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PubMed1999

Osseous spinal pathology.

Pathologic changes have been observed at the spinous processes, intervertebral articulations, and sacroiliac joints in horses. Varying severity of degenerative articular changes are found in many articular processes, intertransverse, lumbosacral, and sacroiliac joints. Pathologic lesions tend to affect multiple vertebral locations within a specimen. Further studies need to be conducted to evaluate the clinical significance of the numerous vertebral and pelvic pathologic findings found in a sample of Thoroughbred racehorses that died because of unrelated injuries. Increased knowledge of osseous pathology inherent in equine athletes will enhance our understanding of the etiopathogenesis of spinal disorders and back pain in horses.

Animals↗
PubMed2006

[Clinical staging of ankylosing spondylitis].

OBJECTIVE: To compare the chronic changes between the sacroiliac joints (SIJ) and the spine or the hip joints in conventional radiography of patients with ankylosing spondylitis (AS) and discuss the clinical staging of this disease. METHODS: All images of the joints of the AS patients were evaluated twice in blinded manner by two doctors. The cervical spine, lumbar spine, sacroiliac joints and hip joints were separately evaluated by BASRI, and the results were averaged and analyzed. Definite involvement was defined as a score > or=2. RESULTS: Thirty-seven AS patients (81.0% male with mean age of 28.49 years) were examined, and 81.0% of them had definite involvement of the spine and 40.5% of hip involvement. Pearson product-moment correlation coefficient was 0.459 between BASRI-SIJ and BASRI-s, and 0.465 between BASRI-SIJ and BASRI-h. CONCLUSION: Separately, the severity of SIJ changes can not represent the severity of changes in the spine and hip, etc, therefore SIJ changes may not be sufficient evidence for AS staging.

Adolescent↗
PubMed1982

CT of acetabular fractures: comparison with conventional radiography.

Computed tomography (CT) and plain radiography of the pelvis were compared in 26 adult patients in whom acetabular fractures or posterior femoral head dislocations were demonstrated or suspected on initial radiographs. The detection of abnormalities of the sacrum, sacroiliac joint, iliac wing, acetabular roof, joint space, anterior pelvic column, posterior pelvic column, posterior acetabular lip, pubic rami, and quadrilateral surface of the ilium by the two methods was compared. The ability of the two techniques to establish the stable fragment was also examined. Three independent readings of each examination for each pelvic region were tabulated, and sensitivity and specificity values were calculated. There was no significant difference between plain radiography and computed tomography in detection of fractures of the iliac wing, anterior pelvic column, posterior pelvic column, and the pubic rami, with high sensitivity and specificity for both examinations. CT was more sensitive than plain radiography in detecting fractures involving the sacrum, quadrilateral surface, acetabular roof, and posterior acetabular lip. In addition, abnormalities of the hip joint space, principally loose bone fragments, were detected more often by CT. Sensitivity of both examinations for abnormalities of the sacroiliac joint was relatively poor, but examinations were highly specific. Determination of the stable fracture fragment(s) was readily accomplished by CT scanning in all 26 patients; in five patients incorrect determinations were made with conventional radiographs alone.

Acetabulum↗
PubMed2000

Functional outcome of open reduction and internal fixation of pelvic ring injuries.

Between January 1996 and August 1998, 15 patients with pelvic ring injuries were treated by open reduction and internal fixation. Fractures types included Tile A1 (7%), B1 (33%), C1 (53%) and C3 (7%). The patients were observed for an average of 1 year (range: 5 to 21 months). Thirteen patients (87%) who were operated within 3 weeks after injury had their pelvic disruption healed. One patient with Tile C1 and non-union of the fracture dislocation of sacroiliac joint was operated 11 months after injury and developed implant failure and non-union of the fracture dislocation of sacroiliac joint. Another patient with Tile C1 injury with transforamina sacral fracture was fixed anteriorly only and developed non-union of the sacral fracture and redisplacement of pelvic disruption. Both of them had a poor functional outcome. A 40 points pelvic outcome grading scale (Cole et al 1996) based on physical examination, pain, radiographic analysis and activity/work status was used. Six patients (40%) (1 Tile A1, 5 Tile B1) had an excellent functional outcome. Seven patients (47%) (6 Tile C1, 1 Tile C3) had a good functional outcome.

