Sonoanatomy and injection technique of the iliolumbar ligament

Abstract

Background: The iliolumbar ligament plays an important biomechanic role in anchoringthe spine to the pelvic ring and stabilizing the sacroiliac joint. Iliolumbar syndrome is aback pain condition caused by pathology of the iliolumbar ligament. History and physicalexamination are important in the assessment of back pain, but they lack sufficientspecificity. Injection of small volumes of local anesthetic into the structure consideredto be the source of the pain (i.e. the iliolumbar ligament) increases the specificity of thediagnostic workup.Objective: To describe an ultrasound - guided technique for injecting the iliolumbarligament.Study design: Case report based on knowledge of topographic anatomy andsonoanatomy.Setting: Outpatient clinic.Methods: A patient with a clinical picture suggestive of iliolumbar syndrome wasselected. An ultrasound-guided injection of the iliolumbar ligament with local anestheticwas performed. We recorded the patient's subjective assessment of pain and the changein range of movement and pain scores during provocative tests.Results: Following the injection, the patient's pain score decreased, provocation testsbecame negative, and the range of movement increased.Limitations: Case report. Target specificity and dispersion of local anesthetic spread notconfirmed with an independent technique (i.e. magnetic resonance imaging).Conclusions: Ultrasound guidance allows the selective deposition of small volumes oflocal anesthetic into structures believed to cause soft tissue back pain and thus to confirmor exclude the working diagnosis. Further studies are needed to confirm our conclusionsand to prove the clinical feasibility of this technique.