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At least 721 records · Page 40Linked to original sources
PubMed1985

Ventrolateral approach for repair of sacroiliac fracture-dislocation in the dog and cat.

A ventrolateral approach to the sacroiliac joint is described as an alternative to the dorsolateral approach for the repair of sacroiliac dislocations and sacral wing fractures. The technique described here usually is performed blindly with digital palpation; however, the approach may be extended craniodorsally, allowing direct visualization of the sacroiliac joint. This technique facilitates reduction and stable fixation, with good purchase of the implants in the sacrum, for the repair of sacroiliac fracture-dislocation. This method of repair was used on 20 patients, with good to excellent clinical results.

Animals↗
PubMed1999

A biomechanical model on muscle forces in the transfer of spinal load to the pelvis and legs.

Based on musculoskeletal anatomy of the lower back, abdominal wall, pelvis and upper legs, a biomechanical model has been developed on forces in the load transfer through the pelvis. The aim of this model is to obtain a tool for analyzing the relations between forces in muscles, ligaments and joints in the transfer of gravitational and external load from the upper body via the sacroiliac joints to the legs in normal situations and pathology. The study of the relation between muscle coordination patterns and forces in pelvic structures, in particular the sacroiliac joints, is relevant for a better understanding of the aetiology of low back pain and pelvic pain. The model comprises 94 muscle parts, 6 ligaments and 6 joints. It enables the calculation of forces in pelvic structures in various postures. The calculations are based on a linear/non-linear optimization scheme. To gain a better understanding of the function of individual muscles and ligaments, deviant properties of these structures can be preset. The model is validated by comparing calculations with EMG data from the literature. For agonistic muscles, good agreement is found between model calculations and EMG data. Antagonistic muscle activity is underestimated by the model. Imposed activity of modelled antagonistic muscles has a minor effect on the mutual proportions of agonistic muscle activities. Simulation of asymmetric muscle weakness shows higher activity of especially abdominal muscles.

Abdominal Muscles↗
PubMed1989

[Diagnostic potentials of quantitative bone scintigraphy in spondylitis ankylopoietica: a comparison with x-ray findings].

In 576 patients quantitative scintigraphy of the sacroiliac joints and the spinal cord with 99mTc-Pyrophosphate was performed. 328 were patients with proven ankylosing spondylitis according to the New-York criteria. 120 were patients with a clinically and roentgenologically suspected ankylosing spondylitis and 128 persons formed a healthy control group. The count rate in small regions of interest (ROI) in the sacroiliac joints, the spinal cord and the os sacrum were compared on the basis of indexes. The scintigraphic data of patients with ankylosing spondylitis were compared with healthy control group and with the radiographic findings and radiologic staging of the disease: In a longitudinal follow-up study during 1 to 6 years these investigations were continued together with clinical and roentgenological checks. Quantitative bone scintigraphy provides characteristic indexes for ankylosing spondylitis, indicating the increased mineral metabolism of the sacroiliac joints and the spinal chord. Skeletal scintigraphy is recommended for early detection and monitoring of ankylosing spondylitis.

Diphosphates↗
PubMed2000

Spinal epidural abscess following blunt pelvic trauma.

A 17-year-old patient with pre-existing grade II spondylolisthesis of L5/S1 sustained a partial disruption of the left sacroiliac joint with haematoma of the iliac muscle after a fall. The haematoma probably led to occlusion of the left ureter, resulting in a urinary tract infection. After initial conservative treatment the patient developed fever and radicular pain of the left leg. Magnetic resonance imaging (MRI) revealed a left-sided epidural abscess at L5/S1, which had probably spread from the infected iliac haematoma along the injured sacroiliac joint. Prompt surgical drainage and antibiotic coverage with cefuroxime and flucloxacillin led to rapid clinical improvement. Staphylococcus aureus was identified as the pathogen. At follow-up 6 months postoperatively all symptoms had resolved, while MRI still revealed residual osseous oedema of the sacroiliac joint. The haematoma of the iliac muscle resolved without surgical intervention.

Accidental Falls↗
PubMed1990

An epidemiologic study of sacroiliac fusion in some human skeletal remains.

A case-control study was undertaken to generate some hypotheses concerning the etiology of sacroiliac fusion in a group of skeletons dating from the 18th and 19th centuries. Forty-one skeletons with fusion of the sacroiliac joint were compared with eighty-two adult skeletons without the condition. The sacroiliac joints were most frequently fused with bridging osteophytes and no preference for site or side of fusion could be detected. Except where there were other features in the skeleton suggestive of a sero-negative arthropathy, radiography demonstrated that there was no intra-articular ankylosis. We were able to confirm earlier observations that the condition is more prevalent in males and in older age-groups. The study also showed a significant association between sacroiliac fusion and the presence of diffuse idiopathic skeletal hyperostosis (DISH) and osteoarthritis of the spine but not for osteoarthritis at any other site. There was a highly significant association between sacroiliac fusion and the phenomenon that we refer to as "bone forming." We devised a series of bone-former scores and were able to show a significant excess of cases with high scores compared with the controls. This association persisted when allowance had been made for potential confounding factors such as DISH, osteoarthritis of the spine, and age.

