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Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review

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Abstract

The sacroiliac joint is a diarthrodial synovial joint in the pelvis. Anatomically, it is described as a symphysis, its synovial joint characteristics being limited to the distal cartilaginous portion on the iliac side. It is a continuous ligamentous stocking comprising interconnecting ligamentous structures and surrounding fascia. Its ligaments, the primary source of its stability, include the anterior, interosseous and dorsal sacroiliac, the iliolumbar, sacrotuberous, and sacrospinous. Structural reinforcement is also provided by neighboring fascia and muscles. Lower back pain is a common presentation of sacroiliac joint disease, the best-established treatments being corticosteroid injections, bipolar radiofrequency ablation, and sacroiliac joint fusion.

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References

  1. Hansen HC, McKenzie-Brown AM, Cohen SP, Swicegood JR, Colson JD, Manchikanti L (2007) Sacroiliac joint interventions: a systematic review. Pain Physician 1:165–184

    Article  Google Scholar 

  2. Agur AMR, Dalley AF (2018) Moore’s essential clinical anatomy, 6th edn. Wolters Kluwer Health, Philadelphia

    Google Scholar 

  3. Vleeming A, Wingerden J, Snijders C, Stoeckart R, Stijnen T (1989) Load application to the sacrotuberous ligament; influences on sacroiliac joint mechanics. Clin Biomech 4:204–209

  4. Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 1:1–12

    Article  Google Scholar 

  5. Puhakka KB, Melsen F, Jurik AG, Boel LW, Vesterby A, Egund N (2004) MR imaging of the normal sacroiliac joint with correlation to histology. Skeletal Radiol 1:15–28

    Article  Google Scholar 

  6. Brolinson PG, Kozar AJ, Cibor G (2003) Sacroiliac joint dysfunction in athletes. Curr Sports Med Rep 1:47–56

    Article  Google Scholar 

  7. Solonen KA (1957) The sacroiliac joint in the light of anatomical, roentgenological and clinical studies. Acta Orthop Scand Suppl 27:1–127

    CAS  PubMed  Google Scholar 

  8. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH (2012) The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 6:537–567

    Article  Google Scholar 

  9. Dechow E, Davies RK, Carr AJ, Thompson PW (1999) A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford) 12:1255–1259

    Article  Google Scholar 

  10. Foley BS, Buschbacher RM (2006) Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil 12:997–1006

    Article  Google Scholar 

  11. Standring S (2020) Gray’s anatomy, 42nd edn. Elsevier, London

    Google Scholar 

  12. NB (1997) Clinical anatomy of the lumbar spine and sacrum. Churchill Livingstone, London

    Google Scholar 

  13. Steinke H, Hammer N, Slowik V, Stadler J, Josten C, Böhme J et al (2010) Novel insights into the sacroiliac joint ligaments. Spine (Phila Pa 1976) 3:257–263

    Article  Google Scholar 

  14. Bogduk N (1997) Clinical anatomy of the lumbar spine and sacrum. Churchill Livingstone, London

    Google Scholar 

  15. Vleeming A, Pool-Goudzwaard AL, Hammudoghlu D, Stoeckart R, Snijders CJ, Mens JM (1996) The function of the long dorsal sacroiliac ligament: its implication for understanding low back pain. Spine (Phila Pa 1976) 5:556–562

    Article  Google Scholar 

  16. 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 1:57–62

    Article  Google Scholar 

  17. McGrath MC, Zhang M (2005) Lateral branches of dorsal sacral nerve plexus and the long posterior sacroiliac ligament. Surg Radiol Anat 4:327–330

    Article  Google Scholar 

  18. Wang M, Dumas GA (1998) Mechanical behavior of the female sacroiliac joint and influence of the anterior and posterior sacroiliac ligaments under sagittal loads. Clin Biomech (Bristol, Avon) 4–5:293–299

    Article  Google Scholar 

  19. Pool-Goudzwaard A, Hoek van Dijke G, Mulder P, Spoor C, Snijders C, Stoeckart R (2003) The iliolumbar ligament: its influence on stability of the sacroiliac joint. Clin Biomech (Bristol, Avon) 2:99–105

