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PubMed1999

Osteoarticular complications of brucellosis in an Atlantic area of Spain.

OBJECTIVE: To assess the frequency and clinical manifestations of osteoarticular brucellosis in an Atlantic area of Spain. METHODS: The case histories of all patients older than 14 years of age with active brucellosis diagnosed at the Hospital Xeral-Calde, Lugo, Spain, between October 1979 and October 1997 were reviewed. Diagnosis of brucellosis was by one of the following criteria: isolation of brucella species in blood or other fluids or tissue samples; or a clinical picture compatible with brucellosis in the presence of raised titers of specific antibodies by seroagglutination or Rose-Bengal plate agglutination tests. RESULTS: Forty-four patients (34 men, 10 women) of the 158 patients diagnosed with brucellosis (27.8%) had osteoarticular complications. Spondylitis (20/44; 45.5%) and sacroiliitis (15/44; 34.1%) were the most common complications. Patients with spondylitis were older and had a more chronic disease course than those with sacroiliitis or peripheral arthritis. Brucella abortus was the pathogenic strain responsible for human brucellosis in this region of Spain. CONCLUSION: In the Lugo region of Northwestern Spain osteoarticular brucellosis principally affects males and mainly involves spine and sacroiliac joints.

Adult↗
PubMed2003

Sacral pseudotumor complicating iliac bone harvest: radiographic, CT and MRI appearances.

We present the imaging appearances of a lytic pseudotumor in the right sacral ala presenting with referred pain to the right thigh. Subsequent imaging revealed the presence of a cystic lesion arising at the site of previous bone graft harvest; CT-guided aspiration yielded synovial fluid presumed to arise from the contiguous sacroiliac joint.

Bone Cysts, Aneurysmal↗
PubMed1992

New clinical and radiographic features of ankylosing spondylitis.

This article reviews new classification criteria for spondyloarthropathies and describes ankylosing spondylitis-like features in nonhuman primates. It describes the literature in general and analyzes specific papers on clinical assessment, outcome measurements, and standardization procedures. The extra-articular manifestations of ankylosing spondylitis and recent papers dealing with the clinical associations and differential diagnosis of ankylosing spondylitis are reviewed. The normal appearance of sacroiliac joints with magnetic resonance imaging and the value of different imaging techniques in the diagnosis of sacroiliitis, are discussed.

Animals↗
PubMed1998

Articular inflammatory manifestations in patients with different forms of leprosy.

OBJECTIVE: To study the articular inflammatory manifestations of leprosy. METHODS: Sixty patients with leprosy from a public clinic in São Paulo, Brazil, participated in a study regarding their articular manifestations. The diagnosis and classification of leprosy were established by the clinical picture, skin smears, skin biopsy, and delayed hypersensitivity test to Mycobacterium leprae antigens (Mitsuda test). According to the Madrid and Ridley-Jopling classifications, 46 patients had lepromatous leprosy, 7 had borderline leprosy, 4 had tuberculoid leprosy, and 3 had indeterminate leprosy. History, general and articular examinations, and roentgenograms were employed and complemented in several cases by scintigraphic examinations with technetium methylene diphosphonate and computed tomographic studies. RESULTS: Three patients were excluded from study due to an association with a rheumatic disease. Among the 57 remaining patients, 44 had peripheral arthritis characterized by involvement of small joints (23/44), large joints (4/44), or both (17/44). The mean duration of arthritis was 11 years (range 1 mo to 51 yrs). Arthritis was detected in all subtypes of patients with leprosy. Supplementary radiological evaluation established the extent of inflammation and diagnosis of sacroiliitis. The diagnosis of sacroiliitis, based on the presence of sclerosis, erosions, and narrowing of the cartilage space in the sacroiliac joints, was established in 35 of 55 radiographs. Sacroiliitis varied from grade I to III, according to the Bennet and Wood classification, and was bilateral in most cases (30/35). There was no significant correlation between low back pain and the finding of sacroiliitis. CONCLUSION: Articular inflammatory manifestations may exist in patients with different forms of leprosy, and can follow a chronic course. In addition, sacroiliitis is a common, previously unrecognized manifestation in patients with leprosy.

Adult↗
PubMed1980

Comparative study of quantitating 99mTc-EHDP uptake in sacroiliac scintigraphy.

Quantitative sacroiliac (SI) scintigraphy was performed 3 h after an i.v. injection of 16 mCi 99mTc-EHDP. The resulting images were recorded and processed and on an ON data system 150. Five technical approaches for objective digital assessment of abnormal uptake of the tracer at the sacroiliac joints were employed. SI indexes from the ratio of radioactivity in the SI joints and in the os sacrum, determined either by a region-of-interest technique or by a profile-scan technique measuring the maxima of the curve over a defined base line, proved to be the best parameters in discriminating normal from abnormal uptake of the radiotracer in the SI joints. The quantitative scan technique appears to be useful as an objective tool in interpreting SI scans.

