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PubMed2005

[Internal fixation of sacroiliac joint disruption].

OBJECTIVE: Stabilization of the completely disrupted sacroiliac (SI) joint with two three-hole DC plates. INDICATIONS: Definitive treatment of the posterior pelvic ring in type C injuries (AO classification) with complete SI joint disruption, transiliac or transsacral fracture-dislocation of the SI joint with an insignificant, small fragment. Emergency stabilization of the SI joint following a laparotomy. CONTRAINDICATIONS: Poor general health of patient. Local soft-tissue damage. Rotationally unstable type B pelvic injuries. SURGICAL TECHNIQUE: Supine. Anterolateral approach to the iliac crest. Subperiosteal detachment of the iliac muscle. Debridement of the SI joint and reduction under direct vision. Stabilization of the SI joint with two three-hole DC plates inserted at an angle of 70-90 degrees. POSTOPERATIVE MANAGEMENT: Partial weight bearing on the injured side at 15 kg for 8-12 weeks with two forearm crutches. Implant removal 6-12 months after injury provided ankylosis has not occurred. RESULTS: In 27 patients with disruption of the SI joint consistent with a type C injury, the average displacement of the affected SI joint was 16 mm (8-30 mm). Complications relating to the osteosynthesis occurred as a deep infection in one patient, originating from a concomitant acetabular osteosynthesis. Iatrogenic nerve damage (lateral femoral cutaneous nerve) was present in two patients. 16 patients were followed up using radiologic techniques (pelvic, possibly inlet and outlet views, computed tomography). 13 SI joints healed in anatomic position. The malalignments observed were relatively slight (2-4 mm). There was no secondary implant failure. Almost all patients (n = 14) showed posttraumatic changes of the SI joint (osteophytes, arthrosis, ankylosis).

Adolescent↗
PubMed1987

Load-displacement behavior of sacroiliac joints.

We measured the load-displacement behavior of both single and paired sacroiliac (SI) joints in fresh cadaver specimens obtained from eight adults between the ages of 59 and 74 years. With both ilia fixed, static test loads were applied to the center of the sacrum along and about axes parallel and normal to the superior SI endplate. Test forces up to 294 N were applied in the superior, inferior, anterior, posterior, and lateral directions. Moments up to 42 N-m were applied in flexion, extension, lateral bending, and axial torsion. Displacements of the center of the sacrum were measured 60 s after each load increment was applied, using dial gauges and an optical lever system. The tests were then repeated with only one ilium fixed. Finally, the three-dimensional location and overall geometry of each SI joint were measured. For an isolated left joint at the maximum test loads, the mean (SD) sacral displacements in the direction of the force ranged from 0.76 mm (1.41) in the medial to 2.74 mm (1.07) in the anterior direction. The mean rotations in the directions of the moments ranged from 1.40 degrees (0.71) in right lateral bending to 6.21 degrees (3.29) in clockwise axial torsion viewed from above. We also examined load-displacement behavior under larger loads. Single sacroiliac joints resisted loads from 500 to 1440 N, and from 42 to 160 N-m without overt failure.

Aged↗
PubMed1992

Quantitative radio-isotope scanning of the sacroiliac joints in ankylosing spondylitis.

A method for applying 99mTc-MDP for dynamic and static quantitative radioisotope scanning (QRS) of the sacroiliac joints (SI) in early progressive sacroiliitis in ankylosing spondylitis (AS) is described. In a prospective study, 2 groups of male AS patients were investigated, one with increased elevated erythrocytic sedimentation rate (ESR) (group A, n = 7) and one with normal ESR (group B, n = 8). In both groups an increased uptake of the radiotracer was found in the static part of the study versus a control group C (n = 9). An increased uptake versus group C was also found for group A in the dynamic part of the study (p = 0.01) while there was no significant difference dynamically between groups B and C. The results of the dynamic study in group A indicate ESR to be a parameter of inflammatory activity in the SI joints. The study also seems to indicate QRS to be a valuable diagnostic method in early AS without definite radiographic changes in the SI joints.

Adult↗
PubMed2005

Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests.

Previous research indicates that physical examination cannot diagnose sacroiliac joint (SIJ) pathology. Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability. This study examined the diagnostic power of pain provocation SIJ tests singly and in various combinations, in relation to an accepted criterion standard. In a blinded criterion-related validity design, 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ. The tests were evaluated singly and in various combinations (composites) for diagnostic power. All patients with a positive response to diagnostic injection reported pain with at least one SIJ test. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. Receiver operator characteristic curves and areas under the curve were constructed for various composites. The greatest area under the curve for any two of the best four tests was 0.842. In conclusion, composites of provocation SIJ tests are of value in clinical diagnosis of symptomatic SIJ. Three or more out of six tests or any two of four selected tests have the best predictive power in relation to results of intra-articular anaesthetic block injections. When all six provocation tests do not provoke familiar pain, the SIJ can be ruled out as a source of current LBP.

Adult↗
PubMed2007

Innervation of the sacroiliac joint in rats by calcitonin gene-related peptide-immunoreactive nerve fibers and dorsal root ganglion neurons.

