Introduction: During routine cadaveric dissection, Simonds et al. in 2019 found a previously undocumented ligament, which they termed the midline interlaminar ligament (MIL), in 24 out of 36 (76.5%) lumbar spinal levels. The MIL is an unpaired ligament located between and distinctly separate from the right and left ligamenta flava (LF).The purpose of this study was to identify the presence or absence of the MIL in the cervical, thoracic, and lumbar spinal regions and obtain detailed measurements of the ligaments' toughness (R) and elastic modulus (E).Materials and Methods: Intact preserved cadaveric vertebrae from C2 to the upper sacral region were dissected. Presence or absence of the MIL was documented, and length and width of each MIL were measured in situ. The R and E of the LFs from corresponding spinal segments were found for comparison.Results: At least one MIL was observed in 90.3% (28) of specimens. Eighty-eight MIL's were observed out of 186 cervical intervertebral levels (0.5%), 371 thoracic intervertebral levels (5.9%), and 101 lumbar intervertebral levels (63.4%). The mean width and
The ligaments of the spine have been well studied and are an essential component of neuromuscular structure and function. However, during routine cadaveric dissection, Simonds et al. 2019 found a previously undocumented ligament, which they termed the midline interlaminar ligament (MIL), in 24 out of 36 (76.5%) lumbar spinal levels; Simonds et al. 2019 did not report the presence or absence of the MIL in the cervical or thoracic regions of the spine. The MIL is an unpaired ligament located between and distinctly separate from the right and left ligamenta flava (LF). The purpose of this study was to identify the presence or absence of the MIL in the cervical, thoracic, and lumbar spinal regions and obtain detailed measurements of the toughness of the MIL. Intact preserved cadaveric spines from C2 to the upper sacral region were dissected. Presence or absence of the MIL was documented, and length and width of each MIL were measured in situ. The toughness of MILs was measured using scissors tests, which help guide fracture through structurally heterogenous tissues like ligaments. The LF from corresponding spinal segments also underwent toughness measurements for comparison to MIL toughness. In 27 cadaveric specimens, 67 MILs were observed out of 621 total intervertebral levels (10.8%), 162 cervical intervertebral levels (0.6%), 324 thoracic intervertebral levels (2.5%), and 135 lumbar intervertebral levels (43.0%). There was at least one MIL observed in 77.8% (21) specimens, and no MIL observed at any spinal level in 22.2% (6) specimens. The mean width and length of the MIL were 1.21 ± 0.36 mm and 16.37 ± 2.17 mm, respectively. The mean toughness of the MIL and the LF were 1390.27 J/m2 and 2068.04 J/m2, respectively. Based on our findings, the MIL was present in the majority of spines with a predominance for the lumbar region. The results of this study may help to improve practitioners' understanding of pathologies of the spine through increased knowledge of the anatomy and biomechanics of the MIL.
Carpal tunnel syndrome (CTS) is a common cause of medical and workforce-related expenses in the United States. It is also frustrating for patients who have difficulty using the affected hand, impairing their activities of daily living and decreasing their quality of life. By utilizing the philosophy of osteopathic medicine, providers can better implement a treatment plan by working with the patient to find one that incorporates all aspects of the patient’s environment. By using the practice of osteopathic manipulative therapy (OMT), osteopathic physicians can often effectively treat the patient’s symptoms without side effects found in medications. This is especially useful in patients who may be unable to take certain medications, such as pregnant patients. Other treatment modalities are also reviewed in this manuscript.
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