    Article  Google Scholar 

  20. Pool-Goudzwaard AL, Kleinrensink GJ, Snijders CJ, Entius C, Stoeckart R (2001) The sacroiliac part of the iliolumbar ligament. J Anat Pt 4:457–463

    Article  Google Scholar 

  21. Loukas M, Louis RG, Hallner B, Gupta AA, White D (2006) Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome. Surg Radiol Anat 2:163–169

    Article  Google Scholar 

  22. Doty J, Rengachary S (1994) Surgical disorders of the sacrum. Thieme Medical Publishers Inc, New York

    Google Scholar 

  23. Ağaçayak E, YamanTunç S, İçen MS, Başaranoğlu S, Fındık FM, Sak S et al (2015) Should we add unilateral sacrospinous ligament fixation to vaginal hysterectomy in management of stage 3 and stage 4 pelvic organ prolapse? Turk J Obstet Gynecol 3:144–150

    Article  Google Scholar 

  24. Tseng LH, Chen I, Chang SD, Lee CL (2013) Modern role of sacrospinous ligament fixation for pelvic organ prolapse surgery–a systemic review. Taiwan J Obstet Gynecol 3:311–317

    Article  Google Scholar 

  25. DonTigny RL (1985) Function and pathomechanics of the sacroiliac joint. A review Phys Ther 1:35–44

    Google Scholar 

  26. Eichenseer PH, Sybert DR, Cotton JR (2011) A finite element analysis of sacroiliac joint ligaments in response to different loading conditions. Spine (Phila Pa 1976) 22:E1446-1452

    Article  Google Scholar 

  27. Rosatelli AL, Agur AM, Chhaya S (2006) Anatomy of the interosseous region of the sacroiliac joint. J Orthop Sports Phys Ther 4:200–208

    Article  Google Scholar 

  28. Kim YH, Yao Z, Kim K, Park WM (2014) Quantitative investigation of ligament strains during physical tests for sacroiliac joint pain using finite element analysis. Man Ther 3:235–241

    Article  Google Scholar 

  29. Slipman CW, Whyte WS, Chow DW, Chou L, Lenrow D, Ellen M (2001) Sacroiliac joint syndrome. Pain Physician 2:143–152

    Article  Google Scholar 

  30. Vrahas MS, Wilson SC, Cummings PD, Paul EM (1998) Comparison of fixation methods for preventing pelvic ring expansion. Orthopedics 3:285–289

    Article  Google Scholar 

  31. Ehara S, el-Khoury GY, Bergman RA, (1988) The accessory sacroiliac joint: a common anatomic variant. AJR Am J Roentgenol 4:857–859

    Article  Google Scholar 

  32. Egund N, Olsson TH, Schmid H, Selvik G (1978) Movements in the sacroiliac joints demonstrated with roentgen stereophotogrammetry. Acta Radiol Diagn (Stockh) 5:833–846

    Article  Google Scholar 

  33. Sturesson B, Uden A, Vleeming A (2000) A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine (Phila Pa 1976) 2:214–217

    Article  Google Scholar 

  34. Taxter AJ, Chauvin NA, Weiss PF (2014) Diagnosis and treatment of low back pain in the pediatric population. Phys Sportsmed 1:94–104

    Article  Google Scholar 

  35. Laslett M (2008) Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther 3:142–152

    Article  Google Scholar 

  36. Stoev I, Powers AK, Puglisi JA, Munro R, Leonard JR (2012) Sacroiliac joint pain in the pediatric population. J Neurosurg Pediatr 6:602–607

    Article  Google Scholar 

  37. Bellamy N, Park W, Rooney PJ (1983) What do we know about the sacroiliac joint? Semin Arthritis Rheum 3:282–313

    Article  Google Scholar 

  38. Snijders CJ, Hermans PF, Niesing R, Spoor CW, Stoeckart R (2004) The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints. Clin Biomech (Bristol, Avon) 4:323–329

