The AAO Journal, 2023/06, 33(2):30. doi: 10.53702/2375-5717-33.2.20, type of study: ,obs,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Free full text   (https://meridian.allenpress.com/aaoj/article/33/2/20/493544/LBORC-NUFA-Poster-Abstracts-2023-Students)

Keywords:

cadaver [21]
iliolumbar ligament [3]
observational study [246]
sacral motion [2]

Abstract:

Introduction/Background: The iliolumbar ligament contacts the lumbar, iliac, and sacral regions. This ligament stabilizes and restricts movement of the lumbosacral junction, as well as protects the L4 and L5 discs from degeneration. When experiencing postural stress, this ligament is one of the first to become tender. Pain referral patterns are to the anterior groin, lateral hip, and low back. During common procedures such as sacroiliac (SI) fusions or laminectomies, the iliolumbar ligament is intentionally ligated potentially leading to sacral instability, disc degeneration, and pain. Through an osteopathic lens, we hypothesize that the structural and functional implications of ligating the iliolumbar ligament can be demonstrated using a cadaveric dissection. Methods: With the cadaver prone, we isolated and removed the musculature surrounding the sacrum to isolate the iliolumbar ligament. Anterior pressure was applied to the sacrum while the ligaments remained intact. One of the ligaments was fully ligated in order to emulate surgical ligation. The same anterior pressure was applied a second time and palpated. To complete the dissection, the second ligament was ligated, and motion palpated. All motion testing was filmed for comparison. Results: After the initial iliolumbar ligament was ligated, increased sacral motion was appreciated via palpation. Following the second ligation, further laxity was manually appreciated. Discussion/Conclusion: The finding of increased sacral motion suggests that sacral instability is a potential consequence of damage to the iliolumbar ligament. Increased awareness of the repercussions of surgical ligation or postural strain will be beneficial to surgeons and providers during patient care. Limitations to this study include lack of variability in human anatomy due to dissection of one cadaver, tissue stiffness resulting from the preservation technique, and use of a single dissection technique.