<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Background</h3>
<p>Iliac crest pain syndrome is a regional pain syndrome that has been identified in many patients with low back pain. Based on anatomical studies, it was suggested that the potential substrate of this syndrome might be the enthesis of the erector spinae muscle at the posterior medial iliac crest. As there have been no imaging studies of this important enthesis, our aim was to assess its characteristics by ultrasound.</p>
</sec>
<sec>
<h3>Methods</h3>
<p>Erector spinae enthesis was first studied in a cadaver. Then its characteristics were recorded in 25 healthy volunteers (median age: 28.92, SD: 5.31, mean Body Mass Index 22.61, SD: 3.38), with Esaote My Lab 7 machine using linear transducer (4–13 MHz).</p>
</sec>
<sec>
<h3>Results</h3>
<p>The cadaver study confirmed the attachment of a substantial part of erector spinae to a well-defined region on the medial posterior iliac crest. The US study in the volunteers consistently showed the entheses as typical hyperechoic fibrillar structures, slightly oblique to the skin in the longitudinal plane and attaching to the iliac crest. In the transverse plane, the entheses were seen as oval, densely dotted structures in contact with the superior edge of posterior superior iliac spine. Their mean thickness (4.9 ± 0.6 and 5.2 ± 0.7 mm longitudinally; 4.3 ± 0.6 and 4.4 ± 0.7 mm transversely), maximum width (16.3 ± 2.8 and 15.7 ± 2.3 mm) and depth (10.8 ± 7.3 and 10.6 ± 6.2 mm) on the left and right side, respectively, as well as their echostructure were recorded and described.</p>
</sec>
<sec>
<h3>Conclusions</h3>
<p>The erector spinae entheses could be assessed in detail by ultrasound, thus their pathological transformation associated with iliac crest pain syndrome could be identified.</p>
</sec>
</abstract>

Background
Iliac crest pain syndrome is a regional pain syndrome that has been identified in many patients with low back pain. Based on anatomical studies, it was suggested that the potential substrate of this syndrome might be the enthesis of the erector spinae muscle at the posterior medial iliac crest. As there have been no imaging studies of this important enthesis, our aim was to assess its characteristics by ultrasound.


Methods
Erector spinae enthesis was first studied in a cadaver. Then its characteristics were recorded in 25 healthy volunteers (median age: 28.92, SD: 5.31, mean Body Mass Index 22.61, SD: 3.38), with Esaote My Lab 7 machine using linear transducer (4–13 MHz).


Results
The cadaver study confirmed the attachment of a substantial part of erector spinae to a well-defined region on the medial posterior iliac crest. The US study in the volunteers consistently showed the entheses as typical hyperechoic fibrillar structures, slightly oblique to the skin in the longitudinal plane and attaching to the iliac crest. In the transverse plane, the entheses were seen as oval, densely dotted structures in contact with the superior edge of posterior superior iliac spine. Their mean thickness (4.9 ± 0.6 and 5.2 ± 0.7 mm longitudinally; 4.3 ± 0.6 and 4.4 ± 0.7 mm transversely), maximum width (16.3 ± 2.8 and 15.7 ± 2.3 mm) and depth (10.8 ± 7.3 and 10.6 ± 6.2 mm) on the left and right side, respectively, as well as their echostructure were recorded and described.


Conclusions
The erector spinae entheses could be assessed in detail by ultrasound, thus their pathological transformation associated with iliac crest pain syndrome could be identified.

The sonoanatomy of lumbar erector spinae and its iliac attachment – the potential substrate of the iliac crest pain syndrome, an ultrasound study in healthy subjects

Journal of Ultrasonography

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Background
Iliac crest pain syndrome is a regional pain syndrome that has been identified in many patients with low back pain. Based on anatomical studies, it...

The sonoanatomy of lumbar erector spinae and its iliac attachment – the potential substrate of the iliac crest pain syndrome, an ultrasound study in healthy subjects

Article Category: research-article

Published Online: Mar 30, 2018

Page range: 16 - 21

Received: Nov 18, 2017

Accepted: Jan 03, 2018

DOI: https://doi.org/10.15557/jou.2018.0003

Keywords
ultrasound, erector spine muscle entheses, iliac crest pain syndrome, low back pain

© 2018 Plamen Todorov et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

The sonoanatomy of lumbar erector spinae and its iliac attachment – the potential substrate of the iliac crest pain syndrome, an ultrasound study in healthy subjects

Article Category: research-article

Published Online: Mar 30, 2018

Page range: 16 - 21

Received: Nov 18, 2017

Accepted: Jan 03, 2018

DOI: https://doi.org/10.15557/jou.2018.0003

Keywordsultrasound, erector spine muscle entheses, iliac crest pain syndrome, low back pain

© 2018 Plamen Todorov et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Keywords
ultrasound, erector spine muscle entheses, iliac crest pain syndrome, low back pain