Anatomy, physiology and radiology of the sacroiliac joints.
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Humans↗
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[TYPICAL STRAIN INJURIES OF THE ANTERIOR ILEOSACRAL JOINT CAPSULE AND ITS LIGAMENTS. (ROENTGEN DIAGNOSTIC STUDIES ON THE SACROILIAC JOINT. V.)].
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Back Pain↗
[Degenerative changes in the sacroiliac joint in persons with amputations of the thigh and biomechanical disorders of gait].
In order to evaluate degenerative changes with amputated persons' sacroiliacal joints--upper leg amputations, 20 male subjects aging 31-57 years and a control group of 56 subjects with no amputation were tested. Changes evaluation was confirmed by a radiologic and scintigraphic result. Changes were observed after amputation-0 level 6 months' walk with an artificial limb. There was a comparison to a control group-56 subjects with no amputation. After evaluating degenerative changes of lumbocoxal triangle it could be concluded that the amputation and the time of amputation were a relevant factor in the beginning of degenerative changes. 6-12 months after the amputation, sacroiliacal joint's degenerative changes on ipsylateral side begin using an adequate orthopedic expedient-an artificial limb used permanently, degenerative changes can be held up at reversibility level or stagnation. Using an adequate physical therapy and an orthopedic expedient by an early discovery of degenerative changes their progress can be prevented.
Adult↗
Can an external frame fixation reduce the movements in the sacroiliac joint? A radiostereometric analysis of 10 patients.
To evaluate whether a Hoffmann-Slätis frame can reduce movements in the sacroiliac joints, 10 patients (7 women) with severe posterior pelvic pain of long duration were externally stabilized. The movements were analyzed with radiostereometric analysis (RSA) in supine and standing positions, preoperatively and postoperatively with the frame applied. In 2 patients, there was no reduction in the movements with the frame, perhaps because it was not properly tightened. In the remaining 8 patients, the median reduction in rotation was 55% on the left side and 63% on the right side around the helical axes, and 74% around the x-axes on the left side and 66% on the right side. Our data suggest that external fixation using the Hoffmann-Slätis frame, substantially reduces sacroiliac joint mobility in some patients, which must be considered when using the frame as a diagnostic tool. Pre-stressing the frame by tightening the vertical bars before the compression bar is applied is recommended to reduce the risk of this shortcoming.
Adult↗
Coronal oblique turbo STIR imaging of the sacrum and sacroiliac joints at routine MR imaging of the lumbar spine.
The objective of the study was to evaluate the clinical impact of coronal oblique imaging of the lumbrosacral junction and the sacrum at initial presentation for MR imaging of the lumbar spine in patients presenting with low back pain or sciatic pain. Two hundred and sixty consecutive patients attending for MRI of the lumbar spine underwent simultaneous coronal oblique turbo short tau inversion recovery (STIR; TR 2500, TE 40, TI 150, echo train length 7, number of scan acquisitions 2) imaging of the sacrum and the sacroiliac joints with a field of view of 30-cm and 3-mm slices (acquisition time 3 min and 20 s). Images were reviewed by two experienced radiologists to determine the cause of back pain, with and without images of the sacrum and sacroiliac joints. The added value of the additional sequence was assessed. Correlation was made with surgery, response to nerve root injection or clinical follow-up at 3 months. Subgroup analysis was performed to determine if patient stratification according to sex or symptoms would be useful. In total, in 19 of 260 patients (7.3%), abnormalities were identified at coronal STIR imaging. In 7 of 260 patients (2.7%), pathology was identified in the sacrum thought to account for back pain, altering the diagnosis made on the standard sequences. These diagnoses were sacroiliitis (n=2), sacral stress fracture (n=1), degenerative sacroiliac joints (n=1), degenerative accessory articulation between the lumbar spine and the sacrum (n=1), Tarlov cyst of nerve root (n=1) and retroverted uterus causing sciatic pain (n=1). Patient stratification according to sex or the presence or absence of sciatic symptoms was not useful in predicting the added benefit of the additional sequence. Routine coronal STIR imaging of the sacrum as part of lumbar spine MRI improves assessment of patients presenting with low back pain or sciatica in only a small number of patients.