Age Factors↗
PubMed1997

Managing Back Pain During Pregnancy.

The incidence of low-back pain during pregnancy is thought to be about 50%. It occurs most commonly after the sixth month and can last until the sixth month postpartum. The major predictors are back pain prior to pregnancy and multiparity. Several biomechanical and physiologic changes during pregnancy contribute to back pain. As the woman's abdominal muscles are stretched and tone is diminished, they lose their ability to contribute to neutral posture. During pregnancy, production of the hormone relaxin increases ten-fold. The hormone creates joint laxity, which not only allows the pelvis to accommodate the enlarging uterus, but also weakens the ability of static supports in the lumbar spine to withstand shearing forces. In the pelvis, joint laxity is most prominent in the symphysis pubis and the sacroiliac joints. On physical exam, neither lumbar nor sacroiliac back pain is generally associated with any evidence of neurologic deficit or hip pathology. In cases of lumbar back pain, the physical exam will be most consistent with discogenic pain and/or facet element pain. Therefore, a pregnant woman's pain may be most pronounced on flexion and standing. Among the tests that can be used to evaluate lower-back pain are the posterior pelvic provocation test; ventral gapping test; dorsal gapping test; sacroiliac joint fixation test; Patrick's test, or FABERE's maneuver (flexion, abduction, external rotation, and extension); and Derbolowski's test. The most common types of back pain during pregnancy are lumbar pain, sacroiliac pain, and nocturnal back pain.

Journal Article↗
PubMed1991

[Pitfalls in the diagnosis of tuberculous arthritis].

Jewish immigrants from Russia, and Arabs added to the population register since 1967, have a relatively high incidence of bone and joint tuberculosis. These patients now account for most of this disease in Israel. Skeletal tuberculosis imitates various joint conditions, most commonly, rheumatoid arthritis, and therefore presents a diagnostic problem. Injections of corticosteroids and/or immunosuppressive therapy can reactivate quiescent tuberculous lesions. During a 12-year period 14 patients with tuberculous arthritis involving 16 joints were seen in this hospital. They included 9 males and 5 females, 14-70 years old, 4 of whom were known to have had previous skeletal tuberculosis: 3 had spinal and 1 had hip involvement. None of the other 10 had a clinical history of tuberculosis, nor X-ray evidence of active pulmonary disease. 7 patients were diagnosed postoperatively as having joint tuberculosis on histopathological and bacteriological examination; 3 had positive cultures from joint aspirations. Most commonly involved were the spine and knee--4 cases of each. The wrist and acromioclavicular joint were affected in 2 cases each, and the hip, sacroiliac joint, ankle and elbow joints in 1 case each. The youngest patient, 14 years old, had triple-joint involvement of the wrist and the acromioclavicular and sacroiliac joints; the others had single-joint disease. In 1 patient the disease was reactivated after 36 years by surgical conversion of a fused hip to a mobile artificial joint. 3, whose joints were injected with corticosteroids, developed active, destructive tuberculous arthritis. A patient with rheumatoid arthritis who underwent total knee replacement was found to have active tuberculous arthritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

Sacroiliitis detected by bone scintiscanning: a clinical, radiological, and scintigraphic follow-up study.

Twenty-four patients had abnormal sacroiliac joints detected by quantitative sacroiliac scintigraphy but no radiological evidence of sacroiliitis on original investigation. We studied them again after intervals of 12 to 36 months. Four patients developed radiological change. Two young, HLA B27-positive men had undoubted ankylosing spondylitis, and a young woman had possible ankylosing spondylitis. A middle-aged man had changes that could be attributed to post-traumatic osteoarthrosis. Of the remaining 20 cases 15 had symptoms and signs suggestive of inflammatory disease of the axial skeleton (and peripheral arthropathy in 5 cases). The sexes were affected equally (8 females, 7 males), and only 2 of the 15 were B27-positive. The response to anti-inflammatory medication was generally good to excellent, and scintiscans tended to improve. Of the remaining 5 patients, 3 had mechanical or traumatic problems, and in 2 there was no explanation for the abnormal sacroiliac scintiscan. We conclude that quantitative sacroiliac scintigraphy may detect ankylosing spondylitis prior to the develpment of radiological change and that it can identify an organic basis for backache in patients with a spondylitis-like syndrome. The clinical circumstances must be taken into account, as scintigraphic abnormalities are not diagnostic of any specific disease entity.

Adult↗
PubMed1975

Reiter's disease in a female, presenting as erythema nodosum.

The case history of a female who presented with erythema nodosum is described, and the diagnosis of Reiter's disease is proposed. Reference is made to literature on Reiter's disease in the female and to sacroiliac joint abnormalities which have been observed in this condition.

Adult↗
PubMed1987

Spondyloarthropathies.

This paper reviews the radiologic features of disorders involving the spine and sacroiliac joints. Analysis is divided into conditions involving the sacroiliac joints, disorders producing bony bridging in the spine, and disorders producing focal vertebral destruction. Conditions discussed include the seronegative spondyloarthropathies, degenerative disorders, infections, and DISH.

