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PubMed1986

[Diagnosis of inflammatory sacroiliitis. Comparison of complementary examinations].

In order to test the sensitivity of different techniques in the diagnosis of sacroiliitis, we have made a prospective and non-controlled study of 22 patients using standard radiography of the sacroiliac joint; conventional tomography and axial scintigraphy (calculation of an ISI sacroiliac index). The normal upper limit of the sacroiliac index (1.42) was studied in parallel, using a group of 63 control subjects. Correlation between the radiological examinations was average, but was very poor between radiology and scintigraphy. Conventional tomography and calculation of the sacroiliac index were of equal value diagnostically. Clear images of juxta-articular geodes were seen during scanning, but were not taken into account in the diagnosis. They may represent the onset of larger erosions and need to be verified.

Adolescent↗

PubMed1979

Bilateral sacroilac dislocations in an adolescent. A case report.

This is a case report of a 15-year-old female who sustained bilateral closed sacroiliac dislocations. She was successfully treated with bilateral skeletal traction and manual closed reduction. The sacroiliac joints redislocated partially despite further traction. Reduction by traction and pelvic sling was then recovered and further displacement was prevented. She regained full range of motion of her hips. This is an uncommon injury produced only by severe trauma.

Adolescent↗

PubMed1994

Anatomic consideration in the anterior approach to the sacro-iliac joint.

Anatomical study of L4 nerve branch, L5 nerve root, and bony stock in the sacroiliac region was performed in cadaveric specimens to provide anatomical references for anterior fixation of the sacroiliac joint. At 1 cm intervals along the sacro-iliac joint, the distance to the lateral border of the L4 nerve branch (to the lumbosacral trunk) and the L5 nerve root was measured. Computed tomography scans and cadaveric sectioning of the sacro-iliac region were performed to evaluate the bony stock available for fixation and the optimal screw direction to prevent neurologic damage. At 4 cm above the pelvic brim, the L4 nerve branch was a mean distance of 23 mm medial to the sacro-iliac joint, whereas the L5 nerve root was 26 mm. At the pelvic brim, those distances decreased to 10 mm for both structures. Four centimeters cephalad to the pelvic brim, the AP dimension of Sl complex was decreased. Screws that were 1 cm medial to the Sl joint and directed posteriorly and parallel to the joint did not endanger neurologic structures. At four centimeters above the pelvic brim, there is less danger of neurologic injury; however, a decrease in sacral bony stock may affect fixation.

Bone Screws↗

PubMed1994

A combined method for quantitative pertechnetate scintigraphy in the diagnosis of sacroiliitis. A controlled study.

A simplified scintigraphic technique for the assessment of sacroiliitis is described. It is based on the fact that an inflamed joint shows increased perfusion activity after administration of sodium pertechnetate. The sacroiliac joints are located by injection of a small amount of bone-seeking activity. Thereafter the pertechnetate activity is injected and the bone-seeking activity subtracted. The perfusion (pertechnetate) activity of the sacro-iliac joints is related to the activity of the large vessels of the thigh. Normal values have been established based on a study of 39 healthy controls. The method has been applied to 2 groups of patients with clinical sacroiliitis, one with and one without radiographical signs of sacroiliitis. The patients with radiographically verified sacroiliitis showed significantly higher values than the controls. The technique offers a high specificity and a high positive predictive value.

Adolescent↗

PubMed2001

[Tuberculous destruction of the iliosacral joint].

In this case report, a 56 year old patient with tuberculous destruction of the right sacroiliac joint is presented. Diagnosis was delayed because of unspecific signs of lumbalgia, which were interpreted as the consequence of nerve root compression. There was a specific infiltration into the surrounding intra- and extrapelvic muscles. Therapy is surgical, followed by a combination drug therapy for at least one year.

Decompression, Surgical↗

PubMed1981

Further observations on the arthropathy of calcium pyrophosphate crystal deposition disease.

The arthropathy of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is distinctive and may affect lumbar spinal and sacroiliac joints, as well as appendicular joints. Subchondral pseudocysts that are a hallmark of the disease have a variable appearance, but often occur as a typical cluster of subchondral, coalescent lucencies with smudged, sclerotic margins. Structural joint collapse with fragmentation of cartilage and bone may occur and appear to be related, at least in some cases, to antecedent pseudocysts. Characteristic intra-articular osteochondral bodies are often extensive and may affect multiple joints; their pathogenesis is discussed. Articular synovial calcification is common and may be due to calcium hydroxyapatite, as well as CPPD, particularly if advanced degenerative changes are present. Recognition of the radiologic features may be encountered in CPPD crystal deposition disease is important for differential diagnosis.