Acute Disease↗
Bridging osteophyte of the anterosuperior sacroiliac joint as a cause of lumbar back pain.
A case report is presented of a patient with an anterosuperior osteophytic bone bridge of the sacroiliac joint causing lumbar back pain. After prolonged physiotherapy, the bone bridge was excised, with complete resolution of the symptoms. Excision should only be considered in cases of symptomatic sacroiliac joint pain that does not respond to rehabilitation programmes and conservative treatment.
Adult↗
An approach to the functional anatomy of the sacroiliac joints in vivo.
This first part of this paper is a review of the literature on the functional anatomy of the sacroiliac joint followed by a preliminary biomechanical study of the fresh post mortem pelvis. The latter was done in order to determine the coefficients of the screw matrix and the position of the instantaneous centers of rotation during the symmetrical movements of nutation and contranutation simulated in the biomechanics laboratory. The main part of this work deals with the spatial analysis in vivo of the relative displacements of the iliac bones with respect to the sacrum in the course of dissymmetrical movements of the pelvis. In the different phases of movement, the roentgenographic observation of the position of the bony components with respect to a three-dimensional orthonormal reference system required the use of material based on the principles of photogrammetry. This technique was used to achieve spatial reconstruction of the data recovered from a series of orthogonal x-ray films of the sacroiliac joints. Data retrieval was carried out on a digital table linked to a computer with a graphic terminal so that the information could be displayed in the form of rectangular coordinates of defined points on the bone. Owing to the limited amplitude of articular displacement, a statistical study was required to retrieve the coordinates from the projection of these points on the X-ray film with an estimated threshold of significance of 0.1 and an error of +/- 0.1 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Clinical x-ray and scintigraphic evaluation of the state of the sacroiliac joints in patients with chronic monarthritis].
The paper is concerned with some comparative data on the frequency of the detection of sacroileitis using clinicoroentgenological and scintigraphic studies in 57 patients with chronic monarthritis of the knee joint of different genesis. On clinical examination 14 patients (24.7%) only had indirect signs of the affected sacroiliac joints, in 30 patients (52.6%) sacroileitis was diagnosed by x-ray. Scintigraphy with 99mTc-pyrophosphate proved to be most effective for the detection of early signs of sacroileitis because lesions in the sacroiliac joints were found in 35 patients (61.4%).
Adolescent↗
Surgical excision of bone sarcomas involving the sacroiliac joint.
Adequate (wide or marginal and uncontaminated) margins and reconstruction are difficult to achieve when performing an internal hemipelvectomy for bone sarcomas involving the sacroiliac joint. We evaluated whether adequate surgical margins could be achieved and if functional outcomes could be predicted based on the type of resection and reconstruction. Forty patients had resections of the sacroiliac joint. Vertical sacral osteotomies were through the sacral wing (n = 2), ipsilateral sacral foramina (n = 27), sacral midline (n = 9), or contralateral foramina (n = 2). Iliac resections were Type I, Type I-II with partial or total acetabular re-section, or Type I-II-III. Surgical margins were adequate in 28 of 38 patients (74%), two (7%) of whom experienced local recurrence, compared with seven of 10 (70%) patients with inadequate margins. Reconstruction consisted of restoring continuity between the spine and pelvis. Resection of the entire acetabulum and removal of the lumbosacral trunk were the two main determinants of function, as assessed using the Musculoskeletal Tumor Society score. There were no life-threatening or function-threatening complications. Internal hemipelvectomy with a limb salvage procedure can be achieved with adequate surgical margins in selected patients. Functional outcomes can be predicted based on the type of resection and reconstruction, which helps the surgeon plan the procedure and inform the patient.
Adolescent↗
The sacroiliac joints: evaluation using nuclear scintigraphy. Part 2: Lame horses.
