Anatomical study of the innervation of different parts of the posterior ligamentous region of the sacroiliac joint

2021 ◽  
pp. rapm-2020-102366
Author(s):  
Weijia Zhu ◽  
Qinghao Zhao ◽  
Runxun Ma ◽  
Zezheng Liu ◽  
Jianjun Zhao ◽  
...  
Keyword(s):  
Sacroiliac Joint ◽  
Anatomical Study ◽  
Transverse Diameter ◽  
Orientation Relation ◽  
Terminal Nerve ◽  
Dorsal Rami ◽  
Sacral Nerves ◽  
Lateral Branches ◽  
Clinical Verification ◽  
Different Parts

Background and objectivesThe periarticular sacroiliac joint (SIJ) technique has become an important area of focus, and the quartering of the SIJ posterior ligamentous region has been proposed as a way to refine this technique. However, detailed nerve distribution combined with the division of the SIJ posterior ligamentous region is lacking. We aimed to explore the innervation of the SIJ posteriorly based on the quartering of the SIJ posterior ligamentous region.MethodsSixteen SIJs from eight embalmed cadavers were studied. Each SIJ posterior ligamentous region was equally divided into areas 0–3 from top to bottom. The origin, distribution, quantity, transverse diameter, spatial orientation, relation with bony structures, and the number of identifiable terminal nerve branches in each area were examined.ResultsAreas 0–1 were innervated by the lateral branches of the dorsal rami of L4−L5 directly in all specimens. Areas 2–3 were innervated by that of both lumbar and sacral nerves via the posterior sacral network (PSN), with L5 contributing to the PSN in all specimens and L4 in 68.75%. The number of identifiable terminal nerve branches were significantly higher in areas 2–3 than in areas 0–1.ConclusionsThe inferior part of the SIJ posterior ligamentous region seems to be the main source of SIJ-related pain and is innervated by lumbar and sacral nerves via the PSN. However, the superior part directly innervated by lumbar nerves should not be neglected, and further clinical verification is needed.

scholarly journals The Anatomy of the Lateral Branches of the Sacral Dorsal Rami: Implications for Radiofrequency Ablation

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. 459-464
Author(s):  
Joseph Fortin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Sacroiliac Joint ◽  
Low Back ◽  
Sacral Foramina ◽  
Dorsal Rami ◽  
Lateral Branches ◽  
The Right ◽  
Segmental Innervation

Background: The sacroiliac joint (SIJ) is a major source of pain in patients with chronic low back pain. Radiofrequency ablation (RFA) of the lateral branches of the dorsal sacral rami that supply the joint is a treatment option gaining considerable attention. However, the position of the lateral branches (commonly targeted with RFA) is variable and the segmental innervation to the SIJ is not well understood. Objectives: Our objective was to clarify the lateral branches’ innervation of the SIJ and their specific locations in relation to the dorsal sacral foramina, which are the standard RFA landmark. Methods: Dissections and photography of the L5 to S4 sacral dorsal rami were performed on 12 hemipelves from 9 donated cadaveric specimens. Results: There was a broad range of exit points from the dorsal sacral foramina: ranging from 12:00 – 6:00 position on the right side and 6:00 – 12:00 on the left positions. Nine of 12 of the hemipelves showed anastomosing branches from L5 dorsal rami to the S1 lateral plexus. Limitations: The limitations of this study include the use of a posterior approach to the pelvic dissection only, thus discounting any possible nerve contribution to the anterior aspect of the SIJ, as well as the possible destruction of some L5 or sacral dorsal rami branches with the removal of the ligaments and muscles of the low back. Conclusion: Widespread variability of lateral branch exit points from the dorsal sacral foramen and possible contributions from L5 dorsal rami and superior gluteal nerve were disclosed by the current study. Hence, SIJ RFA treatment approaches need to incorporate techniques which address the diverse SIJ innervation. Key words: Sacroiliac joint pain, radiofrequency ablation, dorsal sacral rami, low back pain

scholarly journals Comparison of Efficacy of Lateral Branch Pulsed Radiofrequency Denervation and Intraarticular Depot Methylprednisolone Injection for Sacroiliac Joint Pain

2018 ◽  
Vol 1 (21;1) ◽  
pp. 489-496
Author(s):  
Samarjit Dey
Keyword(s):  
Sacroiliac Joint ◽  
Joint Pain ◽  
Pulsed Radiofrequency ◽  
Sacroiliac Joint Pain ◽  
Post Procedure ◽  
Radiofrequency Denervation ◽  
Group A ◽  
Dorsal Rami ◽  
Group B ◽  
Lateral Branches