Arthritis↗
PubMed2005

An assessment of back pain and the prevalence of sacroiliitis in sarcoidosis.

OBJECTIVES: Sarcoidosis is a chronic granulomatous multisystem disease in which arthritis is relatively common. Arthritis of the sacroiliac joints (sacroiliitis) has been described in sarcoidosis but is thought to be rare. The objective of this study was to determine the prevalence of sacroiliitis in a secondary-care population of patients with sarcoidosis. METHODS: Patients attending a specialist secondary-care sarcoidosis clinic underwent evaluation of spinal symptoms using a standard back pain questionnaire, examination of spinal mobility, and laboratory measurements of erythrocyte sedimentation rate, C-reactive protein, serum angiotensin-converting enzyme, and neopterin/creatinine ratio. Tissue typing for the presence of the human leukocyte antigen (HLA)-B27 allele was undertaken. Radiographs of the sacroiliac joints were obtained in each patient and reviewed independently by two observers; a further observer reviewed disputed radiographs. RESULTS: Sixty-one patients completed the assessments (80.3% of all patients invited to participate). Forty-nine of 61 patients (80.3%) reported having back pain at some point in their lives. Thirty-one of 61 patients (50.8%) had a score on the back pain questionnaire suggestive of inflammatory spinal disease, but only 3 of these patients had erosive damage of the sacroiliac joints on radiography indicating sacroiliitis. One further patient had erosive damage on radiography, making a total of four individuals with evidence of sacroiliitis, a prevalence of 6.6%. Four patients (one patient with sacroiliitis) were positive for HLA-B27. The back pain questionnaire had a sensitivity of 75% and a specificity of 51% for sacroiliitis in this population. CONCLUSION: The prevalence of spondyloarthropathy in the normal population has been estimated to be 1.9%. In the sarcoid population studied the prevalence was 6.6% suggesting a possible association between these two conditions. The standard back pain questionnaire for the identification of inflammatory spinal disease had a low sensitivity and specificity in this population.

Arthritis↗
PubMed1988

Quantifying the effects of spinal manipulations on gait using patients with low back pain.

The purpose for conducting this study was to investigate the effects of chiropractic treatment on the gait of a group of subjects with sacroiliac joint syndromes. The clinical results suggest that chiropractic treatments reduce pain, increase mobility of the sacroiliac joint, and restore general functional ability of the patient. Force results obtained by using a force platform during gait of the subjects showed that external forces were significantly different for gait trials executed after chiropractic treatment compared to gait trials executed before chiropractic treatment. Force results were also significantly different for gait trials executed early in the rehabilitation process compared to those executed late in the rehabilitation process. It should now be investigated if and how these changes in external forces influence the internal forces acting on low back structures. Such an investigation may provide further insight into the mechanisms underlying low back problems.

Back Pain↗
PubMed1991

[Radiological assessment of ankylosing spondylitis].

This review presents the radiologic evaluation of AS as well as the radiologic appearances of the disease. The presentation is limited to radiologic changes of the sacroiliac joints and the lumbar spine. Conventional radiography and CT are used for the evaluation of the sacroiliac joints and in the lumbar spine conventional lateral tomography is used in addition to conventional radiography. Radioisotope scanning plays a limited role in the evaluation of AS. The diagnostic value and future potentials of MR imaging await further study.

Humans↗
PubMed1983

[Acute pyogenic sacroiliac arthritis in children].

Three children with pyogenic arthritis of the sacroiliac joints are presented. A study of the literature shows that this condition, although not well known, is not uncommon in childhood. Clinical features and particularly physical examination of the sacroiliac joints are described. They should lead to suspect sacroiliac disease. Radioisotope bone scanning is of great help as it substantially reduces the delay in correct diagnosis. Antibiotic treatment is usually sufficient for adequate management of pyogenic sacroiliitis. The intravenous route for antibiotic administration is not mandatory.

Acute Disease↗
PubMed2003

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 follow-up 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.

Adolescent↗
PubMed1998

Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis.

OBJECTIVE: To compare magnetic resonance (MR) imaging, computed tomography (CT), and radiography in the detection of sacroiliitis accompanying ankylosing spondylitis (AS). DESIGN AND SUBJECTS: Nine volunteers and 24 patients were recruited. Radiography, CT, and MR imaging were completed within a 1-week period in 24 patients with AS. In precontrast MR examination, spin-echo T1, fast spin-echo T2, and gradient echo with rephasing T2* images were obtained without fat saturation using a 0.3-T imager for all volunteers and patients. Postcontrast MR examination was performed using the same precontrast SE T1 sequence for patients with AS. RESULTS AND CONCLUSIONS: MR imaging directly showed the normal cartilage in all 16 sacroiliac joints of the 8 volunteers. In the 24 patients with AS, cartilage abnormalities were observed in 42 sacroiliac joints. More diagnoses of sacroiliitis were made using MR and CT imaging than using radiography (P < 0.001). Therefore, low-field-strength MR can be useful in detecting early sacroiliitis in patients with AS. MR imaging was able to reveal early cartilage changes and bone marrow edema, which could not be found by either CT or radiography.

Adolescent↗