REASONS FOR PERFORMING STUDY: Sacroiliac (SI) joint disease is difficult to diagnose definitively on clinical grounds. HYPOTHESES: Lameness not attributable to SI joint pain may result in asymmetrical uptake of radiopharmaceutical in the tubera sacrale and SI joints; and that horses with clinical signs suggestive of sacroiliac joint disease would have differences in the ratios of radiopharmaceutical uptake between the fifth lumbar vertebra (L5) and either the tubera sacrale or SI joints compared with normal horses. OBJECTIVES: To determine whether differences in radiopharmaceutical activity could identify individuals with presumed SI joint region pain. METHODS: The scintigraphic appearance of the pelvic region of 234 horses (Group I) with lameness unrelated to the SI joints was compared with that for 40 normal horses (Group N) in full work and that for 41 horses with suspected SI joint disease (Group II). The effect of age, sex, lame limb and discipline were assessed in Group I. Motion-corrected scintigraphic images were assessed grossly, using profile analysis and by comparing ratios of uptake of mean count per pixel between L5 and each of the left (L) tuber sacrale (TS), right (R) TS, LSI and RSI joints. Left-right symmetry was compared. RESULTS: Lame horses (Group I) had greater asymmetry of radiopharmaceutical uptake in the tubera sacrale compared with normal horses. Horses with right hindlimb lameness had a larger RSI/LSI ratio compared to normal horses. In Group I L5/LTS, L5/RTS and L5/RSI increased with age, and there was a trend for L5/LSI to increase with age. In horses with presumed sacroiliac joint disease (Group II), L5/LTS, L5/RTS and L5/RSI were all greater compared with normal horses. Detection of marked left-right asymmetry by quantitative analysis or profile analysis was helpful in discriminating between those horses with clinical signs compatible with SI joint disease and either normal horses or those lame due to another cause. CONCLUSIONS AND POTENTIAL RELEVANCE: Scintigraphic evaluation of the SI region is useful to identify SI joint disease in combination with other clinical signs supportive of the diagnosis. However, diagnosis should not be based on this alone because of some degree of overlap in the range of radiopharmaceutical uptake between horses with SI joint disease and both normal horses and those with other causes of lameness.
Age Factors↗
Sacroiliac joint pain after lumbar fusion. A study with anesthetic blocks.
Low back pain persisting or appearing after a technically successful lumbar fusion challenges clinicians. In this context, the sacroiliac joint could be a possible source of pain, but the frequency of its responsibility is not really known. We used sacroiliac anesthetic blocks, the gold standard for diagnosis, to determine this frequency. Our second goal was to search predictive factors for a positive block. Our prospective series consisted of 40 patients with persistent low back pain after a technically successful fusion who received a sacroiliac anesthetic block under fluoroscopic control. The diagnostic criterion was a relief of more than 75% of the pain on a visual analog scale. We found a 35% rate of positive blocks. The only criterion that characterized these patients was a postoperative pain different from the preoperative pain in its distribution ( p =0.017). A free interval of more than 3 months between surgery and appearance of the pain had an indicative value ( p =0.17). An increased uptake in the sacroiliac on bone scintigraphy or a past history of posterior iliac bone-graft harvesting had no significant value ( p =0.74 and p =1.0, respectively). The sacroiliac joint is a possible source of pain after lumbar fusion. The anesthetic block under fluoroscopic control remains the gold standard.
Adult↗
[Are sacroiliac joint block and insertion tendinosis of the musculus erector trunici too rarely diagnosis as the etiology of failed back syndrome after intervertebral disk operation].
Dysfunction of sacroiliac joint and tendinosis of erector trunci muscle may cause severe pain after lumbar discectomy. In this paper we discuss pathophysiology, clinical appearance as well as specific diagnostic procedures and therapy. We want to point out that sacroiliac joint dysfunction must be taken into consideration if persistent pain occurs after discectomy.
Diagnosis, Differential↗
Incidence of sacroiliac joint malalignment in leg length discrepancies.
The purpose of this study was to ascertain the incidence of leg length discrepancies in a sample of asymptomatic female college students, and then to determine the incidence of sacroiliac joint malalignment within that same sample. Structural leg length, functional leg length, and sacroiliac position were determined for each subject. The results indicate a high incidence of leg length discrepancies within the sample, and also a fairly high incidence of asymptomatic sacroiliac joint malalignment when leg length discrepancies are present.
Adult↗
Dysplasia epiphysealis hemimelica of the sacroiliac joint: a case report.