Background: Sacroiliac joint dysfunctional pain has always been an enigma to the pain physician, whether it be the diagnosis or the treatment. Diagnostic blocks are the gold standard way to diagnose this condition. Radiofrequency neurotomy of the nerves supplying the sacroiliac joint has shown equivocal results due to anatomical variation. Intraarticular depo-steroid injection is a traditional approach to treating sacroiliac joint pain. For long-term pain relief, however, lesioning the sacral lateral branches may be a better approach. Objective: This study compared the efficacy of intraarticular depo-methylprednisolone injection to that of pulsed radiofrequency ablation for sacroiliac joint pain. Study Design: This study used a randomized, prospective design. Setting: Thirty patients with diagnostic block-confirmed sacroiliac joint dysfunctional pain were randomly assigned to 2 groups. One group received intraarticular methylprednisolone and another group underwent pulsed radiofrequency of the L4 medial branch, the L5 dorsal rami, and the lateral sacral branches. Results: Reduction in Numeric Rating Scale (NRS) for pain at 1 month post-procedure remained similar in Group A, while in Group B few patients reported a further decrease in the NRS score (3.333 ± 0.4880 and 2.933 ± 0.5936, respectively). At 3 months post-procedure, the NRS score began to rise in most patients in group A, while in Group B, the NRS score remained the same since the last visit (4.400 ± 0.9856 and 3.067 ± 0.8837, respectively). At 6 months post-procedure, the NRS score began to rise further in most patients in group A. In Group B, the NRS score remained the same in most of the patients since the last visit (5.400 ± 1.549 and 3.200 ± 1.207). There was a marked difference between the 2 groups in Oswestry Disability Index (ODI) scores at 3 months post-procedure (Group A, 12.133 ± 4.486 vs Group B, 9.133 ± 3.523) and at 6 months post-procedure there was a significant (P = 0.0017) difference in ODI scores between Group A and Group B (13.067 ± 4.284 and 8.000 ± 3.703, respectively). Global Perceived Effect (GPE) was assessed in both groups at 3 months post-procedure Only 33.3% (Confidence Interval (CI) of 11.8- 61.6 ) of patients in Group A had positive GPE responses whereas in Group B, 86.67% (CI of 59.5- 98.3 ) of patients had positive GPE responses. At 6 months post-procedure, the proportion of patients with positive GPE declined further in Group A, while in Group B, positive GPE responses remained the same (20% with a CI of 4.30- 48.10 and 86.67% with a CI of 59.5- 98.3, respectively ). Limitations: Small sample size. Conclusion: This comparative study shows that pulsed radiofrequency denervation of the L4 and L5 primary dorsal rami and S1-3 lateral branches provide significant pain relief and functional improvement in patients with sacroiliac joint pain. Key words: Low back pain, sacroiliac joint dysfunctional pain, radiofrequency, intraarticular injection

The Sacroiliac Joint as a Cause of Pain – Review of the Sacroiliac Joint Morphology and Models for Pain Genesis

2021 ◽  
Author(s):  
Anna Völker ◽  
Hanno Steinke ◽  
Christoph-Eckhard Heyde
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Radicular Pain ◽  
Leg Pain ◽  
Joint Stability ◽  
Anatomical Structures ◽  
Dorsal Rami ◽  
Lateral Branches ◽  
Complex Joint ◽  
Pain Generator

Abstract Introduction In recent years, the sacroiliac joint has become increasingly important as a generator of low back pain with and without pseudo-radicular pain in the legs. Up to 27% of reported back pain is generated by disorders in the sacroiliac joint. Method This review is based on a selective literature search of the sacroiliac joint (SIJ) as a possible pain generator. It also considers the anatomical structures and innervation of the sacroiliac joint. Results The SIJ is a complex joint in the region of the posterior pelvis and is formed by the sacrum and the ilium bones. The SIJ is very limited in movement in all three planes. Joint stability is ensured by the shape and especially by strong interosseous and extraosseous ligaments. Different anatomical variants of the sacroiliac joint, such as additional extra-articular secondary joints or ossification centres, can be regularly observed in CT scans. There is still controversy in the literature regarding innervation. However, there is agreement on dorsal innervation of the sacroiliac joint from lateral branches of the dorsal rami of the spinal nerves S I–S III with proportions of L III and L IV as well S IV. Nerve fibres and mechanoreceptors can also be detected in the surrounding ligaments. Conclusion A closer look at the anatomy and innervation of the SIJ shows that the SIJ is more than a simple joint. The complex interaction of the SIJ with its surrounding structures opens the possibility that pain arises from this area. The SIJ and its surrounding structures should be included in the diagnosis and treatment of back and leg pain. Published literature include a number of plausible models for the sacroiliac joint as pain generator. The knowledge of the special anatomy, the complex innervation as well as the special and sometimes very individual functionality of this joint, enhance our understanding of associated pathologies and complaints.

scholarly journals The human sacrum shape: metamorphoses and relation of its parts

2018 ◽  
Vol 22 (1) ◽  
pp. 14-18
Author(s):  
V.G. Cherkasov ◽  
O.V. Malikov
Keyword(s):  
Human Body ◽  
Sacroiliac Joint ◽  
Vertebral Column ◽  
Human Life ◽  
Anatomical Study ◽  
External Factors ◽  
Multiple Factors ◽  
National Medical ◽  
University Department ◽  
Medical University