Back Pain↗
PubMedDate not supplied

Fracture of the superior pelvic quadrant in a child.

We present a case report (with review of the literature) of a 3-year-old child who was struck by an automobile, sustaining a superior quadrant pelvic fracture that involved the sacroiliac joint, the adjacent ilium, and the acetabulum. This was successfully treated by open reduction and fixation with cannulated screws.

Acetabulum↗
PubMed1983

The arthritis of Behçet's disease: a prospective study.

A prospective study of arthritis was performed in 47 patients with Behçet's disease followed up over a 47-month period (mean 19.25 months, SD 14.09). These patients had a total of 80 episodes of arthritis, which were analysed for joint distribution and symmetry, in 56 of which the duration could also be determined. Attacks were oligoarticular, affecting up to 4 joints per patient, 54 (68%) being monoarticular. Knees, ankles, and wrists were the most commonly involved joints. Involvement of spinal, shoulder, hip, and sacroiliac joints was rare. The arthritis was usually not deforming and subacute; 82% (46/56) of the attacks lasted for 2 months or less and 18% (10/56) for between 3 months and 4 years. The ESR was moderately elevated during the attacks. In 32 specimens the synovial fluid was inflammatory (cell count 14.7 +/- 10.1 x 10(9)/l), but in 19 (59%) a good mucin clot formed. Synovial biopsy in 12 patients revealed superficial ulceration, paucity of plasma cells, and in 5 instances lymphoid follicle formation.

Adolescent↗
PubMed2004

Did Ramesses II really have ankylosing spondylitis? A reappraisal.

OBJECTIVE: To challenge the diagnosis of ankylosing spondylitis in the mummy of Ramesses II that was suggested about 30 years ago and to propose a differential diagnosis for the changes that were detected in the mummy's spine and pelvis. METHODS: We read and interpreted both the published and unpublished radiographs of the mummy. RESULTS: Changes in the mummy's spine and pelvis included ossification of the anterior longitudinal ligament at the cervical spine level, ossified enthesopathy of both the right and left rectus femoris tendons as well as the right ischial tuberosity, a large osteophyte at both acetabula margins, no ankylosis of the cervical apophyseal joints and no ankylosis of the right sacroiliac joint. CONCLUSION: The radiologic evidence does not support the claim that Ramesses II had ankylosing spondylitis. Our radiologic reappraisal suggests instead the diagnosis of diffuse idiopathic skeletal hyperostosis. This new diagnosis needs to be validated by a computed tomographic scan of the mummy.

Diagnosis, Differential↗
PubMedDate not supplied

Temporomandibular joint ankylosis. A possible complication in juvenile psoriatic rheumatism.

The authors present a rare case of bilateral temporomandibular joint ankylosis secondary to polyarticular juvenile psoriatic arthritis in a 24 year-old man. The patient first presented with arthritis of his right elbow joint at the age of 9, followed by involvement of the distal inter-phalangeal joints of his right foot and both sacroiliac joints. Serum rheumatoid factor was not detected. At the age of 16 he developed psoriatic lesions affecting his nails and skin. By the age of 20, clinical and radiological evidence of arthritis was detected in his temporomandibular joint (TMJ). Subsequently, the patient developed bilateral TMJ ankylosis over a period of 4 years. The patient was managed by bilateral resection of the ankylosis bone blocks, mobilization of the mandible and interposition of Dacron material between the two neo-articular surfaces. 10 months postoperatively the patient maintained an inter-incisal distance of 3 cm. Postoperative mechano-therapy was hindered by the limited use of the patients' hands.

Adult↗
PubMed2001

Caudal epidural injections with sarapin or steroids in chronic low back pain.

