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PubMed1998

Anterior sacroiliac fusion: a new video-assisted endoscopic technique.

We present a case of sacroiliac fusion performed for an intraarticular osteochondroma of the sacroiliac joint, which was the cause of severe pain and disability. Excision of the lesion and sacroiliac fusion were successfully performed by utilizing minimally invasive surgical techniques. Although the application of this technique requires a dedicated and highly experienced team, the encouraging result of our first case, with minimal morbidity and disability due to the operation, induces us to recommend this technique in sacroiliac fusion, especially when fusion is combined with additional procedures such as drainage, biopsy, or excision.

Adult↗
PubMed1996

Traumatic spondylopelvic dissociation. A case report and literature review.

STUDY DESIGN: A case of traumatic spondylopelvic dissociation and a method of fixation are described. OBJECTIVES: The treatment of this rare injury pattern required differentiation from less severe lumbosacral fracture-dislocations or bilateral sacroiliac joint dislocations. SUMMARY OF BACKGROUND DATA: Several case reports have described less severe fracture patterns, but only a handful have illustrated true spondylopelvic dissociation in which there is complete displacement of the lumbar spine into the pelvis. METHODS: After initial stabilization at an outside hospital, the patient was transferred to the authors' institution for definitive care. After computed tomography imaging with three-dimensional multiplanar reconstruction, the fracture was stabilized with a pedicle screw construct attached to the pelvis by means of the Galveston technique. Bilateral iliosacral screws were used to increase stability. RESULTS: At a 2-year follow-up, the patient was pain-free and ambulating in an ankle-foot orthosis. He had a persistent deficit involving the right L5 and S1 nerve roots but was continent of stool. CONCLUSIONS: The unique fracture pattern described in this patient is presented to offer better insight into management of this complex injury and to delineate it from simpler patterns of injury to the lumbosacral junction.

Adult↗
PubMed1993

[Purulent arthritis after blockade treatment].

Injections of local anaesthetics with or without steroids are widespread in the treatment of muscular pain. Occasionally, however, they are followed by serious bacterial infections. Three cases of septic arthritis, one localised to the hip, one to the knee and one to the sacroiliac joint are presented. One should offer great consideration to the possible complications following injections into or near joints.

Adolescent↗
PubMed1976

"Ankylosing spondylitis" without sacroiliitis in a woman without the HLA B27 antigen.

An elderly woman with otherwise typical ankylosing spondylitis for 45 years lacked radiologic evidence of sacroiliitis and the HLA B27 antigen. The illness was complicated by renal tuberculosis requiring a left nephrectomy 23 years after the onset of low back pain, and 20 years after an episode of severe iritis. After the eradication of the tuberculosis by surgery and chemotherapy, she has continued to have symptomatic spondylitis. The case seems to be an exception to the rule that sacroiliitis is a sine qua non for ankylosing spondylitis. Women with ankylosing spondylitis tend to have milder disease with an apparently lower frequency of roentgenographic changes in sacroiliac joints.

Aged↗
PubMed1978

Evidence for sacroiliac disease as a common cause of low backache in women.

99M Tc stannous pyrophosphate bone scanning with quantitative sacroiliac scintigraphy (Q.S.S.) has been used in 50 females with low backache and in 66 symptomless female controls. Mean uptake of radionuclide at the sacroiliac joints was significantly increased in the patients when compared with controls. Q.S.S. gave objective evidence of unilateral sacroiliac disease in 2 of the 66 controls compared with that of unilateral and bilateral sacroiliac disease in 8 and 14 of the 50 patients respectively. Of the 22 patients with abnormal scans, 20 had normal radiographs. An abnormal scan did not correlate with the presence of HLA B27. It is concluded that sacroiliac disease is a common cause of low backache in women, and that it can be objectively diagnosed by Q.S.S. when radiographs are normal.

Adult↗
PubMed1982

Treatment of painful long-standing displaced fracture-dislocations of the sacrum. A case report.

A 19-year-old white man sustained multiple injuries, including a severely displaced Malgaigne fracture. Secondary uncontrollable hemorrhage was treated successfully by arterial embolization. The patient retained a painfully displaced right sacroiliac joint. His multiple injuries resolved symptom free with the exception of the right sacroiliac region. An attempt to reduce the dislocation by an extensive soft tissue release and skeletal traction was unsuccessful. Solid fusion of the L4 and L5 vertebrae to the ilium significantly reduced the patient's pain. Painful, long-standing severely displaced Malgaigne fracture can be successfully treated by sacroiliac arthrodesis without reduction.

