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Surgical and Radiologic Anatomy

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01-04-2011 | Medical Imaging

Bony landmarks in the sacral region: the posterior superior iliac spine and the second dorsal sacral foramina: a potential guide for sonography

Authors: Maurice Christopher McGrath, Mark David Stringer

Published in: Surgical and Radiologic Anatomy | Issue 3/2011

Abstract

Purpose

Identification of the second dorsal sacral foramen (S2F) by sonographic imaging is a possible first step in localising the branches of the dorsal sacral rami. The aim of this investigation is to develop an imaging approach to assist the rapid identification of S2F using a well-known regional landmark, the posterior superior iliac spine (PSIS).

Methods

Twenty-seven skeletal specimens were digitally imaged. Repeated measurements were undertaken of the angle and distance (D¹) between PSIS and S2F, maximum width of S2F (D²), interforaminal distance between contralateral S2F (D³), distance between S1F and S2F (D⁴), and distance between S2F and S3F (D⁵). Sonographically guided needle placement was further undertaken to validate these osseous measurements in five intact cadavers.

Results

In skeletal material, repeated measurements indicated high intraclass correlation coefficients. No statistically significant difference existed in any measure between sides. Combined measurements indicated that S2F was located 46.4 ± 14.9° from the PSIS in both sexes, with a statistical trend toward a greater angle in females. D¹ had a mean value 2.2 ± 0.62 cm but was significantly shorter in females. The mean values of D² and D³ were 0.75 ± 0.18 cm and 2.98 ± 0.27 cm, respectively, with no significant difference between sexes. The mean value of D⁴ was 1.42 ± 0.27 cm with a statistical trend toward a slightly smaller value in females. The mean value for D⁵ was 1.28 ± 0.15 cm. Sonographically guided needle placement in cadavers tended to validate these osseous measurements.

Conclusions

S2F has a mean maximum width of 0.76 cm and lies approximately 2–3 cm from the PSIS, 45° inferior to the horizontal. The medial left and right borders of S2F are approximately 3 cm apart. The upper three ipsilateral dorsal sacral foramina are 1–1.5 cm apart. These measurements may be useful for sonographers imaging the dorsal sacral region and eventually, for the potential identification of neurovascular branches of the dorsal sacral rami.

Asher MA, Strippgen WE (1986) Anthropometric studies of the human sacrum relating to dorsal trans-sacral implant designs. Clin Orthop Relat Res 203:58–62PubMed

Berthelot J-M, Labat J-J, Le Goff B (2009) Origine ligamentaire de certaines douleurs sacro-iliaques (concept de sacro-iliaque lato sensu) Sacro-iliac pain from ligamentous origin. Rev Rhum 76:786–794CrossRef

Braun J, Bollow M, Seyrekbasan F et al (1996) Computed tomography guided corticosteroid injection of sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and follow up by dynamic magnetic resonance imaging. J Rheumatol 23:659–664PubMed

Chakraverty R, Pynsent P, Isaacs K (2007) Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines? J Anat 210:232–236PubMedCrossRef

Cohen SP, Hurley RW, Buckenmaier CC et al (2008) Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology 109:279–288PubMedCrossRef

Danelli G, Gardini M, Gemmi D et al (2009) Ultrasound and peripheral blocks for acute and chronic pain: a review. Eur J Pain 3:145–148

Dreyfuss P, Henning T, Malladi N et al (2009) The ability of multi-site, multi-depth sacral lateral branch blocks to anesthetize the sacroiliac joint complex. Pain Med 10:679–688PubMedCrossRef

Hendrix RW, Lin PP, Kane WJ (1982) Simplified aspiration or injection technique for the sacroiliac joint. J Bone Joint Surg Am 64:1249–1252PubMed

Kaul A, Bauer B, Bernhardt J et al (1997) Effective doses to members of the public from the diagnostic application of ionizing radiation in Germany. Eur Radiol 7:1127–1132PubMedCrossRef

10.

Kim HW, Ko YJ, Rhee WI et al (2007) Interexaminer reliability and accuracy of posterior superior iliac spine and iliac crest palpation for spinal level estimations. J Manipulative Physiol Ther 30:386–389PubMedCrossRef

11.

Klauser A, De Zordo T, Feuchtner G et al (2008) Feasibility of ultrasound guided sacroiliac joint injection considering sonographic landmarks at two different levels in cadavers and patients. Arthritis Rheum 59:1618–1624PubMedCrossRef

12.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRef

13.

McGaugh JM, Brismee JM, Dedrick GS (2007) Comparing the anatomical consistency of the posterior superior iliac spine to the iliac crest as reference landmarks for the lumbopelvic spine: a retrospective radiological study. Clin Anat 20:819–825PubMedCrossRef

14.

McGrath C, Nicholson H, Hurst P (2010) Branch blockade of the sacral dorsal rami. Pain Med 11:281–282PubMedCrossRef

15.

McGrath C, Nicholson H, Hurst P (2009) The long posterior sacroiliac ligament: a histological study of morphological relations in the posterior sacroiliac region. Joint Bone Spine 76:57–62PubMedCrossRef

16.

McMinn RM (1998) Last’s Anatomy (1998), 9th edn. Churchill Livingstone Elsevier, Edinburgh, pp 217

17.

Muhlner SB (2009) Review article: radiofrequency neurotomy for the treatment of sacroiliac joint syndrome. Curr Rev Musculoskelet Med 2:10–14PubMedCrossRef

18.

O’Haire C, Gibbons P (2000) Inter-examiner and intra-examiner agreement for assessing sacroiliac anatomical landmarks using palpation and observation: pilot study. Man Ther 5:13–20PubMedCrossRef

19.

Rosse C, Gaddum-Rosse P (1997) Hollinshead’s textbook of anatomy, 5th edn. Lippencott-Raven, Philadelphia, pp 311

20.

Saladin KS (2007) Anatomy and physiology: the unity of form and function, 4th edn. McGraw Hill, New York, pp 394

21.

Standring S (2008) Gray’s anatomy—the anatomical basis of clinical practice, 40th edn. Churchill Livingstone, Edinburgh, pp 747, 1340, 1366

22.

Yin W, Willard F, Carreiro J et al (2003) Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine 28:2419–2425PubMedCrossRef

Title: Bony landmarks in the sacral region: the posterior superior iliac spine and the second dorsal sacral foramina: a potential guide for sonography
Authors: Maurice Christopher McGrath
Mark David Stringer
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Surgical and Radiologic Anatomy / Issue 3/2011
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-010-0735-0

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Springer Medicine

Bony landmarks in the sacral region: the posterior superior iliac spine and the second dorsal sacral foramina: a potential guide for sonography

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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