    Article  Google Scholar 

  39. Schwarzer AC, Aprill CN, Bogduk N (1995) The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976) 20(1):31–37

    Article  CAS  Google Scholar 

  40. Sembrano JN, Jr Polly DW (2009) How often is low back pain not coming from the back? Spine (Phila Pa 1976) 34(1):E27–E32

    Article  Google Scholar 

  41. Pino CA, Hoeft MA, Hofsess C, Rathmell JP (2005) Morphologic analysis of bipolar radiofrequency lesions: implications for treatment of the sacroiliac joint. Reg Anesth Pain Med 4:335–338

    Google Scholar 

  42. Vilensky JA, O’Connor BL, Fortin JD et al (2002) Histologic analysis of neural elements in the human sacroiliac joint. Spine (Phila Pa 1976) 27(11):1202–1207

    Article  Google Scholar 

  43. Sturesson B, Uden A, Vleeming A (2000) A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine (Phila Pa 1976) 25(3):364–368

    Article  CAS  Google Scholar 

  44. Szadek KM, Hoogland PV, Zuurmond WW, de Lange JJ, Perez RS (2008) Nociceptive nerve fibers in the sacroiliac joint in humans. Reg Anesth Pain Med 33(1):36–43

    Article  PubMed  Google Scholar 

  45. Fortin JD, Falco FJ (1997) The Fortin finger test: an indicator of sacroiliac pain. Am J Orthop (Belle Mead NJ) 26(7):477–480

    CAS  Google Scholar 

  46. Vleeming A, Van Wingerden JP, Dijkstra PF, Stoeckart R, Snijders CJ, Stijnen T (1992) Mobility in the sacroiliac joints in the elderly: a kinematic and radiological study. Clin Biomech (Bristol, Avon) 7(3):170–176

    Article  CAS  Google Scholar 

  47. Lorio MP, Polly DW Jr, Ninkovic I, Ledonio CG, Hallas K, Andersson G (2014) Utilization of minimally invasive surgical approach for sacroiliac joint fusion in surgeon population of ISASS and SMISS membership. Open Orthop J 8:1–6

    Article  PubMed  PubMed Central  Google Scholar 

  48. Polly DW, Swofford J, Whang PG et al (2016) Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-surgical management for sacroiliac joint dysfunction. Int J Spine Surg 10:Article28

    Article  Google Scholar 

  49. Sachs D, Capobianco R (2012) One year successful outcomes for novel sacroiliac joint arthrodesis system. Ann Surg Innov Res 6(1):13

    Article  PubMed  PubMed Central  Google Scholar 

  50. Iwanaga J, Singh V, Ohtsuka A, Hwang Y, Kim HJ, Moryś J et al (2021) Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat 34(1):2–4

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude [50].

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Authors and Affiliations

  1. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada

    Kara Ashby, Marios Loukas & R. Shane Tubbs

  2. Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, NRW, Germany

    Emre Yilmaz

  3. Tulane University & Ochsner Clinic Neurosurgery Program, Tulane University School of Medicine, New Orleans, LA, USA

    Mansour Mathkour

  4. Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland

    Łukasz Olewnik

  5. Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA

    Dany Hage, Joe Iwanaga & R. Shane Tubbs

  6. Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University, New Orleans, LA, USA

    Joe Iwanaga & R. Shane Tubbs

  7. Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA

    R. Shane Tubbs

  8. Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  9. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

  10. University of Queensland, Brisbane, Australia

    R. Shane Tubbs

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  1. Kara Ashby
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Contributions

Conceptualization: EY, JI, RST. Data acquisition: KA, DH, EY, JI, RST. Data analysis or interpretation: MM, LO, DH, ML. Drafting of the manuscript: KA, EY, JI. Critical revision of the manuscript: ML, RST. Approval of the final version of the manuscript: all authors.

Corresponding author

Correspondence to Joe Iwanaga.

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The protocol of the study did not require approval by the ethical committees or informed consent. The study followed the Declaration of Helsinki (64th WMA General Assembly, Fortaleza, Brazil, October 2013).

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The authors declare no competing interests.

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Ashby, K., Yilmaz, E., Mathkour, M. et al. Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review. Neurosurg Rev 45, 357–364 (2022). https://doi.org/10.1007/s10143-021-01625-y

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