Adult↗
PubMed1993

The gluteus maximus superior split muscle flap for complex posterior pelvic wounds.

Coverage of complex posterior-lateral pelvic wounds can be difficult with currently described flaps. Using a superior transposition of the superior portion of the gluteus maximus, coverage can be obtained without resorting to free tissue transfers. No functional deficits are seen in ambulatory patients. We present a cadaver dissection and 2 patient reports to illustrate this versatile flap. Coverage of wounds involving the deeper aspects of the sacroiliac joint, or the posterior iliac crest, can be difficult without resorting to free tissue transfers. After trauma, osteomyelitis of these two areas can be treated by adequate and extensive debridement, but in doing so, significant dead space can be created. We have found the superior split gluteus muscle rotation flap to be an excellent choice in 2 patients whom we have encountered. To our knowledge, the superior rotation of this muscle flap has not been previously reported.

Adult↗
PubMed1979

Computed tomography of the osseous pelvis.

Computed tomography (CT) was used for study of the osseous pelvis in 43 patients with definitive pathological or clinical follow-up. CT accurately characterized and determined extent of bone and soft-tissue involvement; neoplasms and other disease processes, such as sacroiliac joint disease, were well localized. In cases of trauma, CT was able to identify, localize, and characterize fracture fragments and bone or joint displacement. CT was judged "useful" or "definitive" in 80% of all lesions and 96% of neoplasms studied.

Adolescent↗
PubMed2000

Evolution of chronic recurrent multifocal osteitis toward spondylarthropathy over the long term.

OBJECTIVE: To retrospectively assess, with a sufficiently long followup (mean 11.6 years; median 9 years), the long-term outcome of chronic recurrent multifocal osteitis (CRMO), a multifocal, inflammatory bone disease. METHODS: Patients included were 8 children/adolescents and 7 adults with no family history of rheumatic disease who had been diagnosed as having CRMO between 1979 and 1995. Ten patients had undergone at least 1 bone biopsy of the lesions, with histologic examination and multiple cultures. In 1996, in addition to an in-depth interview, 12 patients underwent an extensive physical examination, laboratory evaluation, HLA-A, B, C, and DR typing, bone radiography and scintigraphy, and computed tomography scan of the sternoclavicular and sacroiliac joints. RESULTS: Remission was observed in 3 patients. The other 12 patients developed various associations of vertebral (n = 10), sacroiliac (n = 6), anterior thoracic (n = 7), peripheral articular (n = 2), enthesopathic (n = 4), or dermatologic (palmoplantar pustulosis in 3 cases and psoriasis in 2) involvements. Spine involvement was the most common and occurred the earliest (median time to appearance after the onset of osteitis 5.63 years). Clinical sacroiliitis was always unilateral. No patients carried the HLA-B27 haplotype. CRMO responded well to nonsteroidal antiinflammatory drugs. Twelve patients met the European Spondylarthropathy Study Group criteria for spondylarthopathy. CONCLUSION: After 10 years, CRMO had usually evolved to spondylarthropathy, but with certain features not usually seen in the latter: predominantly, unilateral sacroiliitis, no familial form, and no link with HLA-B27.

Acute Disease↗
PubMed1995

Radiology of the paraglenoid sulcus.

The paraglenoid sulcus is a variable groove in the ilium adjacent to the inferior end of the sacroiliac joint. This study investigates the hypothesis that the groove is due to resorption at the insertion of the anterior sacroiliac ligament in response to stress. The anatomical relationships of the groove are shown with plain films, arteriography and computed tomography. Relationship to parity was tested in 70 adult female subjects; a statistically significant relationship was found, with deep grooves occurring only in parous women. An association with osteitis condensans ilii was also demonstrated. Relationship to lumbosacral posture was tested in 102 adult females, and an association with increased lumbar lordosis was found. These findings are consistent with our initial hypothesis.

Adolescent↗
PubMed1996

Effect of sacral and iliac instrumentation on strains in the pelvis. A biomechanical study.