The sacroiliac joint (SIJ) can be a source of low back pain. Calcitonin gene-related peptide (CGRP) has been reported to play a significant role in nociceptive processing. However, the occurrence of CGRP-immunoreactive (CGRP-ir) sensory nerve fibers in the SIJ has not been fully defined. The present study investigated CGRP-ir nerve fibers supplying the SIJ. CGRP-ir nerve fibers in the vicinity of the SIJ cartilage and CGRP-ir neurons in the bilateral dorsal root ganglia (DRG) were examined immunohistochemically by administering anti-CGRP antiserum to rats. The SIJ was decalcified and cut into sections, and the CGRP-ir fibers around the SIJ cartilage were counted under microscopy. In another group, fluoro-gold (F-G), a neural tracer, was injected into the SIJ from the dorsal or ventral side with dorsal or ventral denervation. The number of F-G-labeled CGRP-ir neurons was counted in individual DRG. CGRP-ir fibers were observed more frequently in the tissues adjacent to the cranial part of the SIJ surface. In the case of dorsal denervation (ventral nerve supply), the CGRP-ir neurons composed 18.2% of the F-G-labeled neurons. In the case of ventral denervation (dorsal nerve supply), the CGRP-ir neurons composed 40.9% of the F-G-labeled neurons. There was a statistically significant difference in the number of CGRP-ir neurons between the ventral and dorsal nerve supplies to the SIJ. The cranial part of the dorsal side could be the part most associated with pain in the SIJ.

Animals↗
PubMed2004

MRI abnormalities of sacroiliac joints in early spondylarthropathy: a 1-year follow-up study.

OBJECTIVE: To describe changes in chronic and acute magnetic resonance imaging (MRI) abnormalities of the sacroiliac joints (SIJs) in early spondylarthropathy (SpA), and to associate these findings with computed tomography (CT), X-ray, and clinical findings during a 1-year follow-up. METHODS: Thirty-four patients, 20 males and 14 females, median age 27 years, with inflammatory low back pain (median 23 months) were included. MRI, CT, and X-ray, as well as clinical and laboratory tests were performed. After a follow-up period of 1 year (median 377 days) the examinations were repeated, and the findings were correlated. RESULTS: MRI and CT changes resulting from SIJ destruction increased significantly during follow-up, and the two modalities were significantly correlated. For the MRI findings of inflammatory activity, only bone marrow oedema decreased significantly. An increase in the Schober test was the only clinical examination that changed significantly. CONCLUSION: In early SpA, MRI can detect significant inflammatory and destructive changes of the SIJs over a 1-year follow-up period, in spite of minimal changes in the clinical parameters. The MRI changes in inflammatory activity are not detectable by CT and X-ray examinations. Thus, MRI may be a sensitive method, without known risks, for early diagnosis and for following disease progression in SpA.

Adult↗
PubMed1996

The influence of two bone agents (99Tcm-pyrophosphate and 99Tcm-methylenediphosphonate) on quantitative sacroiliac joint scintigraphy.

Bone scintigraphy is an extremely sensitive method for the detection of focal bone disease. In many hospitals, quantitative sacroiliac joint scintigraphy is still a routine procedure in detecting sacroiliitis. In previous studies, both 99Tcm-methylenediphosphonate (99Tcm-MDP) and 99Tcm-pyrophosphate have been used for bone imaging. 99Tcm-pyrophosphate is eliminated more slowly than 99Tcm-MDP from the circulation and gives a higher background activity. We wished to discover the sacroiliac/sacral ratio (SI/S ratio) changes when using different bone agents. The aim of this study was to evaluate differences in SI/S ratios between the two bone agents. Forty-six control subjects, aged 31-50 years, with no history of back pain, scoliosis, kyphosis, joint pain, arthritis, lesions within the pelvis, chemotherapy or systemic diseases such as diabetes or systemic lupus erythematosis, were included in the study. A posterior planar image of the pelvis was performed to calculate the SI/S ratio 3 h after the injection of 740 MBq 99Tcm-MDP or 99Tcm-pyrophosphate. Twenty-five subjects were studied with 99Tcm-MDP and 21 with 99Tcm-pyrophosphate. We found the SI/S ratios using 99Tcm-MDP to be slightly higher than those using 99Tcm-pyrophosphate, especially on the left side, but this difference was not statistically significant (P-values > 0.1 on both sides using Student's t-tests for unpaired data).

Adult↗
PubMed1993

Treatment and biomechanical assessment of patients with chronic sacroiliac joint syndrome.