Adolescent↗
PubMed2005

Utilization of iliac screws and structural interbody grafting for revision spondylolisthesis surgery.

STUDY DESIGN: Retrospective case analysis and presentation. OBJECTIVES: The purpose of this article is to discuss the spectrum of failed spondylolisthesis cases for which either anterior column support or iliac screw fixation or both are useful in salvaging failed spondylolisthesis surgeries. SUMMARY OF BACKGROUND DATA: Past studies and experience have suggested that there is a relatively high rate of sacral screw failure both in long constructs to the sacrum in the adult population and also with treatment of both high-grade and adult spondylolisthesis at L5-S1. It has been noted that anterior column support at L5-S1 and additional fixation points in the sacropelvic unit provide some protection to the sacral screws. METHODS: This article details the author's personal and institutional experience with sacropelvic fixation and anterior column support at L5-S1 to salvage failed spondylolisthesis cases. RESULTS: To some extent, each case needs to be individualized. It is not always necessary to provide both anterior column support at L5-S1 and protection of the sacral screws with iliac screws. However, in the most complex problems using both seems to provide the greatest chance for an acceptable radiographic and clinical outcome. Most biomechanical studies have supported the use of anterior column support and iliac fixation to protect sacral screws, suggesting, of the two, that the iliac screws are more valuable. CONCLUSIONS: For many of these cases of both high-grade dysplastic spondylolisthesis and low-grade adult isthmic spondylolisthesis, a reasonable combination of anterior column support and/or iliac screw fixation may be logical to reduce the incidence of failure and need for revision. The biggest concern with using iliac screw fixation is that these screws are prominent in a percentage of patients and the ultimate impact on the sacroiliac joint is not fully investigated. However, at our institution with 5- to 10-year follow-up, the impact on the sacroiliac joint has been minimal.

Adult↗
PubMed1992

[The "in situ" treatment of ureteral calculi with extracorporeal lithotripsy].

The authors report on 80 cases of ureteral calculi treated with in situ extracorporeal shock wave (ESWL), with no retrograde or antegrade maneuvers. Success rate was high (97.5%). Forty-two calculi were located in the proximal ureter above the sacroiliac joint; 10 were in the pre-sacral ureter, and 28 in the pelvic ureter, below the inferior border of the sacroiliac joint. After ESWL, double-J stents were positioned in 5 patients and nephrostomy was performed in 4 cases with positioning of 7-F pig-tail catheters; 8 patients (10%) underwent additional post-lithotripsy urologic and radiologic examinations. Lithotripsy having failed in 2 patients (2.5%), surgery with ureterolithotomy was performed. In situ ESWL of ureteral calculi emerges from this trial as the treatment of choice and not as an alternative to urologic maneuvers or open surgery with ureterolithotomy: the latter methods are necessary only after ESWL failure.

Adult↗
PubMedDate not supplied

Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management.

Local spinal pain and radiculopathy are common conditions that debilitate millions of Americans annually. Most cases are successfully treated conservatively with rest or physical therapy. Chiropractic manipulation or, in some cases, surgery may also be performed. Percutaneous injection has been used for spinal pain management for many years, but many of these procedures have historically been performed without imaging guidance. Recently, however, newer minimally invasive, imaging-guided percutaneous techniques have been added to the list of available treatment options for spinal pain. Imaging-guided techniques with fluoroscopy or computed tomography increase the precision of these procedures and help confirm needle placement. Cervical, thoracic, lumbosacral, and sacroiliac pain can be evaluated and treated safely and effectively with injections of local anesthetics or long-acting steroids into facet joints, sacroiliac joints, selective nerve roots, spondylolytic areas, and the epidural space. Because imaging-guided techniques appear to provide better results and reduce complication rates, they are becoming more popular despite controversy regarding their effectiveness. Controversy will continue to surround these imaging-guided techniques until large, double-blinded studies become available. In the meantime, there is an increased demand for these procedures from referring physicians, and it is important to be able to safely perform them with a minimum of patient discomfort.