STUDY DESIGN: This study is a biomechanical study on human cadaver pelves using strain gauges to measure strains at different locations in response to different load states. OBJECTIVES: To examine the changes in strains, at different sites on the pelvis, and after instrumentation of the lumbosacral joint and the lumbosacroiliac joint. SUMMARY OF BACKGROUND DATA: Pelvic girdle pain after long instrumented fusions to the sacrum has been described and studied along with sacroiliac and pubic instability. Fractures of the pelvic rami or the iliac wing have been reported in patients after surgical fusions that incorporated the sacrum and sacroiliac joint. METHODS: Pelves with lumbar spine attached had three axis rosette strain gauges cemented to specific sites on the pelves (ilium [correction of ileum] and rami). Specimens were tested in different configurations involving lumbosacral and sacroiliac instrumentation. Iliac bone harvest was also tested. Strain values were computed and compared for each configuration. RESULTS: The "Galveston" and "sacral" instrumentation configurations caused significant stress shielding in pelves under all compression loads applied. Axial rotations on the instrumented specimens caused higher strains at all sites. Harvesting of bone from the ilium did not alter the strains seen at the different sites. CONCLUSIONS: This study suggests significant stress shielding provided by sacro and sacroiliac instrumentation systems, supporting the possibility of development of device-related osteopenia that may predispose patients to late, insufficiency-type fractures as their activity increases. The rigid instrumentation of the lumbosacral spine was found to increase the stress during torsion, which may lead to failure during activity.

Adult↗
PubMed1983

Septic sacroiliitis. An analysis of 14 patients.

In most joints arthritis is easily diagnosed. This, however, is not the case with infectious sacroiliitis because of the inaccessibility of the sacroiliac joint, due to the anatomic and topographic relations. Fourteen patients with septic sacroiliitis in whom the diagnosis was established between 10 and 90 days after the onset of the disease are reported for a 5-year period. All patients had scintigraphic high uptake and three patients did not show any radiographic changes.

Adolescent↗
PubMed1985

Radiological and scintigraphic findings in patients with a clinical history of chronic inflammatory back pain.

The prevalence of radiological abnormalities of the sacroiliac joints, the manubriosternal joint, and the lumbar spine were assessed, and quantitative sacroiliac scintigraphy was performed in 151 patients with a history of chronic inflammatory back pain and in 31 controls with non-inflammatory back pain. Sacroiliitis was found in 124 patients (82%), manubriosternal lesions in 84 patients (56%), and lesions of the lumbar spine in 58 patients (38%). In 19 patients (13%), manubriosternal lesions provided the sole radiological abnormality and in five patients (3%) no radiological abnormality could be demonstrated at any of these sites. Quantitative sacroiliac scintigraphy showed increased values in 69 of 137 patients examined (50%), but also in 10 out of 12 control patients with disc degeneration (83%) and is, therefore, nonspecific for inflammatory lesions. Radiological examination of the manubriosternal joint is recommended in patients with inflammatory back pain without radiographic evidence of sacroiliitis.

Adolescent↗
PubMedDate not supplied

The value of quantitative radioisotope scanning in the differential diagnosis of low back pain and sacroiliac disease.

The specificity of scintigraphic scanning in detecting inflammatory sacroiliitis has been investigated. The sacroiliac band profile (R[Band]) was used and a new index (R[SIJ/F]) comparing the sacroiliac joint with the ipsilateral femur is described. Using the R (Band) index the mean value (1.34) for patients with definite sacroiliac disease was no different from that found for control subjects (1.35). There were significant differences using the R(SIJ/F) (7.8 versus 6.4): this ratio alone correlated with age. We conclude that neither technique is sufficiently specific to be of diagnostic value in most instances of low back pain.

Adult↗
PubMed1979

Radionuclide joint imaging in the seronegative spondyloarthropathies.