The human sacrum shape and its metamorphoses should be considered due to their effect, primarily mechanical, predisposing for the vertebral column function evolution. The aim of the study is to define the human sacrum shapes and explain for such variability. The object of the study is represented with 68 sacrums obtained from the review collection of anatomical study preparations of the Bogomolets National Medical University Department of Anatomy. Each of the known human sacrum shapes represents the stage of the process of “sinking” of the sacral vertebrae bodies into the sacrum, with simultaneous fixation of external apices of their lateral parts in the sacroiliac joint. Generally, metamorphoses of the sacrum shape make up an accommodation for the new mechanical conditions as well as causal external factors. The sacrum continuously sustains multiple factors’ effects in each moment of the human life, which affects its shape and metamorphoses. The analysis of the human sacrum shape and functions reveals important instances: first, certain parts of the sacrum don’t preserve permanent relations; secondly, alterations in these relations keep to a certain sequence. This issue permits us to consider various sacrum shapes as sequential stages of the same process, occurring in the human body.

Lateral branch blocks

2021 ◽  
pp. 75-82
Author(s):  
Benjamin K. Homra ◽  
Yashar Eshraghi ◽  
Maged Guirguis
Keyword(s):  
Radiofrequency Ablation ◽  
Local Anesthetic ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Lateral Branch ◽  
Ultrasound Technique ◽  
Posterior Aspect ◽  
Sacroiliac Joint Pain ◽  
Lateral Branches

The posterior sacral network is a complex meshwork of lateral branches of the dorsal sacral rami that innervate the posterior aspect of the sacroiliac joint. Pain arising from this joint can be diagnostically targeted using either a fluoroscopic or ultrasound technique to determine if the patient would benefit from radiofrequency ablation of the lateral branches. Injecting local anesthetic near the dorsal foramina using these techniques will temporarily block the transmission of pain by the lateral branches from the sacroiliac joint. This chapter covers the anatomy of the posterior sacral network, discusses the details of the two techniques for lateral branch blocks and evidence for their utility, provides information about the risks and contraindications associated with the techniques, and concludes by discussing the implications of the procedure.

Anatomical study of superior cluneal nerve entrapment

2013 ◽  
Vol 19 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Hiroshi Kuniya ◽  
Yoichi Aota ◽  
Tomoyuki Saito ◽  
Yoshinori Kamiya ◽  
Kengo Funakoshi ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Lateral Branch ◽  
Medial Branch ◽  
Low Back ◽  
Thoracolumbar Fascia ◽  
Recent Clinical Study ◽  
Lateral Branches ◽  
The Right

Object Entrapment of the superior cluneal nerve (SCN) in an osteofibrous tunnel in the space surrounded by the iliac crest and the thoracolumbar fascia is a cause of low-back pain (LBP). Several anatomical and surgical reports describe SCN entrapment as a cause of LBP, and a recent clinical study reported that patients with suspected SCN disorder constitute approximately 10% of the patients suffering from LBP and/or leg symptoms. However, a detailed anatomical study of SCN entrapment is rare. The purpose of this study was to investigate the courses of SCN branches and to ascertain the frequency of SCN entrapment. Methods Branches of the SCN were dissected in 109 usable specimens (54 on the right side and 55 on the left side) obtained in 59 formalin-preserved cadavers (average age at death 84.8 years old). All branches were exposed at the points where they perforated the thoracolumbar fascia. The presence or absence of an osteofibrous tunnel was ascertained and, if present, the entrapment of the branches in the tunnel was determined. Results Of 109 specimens, 61 (56%) had at least 1 branch running through an osteofibrous tunnel. Forty-two medial (39%), 30 intermediate (28%), and 14 lateral (13%) SCN branches passed through such a tunnel. Of these, only 2 medial branches had obvious entrapment in an osteofibrous tunnel. There were several patterns for the SCN course through the tunnel: medial branch only (n = 25), intermediate branch only (n = 11), lateral branch only (n = 4), medial and intermediate branches (n = 11), medial and lateral branches (n = 2), intermediate and lateral branches (n = 4), and all branches (n = 4). Conclusions Several anatomical variations of the running patterns of SCN branches were detected. Entrapment was seen only in the medial branches. Although obvious entrapment of the SCN is rare, it may cause LBP.

Dextrose injection of sacral lateral branches for chronic sacroiliac joint pain

2011 ◽  
Vol 12 (4) ◽  
pp. P69
Author(s):  
P. Satija ◽  
M. Parker ◽  
M. Eckmann ◽  
S. Ramamurthy
Keyword(s):  
Sacroiliac Joint ◽  
Joint Pain ◽  
Sacroiliac Joint Pain ◽  
Lateral Branches
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