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At least 361 records · Page 20Linked to original sources
PubMed1988

Fractures of the sacrum and sacroiliac joint: evaluation by computerized tomography with multiplanar reconstruction.

Conventional roentgenographic views of the pelvis provide inadequate assessment of complex bony trauma. Computerized tomography (CT) allows simpler patient positioning, more reliable detection of subtle fractures, better characterization of complex fractures, and detection of associated soft tissue and joint space abnormalities. The addition of multiplanar reconstructions (MPR) provides a better understanding of the pathoanatomy. The sacrum and the sacroiliac joint, traditionally problematic to image, are particularly well defined by CT/MPR. Subtle diastasis and intra-articular fragments are more reliably detected when the transaxial image is supplemented by coronal reconstructions. The degree of comminution and direction of fragment displacement are also best defined by coronal and sagittal formatting. Surgeons often find this protocol useful in preoperative assessment of extent and stability of fractures, and in planning conservative or surgical management.

Adult↗
PubMed1989

Clinical sequelae and sacroiliac joint changes by computed tomography after recovery from septic sacroiliitis.

Nine cases of septic sacroiliitis were re-examined clinically and by CT after a follow-up period of 1.5-7 years. At the final check-up, six of the patients were asymptomatic, while pain could be provoked by palpation or compression in three cases. The sacroiliac joint CT findings were considered normal in two cases. Joint space narrowing, subchondral sclerosis, cysts, erosions, ankylosis and/or osteophytes were detected in seven cases. We conclude that recovery from septic sacroiliitis is good although destructive and degenerative changes often develop as sequelae of an osteolytic involvement.

Adult↗
PubMed1997

CT of the sacroiliac joints. Dosimetry and optimal settings for a high-resolution technique.

PURPOSE: The aim was to select an optimal technique for low-dose high-resolution CT of the sacroiliac joints (SJ). MATERIAL AND METHODS: Dose measurements were performed on a Rando anthropomorphic phantom using thermoluminescence dosimeters for 4 CT protocols and 2 conventional radiography protocols used for SJ evaluation. Six available reconstruction algorithms were tested on CT protocols using 285-665 mAs and 120 or 130 kVp settings and noncontiguous 1.5-mm-thin sections with 3.5-mm intervals. Settings with optimum performance on phantom tests were also applied in a series of 10 patients with SJ arthropathies. RESULTS: A CT protocol using 120 kVp/175 mA/2.9 s/1.5-mm slice thickness/5-mm table increment implied the lower radiation dose among all examination protocols tested and provided high image quality of the SJ. A reconstruction algorithm yielding images of improved spatial resolution with acceptable noise was selected. CONCLUSION: A high spatial frequency reconstruction algorithm, and 120 kVp and 508 mAs were considered optimal for a low-dose CT examination of the SJ that employed narrow (1.5 mm) slice images with interspacing.

Algorithms↗
PubMed1997

Rapid spinal trabecular bone loss in female patients with ileitis terminalis Crohn and additional sacroiliac joint inflammation.

Patients with Crohn's disease are well known to have local and generalized osteopenia of varying degrees. The aim of this study was to investigate whether the additional involvement of the sacroiliac joint as an extraintestinal manifestation has an influence on bone turnover in female patients with Crohn's disease. Osteocalcin and other parameters of bone metabolism were measured in 79 female patients with Crohn's disease. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DEXA). Z scores were obtained by comparison with age- and sex-matched normal values. As regards the sacroiliac involvement (n = 26; group 1), we found a significantly lower BMD in the lumbar spine (L4) and in Ward's triangle of the femoral neck compared to controls (P < 0.05) and those patients (n = 53; group 2) with pure ileitis terminalis Crohn. Furthermore, the duration of the disease process in patients with Crohn's disease and extraintestinal involvement was markedly shorter than that of patients in group 2 (P < 0.05). In conclusion, osteoporosis in female patients with sacroiliac involvement manifested itself in a more severe way.

Adult↗
PubMed1992

Increased sacroiliac joint uptake after lumbar fusion and/or laminectomy.

Of 753 adult patients undergoing SPECT and planar bone scintigraphy for the evaluation of low back pain, 43 (6%) showed either unilateral or bilateral increased sacroiliac joint (SIJ) uptake. Five of the 58 abnormal joints were only identified with SPECT (9%), whereas 20 of the 58 abnormal joints were much more convincingly demonstrated by SPECT (34%). Fifteen of the 43 patients with increased SIJ uptake had undergone prior lumbar laminectomy and/or spinal fusion. Such spinal surgery can increase impact loading on the SIJ, leading to mechanical overload and sacroiliitis. Degenerative joint disease, trauma, or other benign pathology accounted for the remaining patients with increased SIJ uptake. The authors conclude that for patients with a history of lumbar spinal fusion and/or laminectomy, increased SIJ uptake usually is caused by altered spinal mechanics rather than malignancy or infection.

