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PubMedDate not supplied

Acute sacroiliitis as a manifestation of calcium pyrophosphate dihydrate crystal deposition disease. A report of two cases.

Whereas radiographic lesions of the sacroiliac joints are common in patients with calcium pyrophosphate deposition crystal disease, they are rarely accompanied with clinical symptoms. We report two cases of acute sacroiliitis probably due to calcium pyrophosphate dihydrate deposition disease. The patients were a 53-year-old man and an 82-year-old woman with chondrocalcinosis in other joints and presence on computed tomography studies of the sacroiliac joints of sclerosis and irregularities of the joint margins with a thin linear calcific deposit within the joint. Both patients recovered fully under therapy with colchicine, analgesics and rest. These two cases suggest that acute sacroiliitis can be caused by calcium pyrophosphate dihydrate crystal deposition disease.

Acute Disease↗
PubMed2000

Imaging of sacroiliitis.

Inflammation of one or both sacroiliac joints is a characteristic feature of patients with spondyloarthropathies (SpA). Sacroiliitis often leads to inflammatory back pain (IBP). IBP and asymmetric peripheral arthritis of the lower limbs are the main clinical symptoms and criteria for classification and diagnosis of SpA in which sacroiliac joints are uni- or bilaterally affected with an intensity ranging from mild to very severe inflammation resulting in partial or complete ankylosis Sacroiliitis is a very frequent feature of undifferntiated SpA. In ankylosing spondylitis (AS) inflammation in the axial skeleton occurs rarely in the absence of sacroiliitis. Objective evidence of sacroiliitis obtained by imaging procedures, especially x-rays, has always been part of diagnostic and classification criteria for AS. This is in contrast to spinal radiography which, however, has been recently included in a core set of outcome items to be assessed in clinical studies. In early and acute stages of sacroiliitis the diagnosis can be difficult because conventional radiographs -- which are known to have considerable intra- and interobserver variability -- may be normal. Since IBP is not a specific indicator of sacroiliitis there is need for valuable imaging techniques. Scintigraphy lacks specificity. Computed tomography (CT) is a very good method to demonstrate already established bony changes and magnetic resonance imaging (MRI) has the advantage of combining a good visualisation of the complicated anatomy of the sacroiliac joint with the ability to localise different degrees of inflammation and oedema and prove a possible spread to muscles as it occurs in septic sacroiliitis, an important differential diagnosis.

Diagnosis, Differential↗
PubMed1997

[Sacroiliitis:the key symptom of spondylarthropathies. 2: morphological aspects].

Because of their curved course and segmental convolution of articular surfaces, the anatomy of the sacroiliac joints is complex. An important part of the diagnosis of sacroiliitis of spondyloarthropathy patients relies on radiographic imaging techniques: x-ray, conventional tomography, computed tomography (CT) and scintigraphy. Diagnosis can be difficult in early and acute stages of sacroiliitis because radiographic findings may be normal, although dynamic magnetic resonance imaging (MRI) of the sacroiliac joints certainly enables to detect chronic as well as acute inflammatory changes. In spondyloarthropathy patients with acute sacroiliitis or acute exacerbation of chronic sacroiliitis who do not respond to or do not tolerate non-steroidal antiinflammatory drugs, CT-guided corticosteroid injection into the sacroiliac joints has proved to be an effective therapy.

Acute Disease↗
PubMed1984

Bilharzial arthropathy.

The joints of 124 young adult patients with bilharziasis were examined. Heels, sacroiliac joints, cervical spine, knee joint, dorsal spine, and tarsal joints were affected. Biopsy of the knee synovia showed synovitis, vasculitis, and the presence of bilharzial ova in three cases. Radiologically the heels and sacroiliac joints showed inflammatory changes. Schistosomiasis may cause an arthropathy.

Adolescent↗
PubMed2006

Interexaminer reliability of three methods of combining test results to determine side of sacral restriction, sacral base position, and innominate bone position.