Radionuclide joint imaging (RJI) of the peripheral and axial skeleton is a recent advance in the detection of early articular inflammation and has proven useful in establishing the extent and pattern of this involvement. The bone-seeking agents--the radiophosphates--are the radiopharmaceuticals presently favored for RJI in adults. They are more sensitive than the clinical examination in detecting inflammatory joint disease in all peripheral joints with the exception of the shoulders, elbows and knees. Radiophosphate may also be used to evaluate the axial skeletion for inflammatory involvement. The sacroiliac joints may be evaluated by a new technique, quantitative saroiliac scintigraphy (QSS). Studies to date have demonstrated that QSS is most sensitive in early sacroiliitis, a time when conventional radiography is normal or shows equivocal abnormalities. While extremely sensitive as a screening procedure for inflammatory articular disease, RJI is nonspecific diagnostically. Radiophosphate uptake by bone occurs in metabolic bone disease, osteoarthritis, trauma and juxta-articular bony abnormalities such as osteomyelitis and bone infraction. The results obtained by radionuclide joint imaging must be supplemented by the clinical findings and conventional investigations to establish a specific diagnosis.

Adolescent↗
PubMed2005

Relief of internal snapping hip syndrome in a marathon runner after chiropractic treatment.

OBJECTIVE: To discuss the assessment, diagnosis and chiropractic management of a patient with sacroiliac joint dysfunction (SIJ) complicated by psoas major snapping hip syndrome (coxa saltans interna). CLINICAL FEATURES: A 32-year-old male marathon runner experienced low-back and left hip pain without radiation accompanied by a "popping" in the anterior hip. He ran approximately 100 to 150 km/wk for the prior 3 years. He had stopped running for the previous 3 weeks because of worsening and consistent pain. INTERVENTION AND OUTCOME: Treatment consisted of side posture SIJ "diversified" manipulation and myofascial release to the psoas muscle twice weekly for 2 weeks. The patient was also taught proprioceptive neuromuscular facilitation exercises of the psoas and iliotibial band muscles. He was instructed to substitute swimming instead of running on a daily basis. Reassessment at 3 weeks found the patient without pain in his hip or back and no clicking or popping in his left hip. CONCLUSION: Clinicians should consider that runners who present with coexisting SIJ dysfunction and internal snapping hip syndrome may benefit from the combined management of both conditions.

Adult↗
PubMed1978

[The overgrowth of cartilaginous and fibrous structures in Paget's Disease (author's transl)].

The overgrowth of cartilaginous and fibrous tissue of the spine in Paget's disease is described in long-term follow-up studies. On cervical manifestation the disease progressed from one vertebrae to the other with destruction of the intervertebral discs, fusion of the vertebral bodies and intervertebral joints and shortening of the affected area. On the lower thoracic and lumbar spine osteomalacia with collapse of the vertebral bodies and biconvex deformities of the discs were seen in the initial period. Several years later the discs flattened, vaulted and fused in the periphery by dystrophic bone. Fusion of the corresponding intervertebral joints and ossification fo the intervertebral ligaments developed. The involved spine was shortened. The sarcroiliacal joint spaces were obliterated in cases with involvement of adjacent bones by Paget's disease. The overgrowth advanced from the periphery towards the center. Ankylosis of sacroiliacal joints has also been observed without fusion of the intervertebral disc spaces. Relatively low age, loss of height, invalidating bone pains and osteomalacia of the pelvis were the main features in cases with spinal changes. Osteomalacia of the spine followed by ossification of intervertebral ligaments and joint capsules and later by vertebral fusion are considered to be a special form of Paget's disease.

Adult↗
PubMed1991

Bacterial arthritis.

In this review of the 1990 septic arthritis literature, we revisit synovial fluid leukocytosis, examine the utility of synovial fluid glucose and protein measurements, and look at the levels of two cytokines, tumor necrosis factor and interleukin-1, in infected joint fluids. We see the many faces of gonococcal arthritis and the ravages of septic arthritis when the host has rheumatoid arthritis. Should we recommend antibiotic prophylaxis for the rheumatoid patient with a prosthetic joint who is undergoing a procedure that leads to transient bacteremia? What are some of the salient features of septic arthritis when it involves the sternoclavicular or sacroiliac joints? We also look at some unusual microorganisms, eg, group C Streptococcus, Streptococcus viridans, Listeria monocytogenes, Pseudomonas cepacia, Pseudomonas maltophilia, and Neisseria sicca. In patients with acquired immunodeficiency syndrome, we encounter reports of septic arthritis, osteomyelitis, and spinal epidural abscess caused by opportunistic microorganisms. Two unusual sites of infection include the C1-2 lateral facet joint and subacromial bursa without involvement of the glenohumeral joint. Finally, we examine how to drain a septic knee: the orthopedic point of view.

Arthritis, Infectious↗