Aged↗

PubMed2004

[Tuberculous sacroiliitis: report of a case].

Our case concerns a 32-year old Cameroonian male presenting with tuberculous sacroiliitis. Diagnosis was made on the basis of a positive abscess needle aspirate. Tuberculous sacroiliitis is rare and generally an isolated phenomenon. Its insidious presentation leads to delayed diagnosis. The affection is often overlooked due to lack of awareness of the clinicians, the usually good condition of the patient and minimal signs of sacroiliac joint infection. Haematological data are frequently non contributory. High risk groups include developing countries immigrants, immunodepressed patients and low socioeconomic status. Accurate diagnosis is based on percutaneous synovial fluid or abscess aspirate bacteriology. CT-scan and NMR are the most helpful radiological examinations.

Adult↗

PubMed1990

Sacroiliitis in psoriasis: relationship to peripheral arthritis and HLA-B27.

One hundred and eighty-one patients attending a dermatology clinic were studied. Twenty-two (12%) were B27 positive. Twenty had peripheral psoriatic arthritis; 3 of these showed sacroiliitis (1 B27 positive, 2 B27 negative). Only one of the other 161 patients had sacroiliitis and he was B27 positive. Subsequently we examined 54 consecutive patients with psoriatic arthritis: 51 had peripheral arthritis (6 with sacroiliitis) and 3 exclusively axial involvement (2 sacroiliitis, one syndesmophytes with normal sacroiliac joints). All patients were pooled together and divided in 4 groups: B27 positive and negative, with or without peripheral arthritis. HLA-B27 and/or peripheral arthritis were associated with an increase in axial involvement. Patients lacking both B27 and peripheral arthritis did not have sacroiliitis and only in one case showed evidence of spinal disease (0.7%). Half of the patients with peripheral arthritis and spinal involvement were B27 positive. All 3 B27 positive patients without peripheral arthritis and with spinal disease were men and they all had bilateral sacroiliitis, indistinguishable from idiopathic ankylosing spondylitis (AS). HLA-B27 and peripheral arthritis appeared to act as separate factors that increased the risk of spinal arthritis in patients with psoriasis. The effect of B27 on psoriasis appeared to be detected in 2 different ways: as a coincidental factor increasing the risk of idiopathic AS (as for the general population) or as one of the multiple HLA associations that increase the risk of psoriatic arthritis; in this latter case the spinal involvement could occur as another manifestation of the clinical course of the disease.

Adult↗

PubMed1989

Sacroiliac dysfunction as a cause of low back pain.

The diagnosis of sacroiliac dysfunction cannot be assessed by the usual movements of the lumbar spine; namely, extension, flexion and lateral flexion. Many patients complaining of lower back pain have good lumbar mobility. If this is so, careful attention must be given to other structures in the region capable of causing lower back pain, including the sacroiliac joints (SIJs).

Back Pain↗

PubMed1988

Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup.

Eighty-eight patients with possible ankylosing spondylitis (AS) were selected for this followup study. They showed normal or at most suspicious radiographic findings of the sacroiliac joints. After 5 years' followup, 24, and after 10 years 32 patients (59% of the 54 finally available, 36% of the 88 original patients) had definite AS. In 12 individuals, AS could be excluded. Of the 10 remaining patients, 6 still had possible, and 4 had undifferentiated spondyloarthropathy. A comparison between HLA-B27 positive and negative patients showed a significantly increased frequency of definite AS or possible and undifferentiated spondyloarthropathy (p less than 0.05) in the group of HLA-B27 positive patients. The development of AS was characterized by a prolonged course: radiological sacroiliitis became evident after at least 9 +/- 6 years, radiological signs of spinal involvement after 11 +/- 6 years mean disease duration. After 18 +/- 6 years 25 (78%) of 32 patients with AS still maintained good or sufficient functional capacity, indicating a good functional prognosis in the great majority of the patients.

Adult↗

PubMed1978

Prevalence of sacroiliitis and ankylosing spondylitis in psoriasis patients.

