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Original research
Anatomical study of the innervation of different parts of the posterior ligamentous region of the sacroiliac joint
  1. Weijia Zhu,
  2. Qinghao Zhao,
  3. Runxun Ma,
  4. Zezheng Liu,
  5. Jianjun Zhao,
  6. Zexian Liu,
  7. Junjie Chen,
  8. Rusen Zhang,
  9. Zhiyang Zheng,
  10. Yejie Xu,
  11. Shangxi Deng,
  12. Liang Cheng and
  13. Qingchu Li
  1. Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
  1. Correspondence to Dr Qingchu Li, Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, China; liqingchu12{at}qq.com; Dr Liang Cheng; sjzchengliang{at}126.com

Abstract

Background and objectives The 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.

Methods Sixteen 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.

Results Areas 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.

Conclusions The 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.

  • complex regional pain syndromes
  • nerve block
  • pain management
  • anesthesia
  • local

https://doi.org/10.1136/rapm-2020-102366

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    Footnotes

    • WZ, QZ and RM are joint first authors.

    • WZ, QZ and RM contributed equally.

    • Contributors WZ, QZ, LC, and QL planned the study; WZ, RM, ZezL, JZ, ZexL, JC, RZ, ZZ, YX, and SD conducted the study. WZ, QZ, and RM helped with reporting. WZ, QZ, LC, and QL helped with conception and design. WZ, QZ, RM, ZezL, JZ, ZexL, JC, RZ, ZZ, YX, and SD helped with the acquisition of data. WZ, QZ, RM, LC, and QL analyzed the data.

    • Funding The authors report grants from Science and Technology Project of Guangdong (Grant No. 2017B020210010), during the conduct of the study.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Data are survey results, statistical forms and images. Please contact corresponding authors, Qingchu Li and Liang Cheng, through the email address listed in the paper for these data.