Abstract Objectives: The differentiation of potential pain generating structures in the sacro-iliac region remains a diagnostic challenge. The aim of this proof of concept study was to evaluate the feasibility of using Doppler ultrasound to image the vascular components of dorsal sacral rami and their associated medial and lateral branches. Using the vascular signature of the dorsal sacral arteries to identify the dorsal sacral rami could assist with the diagnosis and treatment of localisa-ble, extra-articular, posterior sacro-iliac joint pain.Methods: The posterior sacral region was scanned in 30 healthy adults using an Acuson X300 ultrasound machine with 7.5 MHz high-resolution linear transducer in spectral Doppler mode to assess the feasibility of identifying and measuring the Resistive Index (Rl) of the dorsal sacral arteries.Results: The vascular signature of the dorsal sacral rami and associated branches was identified in 62% of participants; S2 70%, S1 57% and S3 59%. More than two vascular signatures were recorded in 23 (76.7%) cases; in only two (6.67%) were no vascular signatures detected. Mean Rl was 0.82 ±0.11, increasing significantly (P < 0.05) at each caudal sacral level. No statistically significant difference in Rl was observed between rami arteries and their branches or between genders. Conclusions: Doppler ultrasound may be useful in identifying the individual dorsal sacral rami (S1-3) and their associated branches. This may assist with selective imaging of the dorsal sacral rami and their branches in the diagnosis and treatment of chronic localisable pain in the posterior sacro-iliac region and facilitate investigation of the hypothesis of entrapment neuropathy in this region.
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