The presence of sacroiliitis was studied in 100 consecutive psoriatic patients, 62 males and 38 females. In this selected population 14 patients (14%) had grade 2 to 4 sacroiliitis, in seven associated with clinical findings of ankylosing spondylitis (AS). Sacroiliac joint involvement was significantly related to more severe cutaneous and ungual psoriatic disease. Sacroiliitis was observed in nine males and five females but clinical AS predominated in the males, six males and one female. No difference in distribution was observed by sex, onset age, or duration of psoriasis when patients with and without sacroiliitis were compared. However, patients with sacroiliitis more frequently had peripheral joint involvement.

Adolescent↗

PubMed1980

An unusual case of gonococcal arthritis.

In cases of gonococcal arthritis the knees, wrists, ankles, hands and feet are the joints most commonly affected. This case is unusual because of the occurrence of gonococcal arthritis in the sacroiliac joint.

Adult↗

PubMed2001

Characteristics and evolution of extraintestinal manifestations associated with ulcerative colitis after proctocolectomy.

AIMS: Describe the characteristics of extraintestinal manifestations complicating ulcerative colitis present preoperatively and determine their evolution after surgery. METHODS: Between 1976 and 1986, 281 patients with ulcerative colitis exhibiting one or more extraintestinal manifestations (EIM) before either IPAA (n = 147), Brooke ileostomy (n = 71), Kock pouch (n = 48) or ileorectostomy (n = 15) were assessed retrospectively. The clinical evolution of each manifestation was classified as having disappeared, improved, remained unchanged or aggravated postoperatively. An efficacy index was designed to assess the ratio of the number of cases cured or improved over the number of cases unchanged or aggravated. The relationship between EIM and gender, age, duration of disease and the type of surgery was also ascertained. RESULTS: 433 EIM were observed in 281 patients. The most common were arthralgias of the large joints (n = 146), of the sacroiliac joint (n = 59) and the small joints (n = 51). In comparison to patients without EIM having received the same operation during the same period of time, EIM were seen more often in women, younger patients, than those with longer duration of disease and the ileoanal anastomosis group. 60% had only one EIM at a time. Based on the efficacy index, thromboembolic accidents and erythema nodosum were the most commonly cured or improved. Ocular manifestations and primary sclerosing cholangitis were unaffected. The other EIM responded favorably but variably with improvement in two thirds of patients. The presence of a rectal remnant (IRA) or ileal reservoir did not affect the evolution of the EIM. CONCLUSIONS: Thromboembolic complications which are life-threatening, erythema nodosum and arthralgia of the small and large joints which impair quality of life, benefited the most from proctocolectomy. Those conditions may be considered preoperatively when making the decision for surgery.

Adult↗

PubMed2001

Treatment of aneurysmal bone cysts of the pelvis and sacrum.

BACKGROUND: Aneurysmal bone cysts are benign, non-neoplastic, highly vascular bone lesions. The purpose of this study was to describe the prevalence, the clinical presentation, and the recurrence rate of aneurysmal bone cysts of the pelvis and sacrum and to examine the diagnostic and therapeutic options and prognosis for patients with this condition. METHODS: Forty consecutive patients with an aneurysmal bone cyst of the pelvis and/or sacrum were treated from 1921 to 1996. Their medical records and radiographic and imaging studies were reviewed, and histological sections from the cysts were examined. Seventeen lesions were iliosacral, sixteen were acetabular, and seven were ischiopubic. Seven involved the hip joint, and two involved the sacroiliac joint. All twelve sacral lesions extended to more than one sacral segment and were associated with neurological signs and symptoms. Destructive acetabular lesions were associated with pathological fracture in five patients and with medial migration of the femoral head, hip subluxation, and hip dislocation in one patient each. The mean duration of follow-up was thirteen years (range, three to fifty-three years). RESULTS: Thirty-five patients who were initially treated for a primary lesion had surgical treatment (twenty-one had excision-curettage and fourteen had intralesional excision); two patients also had adjuvant radiation therapy. Of the thirty-five patients, five (14%) had a local recurrence noted less than eighteen months after the operation. Of five patients initially treated for a recurrent lesion, one had a local recurrence. At the latest follow-up examination, all forty patients were disease-free and twenty-eight (70%) were asymptomatic. There were two deep infections. CONCLUSION: Aneurysmal bone cysts of the pelvis and sacrum are usually aggressive lesions associated with substantial bone destruction, pathological fractures, and local recurrence. Current management recommendations include preoperative selective arterial embolization, excision-curettage, and bone-grafting.

