Iliolumbar Ligament Injection

The iliolumbar ligament runs between the transverse process of L5 and the medial deep iliac crest. It forms a thickened lower border for two thoracolumbar fascia layers.

Imaging is generally unhelpful in iliolumbar syndrome. Imaging may help to rule out other bony pathologies.

liolumbar syndrome is a painful condition caused by pathology of the iliolumbar ligament. It is more common in people lifting heavy loads
while rotating laterally (manual workers, golf players, etc). The pathology is believed to be ligament strain. The pain
is localized to the posterior/medial portion of the iliac crest. Patients describe a constant ache, which is aggravated by activity (especially bending to the contralateral side). Pain may refer to areas including hip, groin and perineal structures. There is tenderness on palpation over the posterior/ medial aspect of the iliac crest.

A combination of history and physical exam, in conjunction with appropriate diagnostic injections, can lead to the correct diagnosis.

In differential diagnosis, one has to consider other sources of pain—for example, the quadratus lumborum muscle, erector spinae muscle, the facet joints, the sacroiliac joint and the hip joint.

Iliolumbar ligament injection is usually done on an outpatient basis. The procedure is performed under ultrasound guidance to ensure accuracy of needle placement. Patients need to be aware that the outcome of the procedure is variable and they may not receive the desired benefits. Similarly, they must be aware of the transient nature of the therapeutic benefits and that there may need repeated injections.

Generally a mixture of local anaesthetic and steroid is injected. The anaesthetic is probably responsible for immediate pain relief, whereas steroids are believed to be responsible for pain relief 2–6 days after their administration. For a diagnostic block, a short-acting anaesthetic alone is sufficient. Botox injection may be considered for a more sustained response.

Complications are rare, particularly if injections are performed using a precise needle-positioning technique. Severe allergic reactions to local anaesthetics are uncommon. Steroid injections may produce local reactions, occurring most often immediately after injection. These local reactions last for 24 to 48 hours, and are relieved by application of ice packs. Post-procedural pain flare-up may occasionally occur, and may be treated with pain killers. Neurological complications including paraesthesias, numbness and paralysis have been described but are extremely rare. Infection may occur but the incidence is very low as the procedure is performed under strict aseptic conditions.