Anesthetics, Local↗
PubMed2000

Sacral stress fractures in long-distance runners.

OBJECTIVE: Sacral stress fractures in athletes are rare but important to recognize because the symptoms often mimic sciatica and can lead to delay in diagnosis and treatment. The radiographic findings are characteristic and can facilitate early diagnosis and lead to appropriate treatment. CONCLUSION: The clinical presentation of runners with sacral stress fractures can mimic disk disease. However, stress fractures in athletes, especially long-distance runners, must be treated differently. The imaging characteristics appear as linear abnormal signal intensity paralleling the sacroiliac joint on MR imaging and linear sclerosis with cortical disruption on CT. Imaging with bone scintigraphy shows increased uptake that parallels the sacroiliac joint.

Adolescent↗
PubMedDate not supplied

[Diffuse idiopathic skeletal hyperostosis of the cervical spine in a patient with ankylosing spondylitis. Description of a personal case].

Diffuse idiopathic skeletal hyperostosis (DISH) is a well-described disorder of middle-aged people, with a unique spinal pathology characterized by calcification and ossification of the antero-lateral aspect of at least four contiguous vertebral bodies, with the sparing of intervertebral spaces and sacroiliac joints. DISH has rarely been reported associated with ankylosing spondylitis (AS), a chronic inflammatory articular disease most commonly involving the spine and sacroiliac joints. A 63-year-old man with clinical and radiological findings of DISH with associated AS is described here. The authors conclude that these two diseases may, albeit rarely, coexist.

Cervical Vertebrae↗
PubMed1998

Inflammatory arthritis in large cats: an expanded spectrum of spondyloarthropathy.

Spondyloarthropathy was documented for the first time in 14 (3.7%) of 386 large cats, affecting eight species belonging to three genera. The limited distribution of joint erosions, associated with spine and sacroiliac joint pathology, was indistinguishable from that occurring in humans with spondyloarthropathy of the reactive type. This form of inflammatory arthritis is almost twice as common as osteoarthritis (for felids as a whole), and animal well-being may be enhanced by its recognition and by initiation of specific treatment.

Acinonyx↗
PubMed1978

[Arthropathy of sacro-iliac joints in psoriasis (author's transl)].

Roentgenographic studies of the sacroiliac joints were carried out in 117 psoriatic patients with associated symptoms of joint and/or bone involvement and in eleven psoriatic patients without signs of bone or joint disease. In all patients arthritis of the sacro-iliac joints with varying degree of severity was demonstrated. The sacro-iliac joint space remained open in patients without associated rheumatoid arthritis or ankylosing spondylarthritis. It was shown that the described method in the assessment of the sacro-iliac joints is fully justified.

Adult↗
PubMed1978

The sacral tubercle--a cause for hot spots on bone scan.

The sacral tubercle, S1 posterior spinous process, can appear as intense as the sacroiliac joints on posterior bone scan in 4% of normal adult male patients. Due to sexual differences in anatomy, the scan appearance of the sacrum can cause false-positive readings. The converse, false-negative readings, can occur if the sacral intensity is taken as a constant when comparing ratios of sacroiliac joint intensities and sacral intensities on bone scans of patients with sacroiliac disease. This study demonstrates the normal anatomy of the sacrum and presents a sequence of tests to diagnose disease in the sacrum.

Adolescent↗
PubMed1998

Radiologic diagnosis and pathology of the spondyloarthropathies.