Adolescent↗

PubMed1992

[Kinematics of the pelvis. Grading and pathomechanical classification of injuries of the pelvic joints and kinematic and clinical consequences of surgical management].

The concept of kinematics as an idea basic to the operative and non-operative treatment of pelvic trauma, whether a fractures or a pelvic joint dislocation, is gaining ground in thinking and in technical management. The human pelvic ring may be interpreted by kinematic aspects as a three-bar linkage moving with three bony links (sacrum and both ossa coxae), (n = 3), in three real joints (symphysis pubis and both sacroiliac joints, (g = 3), as a transformer of great forces into small movements, and as a halter under periodic oscillating femoral impulses. The closed kinematic chain of the symmetric pelvic girdle possesses eight degrees of freedom (sigma g f = 8) subject to two external parameters of influence (F = 2), the gravity exerted by the trunk acting on the sacrum as a driving link caudally and ventrally, jointly creating a ring tension inside the pelvis. The guided linkage allows synthesis of a kinematic number and a positive movement equation in accordance with the spatial kinematic rule: F = 6(n-1)-6g + sigma g f = 2. This formula is applied to the investigation of all possible of pelvic joint dislocations types and fractures, and different forms of surgical treatment are described.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗

PubMed2005

Fluoroscopy radiation safety for spine interventional pain procedures in university teaching hospitals.

BACKGROUND: Fluoroscopic guidance is frequently utilized in performing various types of interventional techniques. The major purpose of fluoroscopy is accurate needle placement to ensure target specificity and accurate delivery of the injected drug. However, radiation exposure may be associated with risks to physician, patient, and personnel. Multiple studies have evaluated the risk of radiation exposure and techniques to reduce the risk in private practice settings. However, the literature is scant in evaluating the risk of radiation exposure in teaching hospitals in university settings. OBJECTIVE: To evaluate safety and duration of radiation exposure for fluoroscopy guided interventional pain procedures in university pain clinics. STUDY DESIGN: Retrospective, case study. METHODS: The data was reviewed from the fluoroscopy machines from March 2004 to April 2004 at two university pain clinics. Mean fluoroscopy time (FT), mean radiation dose per procedure, and utilization of pulsed fluoroscopy were analyzed. RESULTS: Data of a total of 165 cases of spine injection procedures were collected. The mean fluoroscopy time for lumbar epidural steroid injection, facet joint block, sympathetic nerve block, sacroiliac joint injection, and discography were 46.6 +/- 4.2; 81.5 +/- 12.8; 64.4 +/- 11; 50.6 +/- 41.9 and 146.8 + 25.1 seconds respectively. There were significant differences in fluoroscopy exposure times and radiation dosage for epidural steroid injection among different teaching physicians. Pulsed fluoroscopy was used in less than 10% of cases. CONCLUSION: The results of this study show that the fluoroscopy exposure time for various interventional procedures performed in the university settings are significantly higher than the radiation exposure periods in private practice settings. This study also showed significant differences among physicians in the same university setting.

Journal Article↗

PubMed1987

Primary septic arthritis in heroin users: early diagnosis by radioisotopic imaging and geographic variations in the causative agents.

We reviewed 37 cases of septic arthritis in heroin users. Our data confirm the predominance of the fibrocartilaginous joint infections in this group (sacroiliac joint 39%, chondrosternocostal unions 37%). In Spain, Staphylococcus aureus is the most commonly isolated organism (73%). This emphasizes the geographic variations in the causative germs since, in contrast to other reports, we have not identified any gram negative bacillary arthritis in our population of heroin users. Our data show that the 67gallium citrate scintigraphy is positive earlier than the 99mTc-MDP bone scan in the poorly vascularized joints (p less than 0.0005). The early localization of the infectious focus by 67gallium citrate scintigraphy followed by a prompt bacteriologic diagnosis (blood, synovial fluid or tissue cultures) allowed good therapeutic results.

Adolescent↗

PubMed1994

Bilateral sacroiliac dislocation with intrapelvic intrusion of the lumbosacral spine. A case report.

A patient sustained bilateral sacroiliac dislocation in which the proximal part of the sacrum was displaced 10 cm anteriorly and 6 cm inferiorly into the pelvis. Stabilisation was initially obtained with an external fixator. Operation was carried out later: reduction was achieved by overhead skeletal traction using sublaminar wires; two screws were inserted through each sacroiliac joint and the two fragments of the sacrum were wired in place.

Adult↗