CONTEXT: Sacroiliac joint dysfunction is diagnosed based on the combined results of several palpatory examinations. Previous studies have compared the interexaminer reliability of only one of these methods of diagnosis. OBJECTIVE: To compare the interexaminer reliability of three methods of combining palpatory examinations to determine the side of sacroiliac joint dysfunction, sacral base position, and innominate bone position. DESIGN: Blinded single-cohort reliability study. METHODS: Patients with low back pain underwent two identical sets of palpatory examinations given by two physicians, separately, at a university spine center. The results of each set were compiled and interpreted by three methods: using the test result with the highest interexaminer reliability (method 1), requiring at least one test result to be abnormal for the variable to be abnormal (method 2), and requiring all test results to be abnormal for the variable to be abnormal (method 3). The kappa was calculated for each method. RESULTS: There were 24 subjects (mean age, 68.3 years), of which 15 (62%) were women. The kappa was consistently higher with method 1, at 0.47, 0.08, and 0.32 for the sacral position, innominate bone position, and side of sacroiliac joint dysfunction, respectively. Corresponding values for method 2 were 0.09, 0.4, and 0.16, and for method 3 were 0.16, 0.1, and -0.33. CONCLUSION: Using the results of the most reliable examination consistently has the best interexaminer reliability.

Aged↗
PubMed1996

Evaluation of new plate designs for symphysis pubis internal fixation.

The purpose of this study was to evaluate and compare biplanar and other newly designed plates used for pubic symphysis internal fixation to other standard plates. Our data demonstrate that neither of the newly designed symphyseal plates, curved (Zimmer four-hole plate with either two or four 4.5-mm cortical screws) nor the biplanar (Zimmer six-hole plate with four 4.5-mm cortical screws in one plane and two 4.5-mm cortical screws in another) significantly reduce motion more than the other plates tested (Synthes two-hole 4.5-mm dynamic compression plate with two 6.5-mm cancellous screws and six-hole 3.5-mm reconstruction plate with four 3.5-mm cortical screws). All of the plate constructs were able to restore motion to nearly that of the intact symphysis pubis and sacroiliac joint. In summary, using the anteroposterior compression disruption pattern and model, the disrupted symphysis does gap under load but has no effect on sacroiliac joint gapping. It does permit increase in relative flexion angles between the wings of the pelvis. All of the plate systems tested restore normal gap motion at the symphysis and normal sacroiliac joint flexion.

Bone Density↗
PubMed2002

Anatomically correct reduction and fixation of a Tile C-1 type unilateral sacroiliac disruption using a rod and pedicle screw system between the S1 vertebra and the ilium: experimental and clinical case report.

We have developed a new surgical technique for the treatment of Tile C-1 type sacroiliac disruption. We tried this procedure first in a cadaveric specimen and then applied it to a clinical case. We used the Texas Scottish Rite Hospital (TSRH) rod and pedicle screw system to insert one screw into the S1 vertebra without using an image intensifier and the other screw into the bone marrow of the ilium from the posterosuperior iliac spine. A straight rod was connected between the two screws by using a manipulator to attempt to reduce and fix the sacroiliac disruption. The combined pubic symphysis diastasis could be simultaneously reduced and fixed by using a plate through another incision, resulting in anatomically correct reconstruction of the pelvic ring. In this procedure, the alignment of the sacroiliac joint can be reversibly and directly changed during reduction and fixation. The sacroiliac joint can be strongly fixed because the screws can be freely inserted into the intact portion of the pelvis and the adjacent lumbar spine, if necessary. Good reduction is obtained because direct compression force is applied to the fracture site. The posterior and anterior procedures can be simultaneously performed under the same lateral position.

Aged↗
PubMed2002

The reliability of multitest regimens with sacroiliac pain provocation tests.

BACKGROUND: Studies concerning the reliability of individual sacroiliac tests have inconsistent results. It has been suggested that the use of a test regimen is a more reliable form of diagnosis than individually performed tests. OBJECTIVE: To assess the interrater reliability of multitest scores by using a regimen of 5 commonly used sacroiliac pain provocation tests. METHODS: Two examiners examined 78 subjects. The threshold for a positive selection was set at 3 positive tests out of 5 tests performed. The test order and the order in which the subjects were examined were randomized per patient, and the examiners were blinded from all information regarding the subjects tested. Fifty-nine of the subjects were symptomatic for low back pain, and 19 of the subjects were asymptomatic. Weighted kappa statistic, bias-adjusted kappa, prevalence-adjusted kappa, and 95% CI intervals were used to evaluate the interrater reliability of the test regimen. RESULTS: Weighted kappa was found to be 0.70 (95% CI = 0.45-0.95). CONCLUSIONS: A multitest regimen of 5 sacroiliac joint pain provocation tests is a reliable method to evaluate sacroiliac joint dysfunction, although further study is needed to assess the validity of this test method.