Adult↗
PubMed1991

CT-guided fixation of sacral fractures and sacroiliac joint disruptions.

Open reduction and internal fixation (ORIF), the currently preferred method for treatment of unstable posterior pelvic and sacral fractures, has two significant disadvantages: the need for blind placement of the fixation screws and the occurrence of high complication rates. Advantages of computed tomographic (CT)-guided sacral fixation include direct visualization of the course of the screws and absence of significant complications. Eight patients with unstable but reducible sacral fractures or sacroiliac joint (SIJ) disruptions (seven unilateral and one bilateral) underwent CT-guided sacral fixation with use of the standard orthopedic A-O, 7.0-mm-diameter cannulated screw system. The guide pin was positioned across the fracture or SIJ by using depth and angulation measurements derived from the scout CT scans. After confirmation of the position of the pin with CT, the screw tract was drilled, and the cannulated screw was placed into position. Radiographic and clinical follow-up (5-9 months) showed healing with no significant complications in all eight patients. CT-guided sacral fixation is a safe alternative to ORIF in patients with reducible unstable pelvic fractures.

Adolescent↗
PubMed1990

Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome.

The purpose of this article is to describe the author's theories as to how anterior dysfunction of the sacroiliac joints (SIJs) is a major factor in the etiology of idiopathic low back pain syndrome (ILBPS). Most research and treatment have been directed toward the intervertebral disk; however, it is unlikely that disk dysfunction is always the primary etiology. A review of the literature is used to outline and describe the characteristics of ILBPS and to make a case that these characteristics are consistent with those of a specific dysfunction of the SIJs. Functions of the intervertebral disks and the SIJs are described and related to SIJ dysfunction and to some of its common consequences. Treatment is discussed as it relates to the pathomechanics and their correction.

Back Pain↗
PubMed2001

HLA-B27 positive juvenile arthritis with cardiac involvement preceding sacroiliac joint changes.

While cardiovascular disease develops in up to 50% of adult patients with ankylosing spondylitis, it is very uncommon in its juvenile counterpart. Regarding the early stage of the disease, before onset of sacroiliac joint changes, only two cases with aortic incompetence have been published while reports of mitral valve involvement are not available. A 13 year old boy is described with an HLA-B27 positive asymmetric oligoarthritis and enthesitis, without back pain or radiographic evidence of sacroiliitis. Echocardiography showed an echogenic structure measuring 8 x 11 x 20 mm at the fibrous continuity between the aortic and mitral valves extending through a false tendon into an echogenic thickened posterior papillary muscle, causing a grade II aortic and grade I/II mitral regurgitation. Short term corticosteroid and long term non-steroidal anti-inflammatory drug and disease modifying antirheumatic drug treatments efficiently controlled the symptoms. The cardiac findings remained unchanged during a follow up of 20 months. Careful cardiac evaluation appears to be mandatory even in these young patients.

Adolescent↗
PubMed1984

The normal sacroiliac joint: a CT study of asymptomatic patients.

The sacroiliac (SI) joints of 45 asymptomatic subjects were prospectively studied to define better the normal appearance of SI joints on CT scans and thereby attach appropriate significance to CT signs of sacroiliitis. We evaluated joint space narrowing, subchondral sclerosis, erosions, ankylosis, osteophytes, subchondral cysts, and symmetry. The results indicate that the SI joints demonstrate symmetry in patients under the age of 30 (100% of subjects in this age group). Asymmetry was demonstrated in 77% of subjects over the age of 30 and in 87% of subjects over the age of 40. Abnormal CT findings of sacroiliitis, which occurred frequently in the asymptomatic population and thus by themselves are believed to be poor indicators of sacroiliitis, include nonuniform iliac sclerosis (83%), focal joint space narrowing in patients over the age of 30 (74%), and ill-defined areas of subchondral sclerosis, particularly on the iliac side (67%). Those CT findings of sacroiliitis that occurred infrequently in the asymptomatic population, and hence may represent good indicators of sacroiliac disease, include increased sacral subchondral sclerosis in subjects under the age of 40 (11%), bilateral or unilateral uniform joint space of less than 2 mm (2% or 0%, respectively), erosions (2%), and intraarticular ankylosis (0%).