Five different subtypes of spondyloarthropathy (SpA) are now recognized. Clinical and radiologic involvement of the sacroiliac joint is an outstanding feature of the SpA, especially ankylosing spondylitis (AS). In this partly debilitating form of SpA a unique type of inflammatory axial involvement is observed which is characterized by inflammation and new bone formation at different spinal sites. In longstanding disease sacroiliitis, spondylitis and spondylodiscitis are easily recognized by conventional radiography and even better by computed tomography--especially when bony changes have already taken place. The advantage of dynamic magnetic resonance imaging (MRI) is to visualize morphologic changes and inflammation at the same time. This facilitates detection of sacroiliitis and spondylitis/spondylodiscitis at early time points. Hopefully, this will lead to other forms of therapy to prevent ankylosis of the spine. The origin of the granulation tissue infiltrating cartilage and bone in AS might be the synovium, the subchondrium or the bone marrow itself. T cells and macrophages seem to play an important role in this inflammatory process in which TNF-alpha is present in severe cases. The mechanisms responsible for the increased bone formation observed in the course of AS are unknown.

Animals↗
PubMed1991

New clinical and radiographic features of the seronegative spondyloarthropathies.

This article reviews new data supporting the hypothesis that the clinical spectrum of the seronegative spondyloarthropathies is wider than previously realized. It describes the literature in general and specific reports on the prevalence and clinical features of seronegative spondyloarthropathies in a number of different populations from America and Asia. Undifferentiated or unclassified spondyloarthropathies are now recognized more frequently. There is an extensive analysis of new proposals for nomenclature and criteria for classification that need to be validated. The normal appearance and biomechanics of the sacroiliac joints as well as new imaging techniques to approach them in several diseases are also discussed. Clinical, radiographic, and histopathologic findings in spinal disease and further observations on gut inflammation and intestinal permeability are also presented here. A long list of clinical associations of the seronegative spondyloarthropathies is also given.

Humans↗
PubMed1990

In situ lithotripsy of ureteral calculi: review of 261 cases.

The authors report 261 cases of single ureteral calculi treated with in situ lithotripsy after retrograde manipulations had failed. Previous reports have indicated that extracorporeal lithotripsy of impacted ureteral calculi has not been highly successful. Two hundred five of the calculi were located in the proximal ureter, above the sacroiliac joint; 27 were in the presacral ureter, overlying the bony pelvis; and 29 were in the juxtavesicular ureter, below the inferior border of the sacroiliac joint. Retrograde ureteral catheters were in place during lithotripsy for 215 calculi. Two hundred fifty-four (97%) calculi were successfully treated with lithotripsy and, when necessary, with additional postlithotripsy radiologic and urologic interventions. Seven (3%) calculi were not successfully fragmented. Nephrostomy was performed in 13 (5%) patients. Retrograde ureteral catheters were not found to enhance calculus fragmentation. In situ lithotripsy of ureteral calculi has been shown to be feasible as an alternative to ureterolithotomy when retrograde manipulation has failed.

Follow-Up Studies↗
PubMed2006

Pelvic bone complications following radiation therapy of gynecologic malignancies: clinical evaluation of radiation-induced pelvic insufficiency fractures.