Adult↗
PubMed2003

Force and time recording for validating the sacroiliac distraction test.

OBJECTIVE: The present aim was to investigate whether applied force and time interval of force exposure during the sacroiliac distraction test could discriminate subjects with sacroiliitis pain from healthy subjects. DESIGN: The study was a methodological one using force plates sensing three orthogonal forces. BACKGROUND: Studies evaluating the validity of sacroiliac joint tests show conflicting results. To our knowledge, no previous studies have evaluated force recording combined with pain reports. METHODS: Eleven subjects with sacroiliitis and 11 healthy subjects were examined with distraction test once by each of three physiotherapists. The subjects indicated any pain by pressing a button giving a mark in the data collection. RESULTS: The magnitude of the total force vector was significantly smaller (P<0.05) and the time interval was significantly shorter (P<0.05) in the sacroiliitis group, although almost 20 s could elapse before pain was provoked. The sensitivity of the test was 0.55 calculated for all physiotherapists involved, and varied between them, range 0.55-0.82. The specificity was 1.0. CONCLUSIONS: The results support the advantage of force and time recording during the distraction test as a technique for evaluating pain. Further investigation is needed on whether the velocity of force application, the ability to maintain the same pressure and the bilateral distribution of force on the sacroiliac joints influence the sensitivity. RELEVANCE: There is a need for objective evaluation methods in manual tests that are easy to perform. Recording force and its time interval may be a step towards standardising pain-provocation sacroiliac joint tests.

Adult↗
PubMed1992

Computed tomography in diagnosis of septic sacroiliitis: report of three cases.

Disorders of the sacroiliac joint are often overlooked during an initial physical examination because the patient is usually in a supine position and the posteriorly located joint is not accessible. Local pain and tenderness at the sacroiliac joint on lateral compression of the pelvis, together with Gaenslen and Fabere maneuvers, may direct the physician's attention to the joint. However, these symptoms are not specific or pathognomonic. Unusual presentation of septic sacroiliitis, which does not show radiologic changes during the early stages, may mimic gluteal, lumbar disc or intra-abdominal syndromes, leading to unnecessary abdominal exploration or lumbar discectomy. Computed tomography (CT), with its superb delineation of osseous, synovial and peri-articular structures, was applied to diagnose septic sacroiliitis in three patients. In Patient 1, septic arthritis and juxta-articular osteomyelitis with sequestrum formation were demonstrated by CT four weeks before abnormalities were shown on a roentgenogram. In Patients 2 and 3, inflammatory processes affected the synovium and peri-articular muscles; thus, abnormalities were shown by CT but not by a roentgenogram. We consider CT to be helpful and superior to conventional radiography in the diagnosis of septic sacroiliitis.

Arthritis, Infectious↗
PubMed2006

Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure?