Dysplasia epiphysealis hemimelica is a rare developmental abnormality involving aberrant epiphyseal cartilage growth. This is the first known case report describing dysplasia epiphysealis hemimelica arising from the sacroiliac joint. The operative technique described through an indirect computed tomography guided approach limited the exposure and potential morbidity involving the sacroiliac joint.
Bone Neoplasms↗
Effects of Salter innominate osteotomy on the sacroiliac joint in patients with developmental hip dysplasia.
The pressure effects of Salter innominate osteotomy (SIO), a surgical treatment for developmental hip dysplasia (DHD), on the sacroiliac joint were investigated in a retrospective study. Pre- and post-operative direct anteroposterior pelvic radiographs of 60 cases with unilateral DHD treated by SIO were examined. The mean age at surgery was 27.7 months (range 18-48 months). The distance from the posterior inferior iliac spine to the midline (from the middle of the first sacral vertebra to the symphysis pubis) was measured. No difference was found between pre- and post-operative distances on the normal, non-operated side. On the operated side, no change was observed in 10 cases (16.7%), but the distance increased by 2 mm or 3 mm in 50 cases (83.3%) post-operatively. This increase was statistically significant, but not related to age at surgery. These findings indicate that SIO creates pressure on the inferior part of the sacroiliac joint, resulting in some displacement. Such irreversible changes may eventually lead to joint degeneration and pain.
Child, Preschool↗
In vitro study of the ilial anatomic landmarks for safe implant insertion in the first sacral vertebra of the intact canine sacroiliac joint.
OBJECTIVE: To define landmarks on the canine ilial wing for accurate, consistent insertion of implants into the 1st sacral (S1) vertebral body when the sacroiliac joint is intact. STUDY DESIGN: Anatomic study. ANIMALS: Intact, cadaveric canine pelves and sacra (n=25). METHODS: Median sections (5 specimens) were drilled from the center of S1 in a lateral direction, exiting on the ilial wing. Landmarks on the ilial wing and shaft used to define this exit point were then used to locate this point on both wings of 20 articulated specimens, positioned and rigidly held so that the dorsal plane of the pelvis was aligned with a plumb line and the median plane of the pelvis was horizontal. A 2 mm hole was drilled from the marked point, parallel to the plumb line, until it exited the contralateral ilial wing. Distance of drill hole position from the geometric center (GC) of S1 was located on median and paramedian plane images derived from plane, computed tomographic (CT) scans. RESULTS: The entire drill hole was located within S1 in 18 specimens. Mean deviation of the hole from GC (ratio of the distance of GC from the closest S1 body border) in median section was 0.40 +/- 0.29 (craniocaudal direction) and 0.29 +/- 0.23 (dorsoventral). CONCLUSIONS: Use of ilial wing landmarks and drilling perpendicular to the median plane will improve accuracy for insertion of implants into S1 when the sacroiliac joint is intact. CLINICAL RELEVANCE: Ilial wing landmarks should be used to improve accuracy of implant insertion into S1.
Animals↗
A limited, low-dose computed tomography protocol to examine the sacroiliac joints.
Limited, low-dose, three-scan computed tomography (CT) was shown to be as accurate as a complete CT series in examining the sacroiliac joints and is suggested as an effective alternative to plain radiography as the primary means to detect sacroiliitis. The advantages include the brevity of the examination, a 2-fold to 4-fold reduction in radiation exposure relative to conventional radiography and a 20-fold to 30-fold reduction relative to a full CT series. The technique was developed from studies of anatomic specimens in which the articular surfaces were covered with a film of barium to show clearly the synovial surfaces and allow the choice of the most appropriate levels of section. From the anteroposterior scout view the following levels were defined: at the first sacral foramen, between the first and second sacral foramina and at the third sacral foramen. In the superior section a quarter of the sacroiliac joint is synovial, whereas in the inferior section the entire joint is synovial. The three representative cuts and the anteroposterior scout view are displayed on a single 14 x 17 in. (36 x 43 cm) film. Comparative images at various current strengths showed that at lower currents than conventionally used no diagnostic information was lost, despite a slight increase in noise. The referring physicians at the authors' institution prefer this protocol to the imaging routine previously used.
Arthritis↗
[INJURIES OF THE SACROILIAC JOINT].
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Accidents↗