Adult↗
PubMedDate not supplied

CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast-enhanced MRI.

PURPOSE: Our goal was to prospectively study the therapeutic efficacy of CT-guided intraarticular corticosteroid instillation of inflamed sacroiliac joints (SIJs) in patients with spondyloarthropathies and to evaluate the role of MRI as a procedure for establishing the indication and for therapeutic follow-up. METHOD: A total of 103 CT-guided corticosteroid injections of the SIJs were performed in 66 patients with inflammatory back pain (IBP): 37 bilateral, 29 unilateral. All patients did not respond to an immediately preceding 4 week nonsteroidal antiinflammatory therapy. Forty milligrams of a crystalline long-acting corticoid was instilled in each joint. All 66 patients underwent continuous clinical follow-up at 10 to 12 week intervals after corticosteroid injection to a maximum of 18 months. The degree of subjective complaints before and after the intervention was recorded using a analogue scale (0 = no pain, 10 = unbearable pain). Dynamic contrast-enhanced (Gd-DTPA, 0.1 mmol/kg body wt) MRI with quantitative determination of contrast enhancement was performed in all patients before the therapeutic intervention and in 38 patients at 8 +/- 4 months. RESULTS: Sixty-one of the 66 study patients (92.5%) showed a statistically significant abatement of subjective complaints from 8.8 +/- 1.3 to 3.3 +/- 2.3 (p < 0.01) at 1.7 +/- 1.1 weeks after intervention, and this improvement lasted for 10 +/- 5 months. The percentage contrast enhancement at dynamic MRI likewise showed a significant reduction from 100.3 +/- 48% before to 44.3 +/- 36.1% after intraarticular cortisone administration (p < 0.01). CONCLUSION: CT-guided intraarticular corticosteroid instillation in the SIJs may be regarded as an effective therapy for florid sacroiliitis. The severity of inflammation and the response to therapy can be determined quantitatively by dynamic MRI.

Adult↗
PubMed2003

Sacroiliac joint dislocation in 11 years old boy treated by open reduction and internal fixation.

Pelvic fractures in children are relatively rare, especially unstable pelvic ring disruptions. Generally, nonoperative treatment has been recommended for children with these injuries because healing is rapid and remodeling extensive in children. Treatment generally is a period of recumbency until the fractures heal, followed by gradual weight bearing. Various methods of operative treatment were advised by some authors. They reported a higher incidence of residual problems after pelvic disruption such as malunion, hemipelvic undergrowth, low back pain and leg length discrepancy. These authors are of opinion, that principles of treatment should not differ from the treatment of adults if the pelvis is unstable and if there is significant displacement. We describe a case of a vertically unstable pelvic ring injury with sacroiliac joint dislocation and limb length discrepancy in 11 year old boy. Patient was received for treatment 14 days after trauma. He was treated by open reduction from anterior approach and percutaneous screw fixation. In one year follow-up he has very good functional result.

Child↗
PubMed1998

Musculoskeletal pain clinic in Singapore--sacroiliac joint somatic dysfunction as cause of buttock pain.

Buttock pain was a predominant symptom in a series of patients seen with recalcitrant "backache" in the author's pain clinic which has a musculoskeletal emphasis. Assessment suggested the sacroiliac joint as the culprit pain generator and patients underwent confirmatory testing which included fluoroscopy-guided intra-articular injections of lignocaine and steroid along with combined therapeutic modalities of oral analgesics, physical therapy, manual medicine techniques and ergonomic assessments. Two case reports illustrate this condition which is probably under-recognised and inadequately addressed locally.

Adult↗
PubMedDate not supplied

Exercise-related stress reaction of the sacroiliac joint. An unusual cause of low back pain in athletes.

Low back pain, secondary to a variety of musculoskeletal injuries, is common in individuals engaged in athletics. Sports-related stress reactions of the pars interarticularis are not uncommon. Stress reactions of the sacroiliac joint, on the other hand, are considered very rare. The limitations of plain radiographs and the ability of bone scintigraphy to detect stress lesions in athletes is well documented. In this paper we describe four young athletes with stress reactions of the sacroiliac region. We consider these to be uncommon but not rare, and probably self-limiting. Accurate diagnosis is important, however, to exclude more important causes of low back pain that require therapy. This type of injury also results in abnormal stresses to the lower extremities which can result in an independent and more serious injury. All sacroiliac stress reactions were unsuspected and were diagnosed only by bone scintigraphy after plain radiographs were noncontributory.

Adolescent↗