OBJECTIVE: To measure the failure rate of percutaneous iliosacral screw fixation of vertically unstable pelvic fractures and particularly to test the hypothesis that fixations in which the posterior injury is a vertical fracture of the sacrum are more likely to fail than fixations with dislocations or fracture-dislocations of the sacroiliac joint. DESIGN: Retrospective review. SETTING: Level 1 trauma center. METHODS: All patients with pelvic fractures admitted between January 1, 1993, and December 31, 1998, were identified from the trauma registry. Hospital records were used to identify patients treated with iliosacral screws. Radiologic studies were examined to identify patients who had unequivocally vertically unstable pelvic fractures. Immediate postoperative and follow- up anteroposterior, inlet, and outlet radiographs from a minimum of 12 months postinjury were examined. Position, length, and numbers of iliosacral screws and any evidence of screw failure (eg, bending or breakage) were recorded. Residual postoperative displacement and late displacement of the posterior pelvis were measured. The main outcome measure was failure, defined as at least 1cm of combined vertical displacement of the posterior pelvis compared with immediate postoperative position. The main analysis was for association between fracture pattern and failure. Patient demographic data, iliosacral screw position, and anterior pelvic fixation method also were studied. RESULTS: The study group comprised 62 patients with unequivocally vertically unstable pelvic fractures in whom the posterior injury was treated with closed reduction and percutaneous iliosacral screw fixation. Of patients, 32 had dislocations or fracture-dislocations of the sacroiliac joint, and 30 had vertical fractures of the sacrum. Fixation failed in four patients, all with vertical sacral fractures and all within the first 3 weeks after surgery. These four patients required revision fixation. In two further cases with vertical sacral fractures, there was evidence that the fracture had only barely been held by the fixation, but these fractures healed, and followup radiographs did not meet the displacement criteria for failure. A vertical sacral fracture pattern was associated significantly with failure (Fisher exact test, P = 0.04); the excess risk of failure compared with sacroiliac joint injury was 13% (95% confidence interval 1% to 25%). There was no significant association between failure and anterior fixation method, iliosacral screw arrangement or length, or any demographic or injury variable. CONCLUSIONS: Percutaneous iliosacral screw fixation is a useful technique in the management of vertically unstable pelvic fractures, but a vertical sacral fracture should make the surgeon more wary of fixation failure and loss of reduction.

Acetabulum↗
PubMedDate not supplied

[Arthrography of the iliosacral joint].

We anatomically dissected four pelvic bones without damaging any ligaments, and tried to find a dorsal approach to arthrograph the sacroiliac joint. The joint could not be punctured through its proximal two-thirds: on the one hand, because of its overall angulated orientation, on the other hand, because of the significant overhang of the spina iliaca posterior superior, medially, and the impossibility to make further needle corrections through the very strong ligaments. The only possible approach was situated one finger's width medially to the spina iliaca posterior inferior, with the needle directed laterally at an angle of 20 degrees to the horizontal. Only 0.1-0.2 ml of contrast fluid could be injected. The arthrographic information was reduced to only determining the form of the joint; the state of the cartilage and integrity of the capsule could not be assessed. The best image exposure had to be determined individually and for each case under fluoroscopy, with, unfortunately, a certain level of irradiation. In vivo, the puncture of the lower third of the joint is impossible; the concept of "intraarticular injection of the sacroiliac joint" must be abandoned, as this joint can hardly be punctured dorsally.

Arthrography↗
PubMed2006

Uveitis screening: HLAB27 antigen and ankylosing spondylitis in a New Zealand population.

AIMS: To establish rates of HLAB27-positive uveitis and ankylosing spondylitis in a New Zealand population and to examine characteristics of patients with ankylosing spondylitis that present with uveitis. METHODS: A retrospective audit of 124 consecutive patients presenting to the Acute Eye Clinic at Auckland City Hospital with a diagnosis of either bilateral uveitis or their second episode of uveitis was undertaken. All patients underwent full blood count, erythrocyte sedimentation rate, HLAB27 typing, and radiographs of the sacroiliac joints and lumbar spine. RESULTS: The HLAB27 antigen was detected in 36% of patients undergoing uveitis screening tests. Ankylosing spondylitis was diagnosed on lumbar spine and sacroiliac joint X-ray in 41% of HLAB27-positive patients and in none of the HLAB27-negative patients. No correlation was identified between age at first presentation and diagnosis of ankylosing spondylitis. Ankylosing spondylitis was not associated with elevated white cell count or erythrocyte sedimentation rate. Male gender and detection of the HLAB27 antigen were strongly associated with a diagnosis of ankylosing spondylitis (p<0.001). CONCLUSIONS: Ankylosing spondylitis was detected in 41% of the HLAB27-positive patients and in 0% of the HLAB27-negative patients. Routine lumbar spine and sacroiliac joint X-rays are only recommended for HLAB27-positive patients.

Adolescent↗
PubMed1994

The extended ilioinguinal approach for specific both column fractures.

The surgical approach for exposure of an acetabular fracture is determined by Letournel's fracture classification. Both column fractures typically can be treated through the ilioinguinal approach. If a fracture extends posteriorly to involve the sacroiliac joint or the sciatic buttress, exposure through the ilioinguinal approach can be quite difficult and the extended iliofemoral approach is often recommended. The authors have combined the ilioinguinal and the posterior approach to the sacroiliac joint into one incision termed the extended ilioinguinal approach. Six patients were treated by this approach. The approach allows improved visualization and should prevent some morbidity usually associated with the extended iliofemoral approach. Perfect or near perfect reductions were achieved in all cases. The extended ilioinguinal approach can be useful when treating both column fractures extending posteriorly to involve the sacroiliac joint or the sciatic buttress.