OBJECTIVE: To evaluate diagnostic and biomechanical correlates and treatment outcomes of manipulative/adjustive care in patients highly selected for sacroiliac joint syndrome (SIJS). DESIGN: Descriptive case series, 1 wk baseline, 1 yr follow-up. SETTING: Private chiropractic practice. PATIENTS: Ten out of 153 consecutive new patients (4 male and 6 female) with "primary," chronic, uncomplicated SIJS were selected over an 11-mo period on the basis of painful SIJ and provocation tests. MAIN OUTCOME MEASURES: Back pain (visual analogue scale), Oswestry disability index, lumbar provocation tests and biomechanical measures of gait and postural sway. INTERVENTION: Six-wk regimen of mechanical force, manually assisted, short lever adjustments (MFMA) with an Activator instrument. RESULTS: Pain decreased significantly from a mean baseline value of 25 to 12 (t = 2.28; p < .05). Likewise, the average disability scores diminished from 28 to 13% (t = 2.3; p < .05), and a reduction in the number of positive provocation tests was noted (Fisher Exact Probability range Z = 0.025-0.045). Gait and sway parameters were indistinguishable from normals, before or after treatment. Response to the 1-yr follow-up questionnaire (6/10) revealed stability of symptoms at a low level. CONCLUSIONS: While the majority of subjects recorded some degree of positive outcome, we conclude that: a) discrete SIJS remains difficult to diagnose, but may be possible by judicious choice of screening tests; b) MFMA may benefit some patients with chronic SIJ pain; and c) gait and sway measurement yielded no correlation with clinical conditions.

Adult↗
PubMed1989

Reliability of motion palpation procedures to detect sacroiliac joint fixations.

The purpose of this study was to assess the inter- and intraexaminer reliability of the Gillet-motion palpation procedure using 10 qualified chiropractors and 11 patients with a sacroiliac joint problem. Intraexaminer reliability was found to be statistically significant for all agreement scores investigated. Interexaminer reliability was found to be statistically significant for some of the agreement scores investigated but not for others. Severity of the low back problems did not seem to influence intra- or interexaminer agreement scores; however, chiropractor expertise did. High expertise was associated with lower intraexaminer agreement scores than low expertise. This finding is in contradiction with traditional beliefs and reported findings. The gait of the patient group was found to be significantly different from that of normal subjects as noted in an earlier report.

Adult↗
PubMed1981

[Scintigraphic examinations of sacroiliacal joints in patients with early forms of ankylosing spondylitis].

In contrast to the X-ray examination the scintigraphy of the sacroiliacal joints in the early phase of the ankylosing spondylarthritis allows an evidence to the local processes of bone reconstruction directly depending on their activity. Positive findings of scintigraphy have a high sensitivity and a low specifity. They demand a further differential-diagnostic clarification. In this sense, supplementing the X-ray findings, the scintigraphy brings valuable informations for the early diagnostics of ankylosing spondylarthritis. The radiation exposure of the gonads which is smaller by factor 3 in comparison to the X-ray examination of the pelvis is an essential advantage in the above all young patients. The valuation of the scintigramme must be performed in close connection between clinical rheumatologists and specialists in nuclear medicine. Our results show that longitudinal examinations let expect a further improvement of the evidence.

Diagnosis, Differential↗
PubMed1997

Tuberculosis of the sacroiliac joint.

A 23-year-old woman presented with low back pain of several months' duration. A tuberculous infection of the left sacroiliac joint was diagnosed by closed-needle biopsy. The clinical presentation, radiological features and outcome of this patient are discussed.

Adult↗
PubMed2003

Sacroiliac joint fusion for chronic pain: a simple technique avoiding the use of metalwork.

A previously undescribed method for posterior fusion of the sacroiliac joint (SIJ) utilizing the Cloward instrumentation is presented, suitable for cases with chronic pain and intact ligamental structures of the SIJ. The advantages of the method in comparison with other described options include minimal disturbance of the periarticular structures, avoidance of introduction of metalwork and preservation of the iliac crest contour. This technique has been used in five cases with follow-up longer than 2 years (mean 29 months, range 25-41 months). In all cases there was resolution of their painful symtomatology.

Adult↗
PubMedDate not supplied

Sacroiliac joints: anatomical variants on CT.

The purpose of this work was to examine the type and prevalence of anatomical variants of the sacroiliac joints (SJs) in patients without SJ disease on CT examinations. The study comprised 534 consecutive patients undergoing pelvic CT with various indications not related to diseases that could involve the SJ. Images printed on bone window settings were evaluated with reference to any deviation from the usual appearance of the SJ. Physical data and history of low back pain were recorded in each patient. Six types of anatomical variants were observed: accessory joints in 102 patients (19.1%), "iliosacral complex" in 31 (5.8%), bipartite iliac bony plate in 22 (4.1%), crescent-like iliac bony plate in 20 (3.7%), semicircular defects at the sacral or iliac side in 16 (3%), and ossification centers in 3 patients (0.6%). Accessory joints were more common in obese than in normal-weight individuals (p < 0.05) and in older than younger (<60 years) patients (p < 0.001) and presented degenerative alterations especially in patients with episodes of low back pain. Three of these variants (iliosacral complex, bipartite iliac bony plate, and crescent-like iliac bony plate) had higher incidence in women than in men (p < 0.05) and were not associated with degenerative changes. Knowledge of the normal variations in the SJ appearance broadens the understanding of SJ anatomy, facilitating image interpretation.

Adolescent↗