OBJECTIVE: To investigate the incidence, clinical and imaging finding of insufficiency fractures (IF) of the female pelvis following radiation therapy. METHODS: We reviewed the radiation oncology records of 158 patients with gynecologic malignancies who underwent external beam radiation therapy of the whole pelvis between April 1993 and March 2004. All patients underwent computed tomography (CT) scan every 6 months in follow-up after radiation therapy and magnetic resonance imaging (MRI) and radionuclide bone scan were added when the patients complained of a pelvic pain. RESULTS: Eighteen of 158 patients (11.4%) developed IF in the irradiated field with a median interval of 6 months (range 3-51) from the completion of external beam radiation therapy. The cumulative incidence of symptomatic IF at 5 years calculated with Kaplan-Meyer methods was 13%. Median age of the patients who developed IF was 70 years (range 48-88), and all of them were postmenopausal. IF occurred in the sacloiliac joints, upper limb of pubic bone, acetabulum, sacral body and 5th lumbar vertebra. Twelve of 18 patients had multiple lesions and 8 had symmetric longitudinal fracture lines parallel to the sacroiliac joints. Avoidance of weight bearing by bed rest and analgesics provided good pain relief in all patients, although symptoms lasted from 3 to 20 months. CONCLUSIONS: Radiation-induced pelvic IF following radiation therapy for gynecologic malignancies were frequently observed in the postmenopausal patients within 1 year after external beam radiation therapy. Symmetric fractures of the both sacroiliac joints were the characteristic pattern of pelvic IF. Knowledge of characteristic imaging pattern of IF is essential in order to rule out the bone metastasis. Therapy recommendations are conservative with analgesics.

Aged↗
PubMed2004

Lumbosacral transitional vertebral articulation: evaluation by planar and SPECT bone scintigraphy.

It has been suggested that low back pain (LBP) may arise from lumbosacral transitional vertebral articulation (LSTVA) itself. It is known that bone scintigraphy is a valuable tool for the recognition of pain arising from bone and articular diseases. Therefore we aimed to show planar and SPECT bone scintigraphic findings of LSTVA and compare them with the LBP and X-ray findings. Twenty-eight patients (aged 20-63 years) in whom LSTVA had been identified radiographically were evaluated with planar bone scintigraphy, utilizing 99mTc methylene diphosphonate; and single photon emission computed tomography (SPECT) bone scintigraphy. Eighteen patients had LBP whereas 10 had not. There were 25 type IIA, one type IIB and two type IIIA LSTV articulation. On planar images, normal or non-focal minimally increased uptake superimposed on the upper sacroiliac joint was seen in patients without degenerative changes regardless of LBP whereas SPECT showed non-focal mild increased uptake on the area medial to the upper sacroiliac joint. Planar scans showed normal to non-focal mild, and mild-to-moderately increased uptake whereas SPECT demonstrated focal mild-to-moderately and markedly increased uptake in patients with degenerative changes without LBP and with LBP, respectively. The X-ray results showed an association of LBP degenerative changes, and the SPECT results showed a focal, markedly increased, uptake. We conclude that this focal, markedly increased, uptake may show the metabolically active degenerative changes of LSTV articulation and may help to reveal the pain arising from LSTVA. Therefore we propose that bone scintigraphy may be considered for the evaluation of patients with LBP thought to arise from LSTV articulation.

Adult↗
PubMedDate not supplied

The sacrum: pathologic spectrum, multimodality imaging, and subspecialty approach.

The sacrum is a structure that is imaged by both general and subspecialty radiologists. A wide variety of disease processes can involve the sacrum either focally or as part of a systemic process. Plain radiographs, although limited in evaluation of the sacrum, should be carefully examined when abnormalities of the sacrum are suspected. Cross-sectional imaging, particularly computed tomography and magnetic resonance (MR) imaging, plays a crucial role in identification, localization, and characterization of sacral lesions. Congenital lesions of the sacrum, including sacral agenesis and meningocele, are optimally imaged with MR. The most common sacral neoplasm is metastatic disease. Primary neoplasms of the sacrum, which include giant cell tumor, chordoma, and teratoma, are infrequent. Infection of the sacrum or sacroiliac joint is most often due to contiguous spread from a suppurative focus. A wide variety of arthritic disorders such as ankylosing spondylitis and osteoarthritis can involve the sacroiliac joints as part of a localized or systemic process. Sacral fractures related to acute trauma or repetitive stress are difficult to diagnose and treat. Knowledge of these abnormalities and familiarity with the imaging of these processes will allow radiologists of all subspecialties to contribute to the diagnosis and management of sacral disorders.

Diagnosis, Differential↗