound infection. At the latest follow-up, no patient had complications of screw head prominence, pseudarthrosis, or instrument failure. The modified iliac screw is characterized by its minimal invasiveness and simplicity of placement. It is an ideal alternative for lumbopelvic fixation after sacral tumor resection.