Acetabulum↗
PubMed2001

Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients.

OBJECTIVE: To report the imaging findings in nine patients who developed pelvic instability after bone graft harvest from the posterior aspect of the iliac crest. DESIGN AND PATIENTS: A retrospective study was performed of the imaging studies of nine patients who developed pelvic pain after autologous bone graft was harvested from the posterior aspect of the ilium for spinal arthrodesis. Plain films, bone scans, and CT and MR examinations of the pelvis were reviewed. Pertinent aspects of the clinical history of these patients were noted, including age, gender and clinical symptoms. RESULTS: The age of the patients ranged from 52 to 77 years (average 69 years) and all were women. The bone graft had been derived from the posterior aspect of the iliac crest about the sacroiliac joint. All patients subsequently developed subluxation of the pubic symphysis. Eight patients had additional insufficiency fractures of the iliac crest adjacent to the bone graft donor site, and five patients also revealed subluxation of the sacroiliac joint. Two had insufficiency fractures of the sacrum and one had an additional fracture of the pubic ramus. CONCLUSIONS: Pelvic instability is a potential complication of bone graft harvesting from the posterior aspect of the iliac crest. The pelvic instability is manifested by insufficiency fractures of the ilium and subluxation of the sacroiliac joints and pubic symphysis.

Aged↗
PubMed1992

Sacroiliac sprain: an overlooked cause of back pain.

Since sacroiliac sprain syndrome is not a common disorder, it may be overlooked as a cause of low back pain. Even though the sacroiliac joint is very strong, it can incur painful injury. The diagnosis of sacroiliac sprain syndrome requires more than just tenderness on palpation of the sacroiliac area. Certain maneuvers, such as Patrick's test and the sacroiliac compression test, are useful in establishing the diagnosis. Proper treatment consists of bed rest, heat, nonsteroidal anti-inflammatory drugs and muscle relaxants. Physical therapy and manipulation may also help. In recalcitrant cases, injection of the sacroiliac joint with a corticosteroid and a local anesthetic can be effective.

Adrenal Cortex Hormones↗
PubMed1986

Gas in spinal articulations.

The purpose of this review is to illustrate, some for the first time, a variety of gas collections in lumbar facet joints and intervertebral discs and in the sacroiliac joint.

Arthrography↗
PubMed1999

Ultrasound localization of the ovaries for radiation-induced ovarian ablation.

The case notes and simulator films were reviewed from 70 sequential patients who received pelvic irradiation to induce an early menopause as part of their treatment for breast cancer at the Staffordshire Oncology Centre. These patients underwent ultrasound localization of the ovaries immediately prior to simulation. Altogether, 128 ovaries were plotted on a diagrammatic representation of a gynaecoid pelvis to represent their position in both craniocaudal and lateral dimensions in relation to the true bony pelvis. The craniocaudal ovarian position varied from 2.5 cm above the lower aspect of the sacroiliac joint to 2.0 cm above the symphysis pubis. Three (4.6%) right sided ovaries were within 1 cm medial to the right lateral side wall, with none lying lateral to the wall. Seventeen (26%) left sided ovaries were lying within 1 cm of the left pelvic side wall, with four of these lying outside. The limits of the pelvic fields used were from the top of the sacroiliac joint to the bottom of the symphysis pubis. Sixty-one (88%) upper borders were on or above the lower sacroiliac joint. Twenty-six (38%) and 49 (71%) fields were outside the right and left pelvic side walls respectively. This would suggest that field sizes were larger than standard; however, 87% were smaller than 150 cm(2) (assuming a 10x15-cm field as standard). Only one patient failed to respond to treatment. This was thought to be due to underdosing rather than a geographical miss. This patient was successfully retreated. The authors advocate the use of ultrasound localization prior to planning an irradiation menopause, to ensure that the ovaries are encompassed in the pelvic field, thus preventing a geographical miss and reducing field sizes.

Adult↗