Epidural steroid injections are the most commonly used procedures to manage chronic low back pain in interventional pain management settings. Approaches available to access the epidural space in the lumbosacral spine include the interlaminar, transforaminal, and caudal. The overall effectiveness of epidural steroid injections has been highly variable. This study included 65 patients who underwent diagnostic facet joint nerve blocks utilizing comparative local anesthetic blocks and were shown to be negative for facet joint pain and other problems such as sacroiliac joint pain before enrollment into the study. They were randomly selected from 105 patients negative for facet joint pain allocated into three groups, with Group I consisting of 15 patients comprising a convenience control sample treated conservatively; Group II, consisting of 22 patients treated with caudal epidural with local anesthetic and Sarapin(R); and Group III, consisting of 33 patients treated with caudal epidural with a mixture of local anesthetic, and betamethasone. The study period lasted for 3 years. Results showed that there was significant improvement in patients receiving caudal epidural injections, with a decrease in pain associated with improved physical, functional and mental status; and decreased narcotic intake combined with return to work. The study showed that at 1 month 96% of the patients evaluated showed significant improvement, which declined to 56% at 3 months and 16% at 6 months, with administration of 1 to 3 injections. Cumulative relief with 1 to 12 injections was noted in 96% of the patients at 1 month, 95% at 3 months, 85% at 6 months, and 67% at 1 year. The study also showed cost effectiveness of this treatment, with a cost of $ 2550 for 1-year improvement of quality of life . In conclusion, caudal epidural injections with steroids or Sarapin are an effective modality of treatment in managing chronic, persistent low back pain that fails to respond to conservative modalities of treatments and is also negative for facet joint pain. The treatment is not only effective clinically but also is cost effective.

Journal Article↗
PubMed1984

Perception--a problem in the grading of sacro-iliac joint radiographs.

Reliability in the assessment of radiographic abnormalities in the sacro-iliac joint was investigated by rheumatologists and radiologists experienced in the reading of such films. This study differs from previous ones in that films were masked to reduce cueing from the radiographic appearance of other pelvic bone and joint structures. Agreement was greatest (greater than or equal to 80%) when only the presence or absence of abnormality was considered. When corrected for chance, agreement on the individual radiographic abnormalities was frequently poor or modest. The use of reference radiographs reduced absolute disagreement and had a modest influence on absolute agreement. The scoring of films for epidemiologic purposes should preferably be delegated to senior radiologists using standard reference films. Nevertheless, there remains a considerable margin of error in the interpretation of sacroiliac joint radiographs which is of clinical and epidemiological importance considering the weight that radiographs of this joint carry in diagnostic rheumatology.

Ankylosis↗
PubMed1995

The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs.

STUDY DESIGN: The superficial and deep lamina of the posterior layer of the thoracolumbar fascia have been studied anatomically and biomechanically. In embalmed human specimens, the posterior layer has been loaded by simulating the action of various muscles. The effect has been studied using raster photography. OBJECTIVES: To study the role of the posterior layer of the thoracolumbar fascia in load transfer between spine, pelvis, legs, and arms. SUMMARY OF BACKGROUND DATA: It has been determined whether muscles such as the gluteus maximus, latissimus dorsi, erector muscle, and biceps femoris are functionally coupled via the thoracolumbar fascia. The caudal relations of the posterior layer of the thoracolumbar fascia have not been previously studied. METHODS: Dissection was directed to the bilaminar posterior layer of the thoracolumbar fascia of 10 human specimens. The superficial and deep lamina were studied using visual inspection and raster photography. Tension to the posterior layer of the fascia was simulated by traction to various muscles and measured by studying the displacement in the posterior layer. RESULTS: Traction to a variety of muscles caused displacement of the posterior layer. This implies that in vivo, the superficial lamina will be tensed by contraction of various muscles, such as the latissimus dorsi, gluteus maximus and erector muscle, and the deep lamina by contraction of the biceps femoris. Caudal to the level of L4 (in some specimens, L2-L3), tension in the posterior layer was transmitted to the contralateral side. CONCLUSIONS: Anatomic structures normally described as hip, pelvic, and leg muscles interact with so-called arm and spinal muscles via the thoracolumbar fascia. This allows for effective load transfer between spine, pelvis, legs, and arms--an integrated system. Specific electromyographic studies should reveal whether the gluteus maximus muscle and contralateral latissimus dorsi muscle are functionally coupled, especially during rotation of the trunk. In that case, the combined action of these muscles assists in rotating the trunk, while simultaneously stabilizing the lower lumbar spine and sacroiliac joints.

Aged↗
PubMed1996

Missed sacral fracture before chiropractic adjustment.

OBJECTIVE: Reports of complications after chiropractic adjustments were administered to the lumbar spine and/or pelvis are rare. This case report provides the events associated with a sacral fracture that was not identified before a side-posture sacroiliac adjustment. CLINICAL FEATURES: The patient suffered from blunt, low back trauma as a result of a fall. Clinical evaluation indicated fixation dysfunction at the left sacroiliac articulation, with minimal edema/tenderness at the inferior portion of the left sacroiliac joint. Initial radiological evaluation failed to disclose the zone 2 sacral fracture because of an underexposed radiograph; thus, the patient was given a diagnosis of a sacroiliac sprain subluxation. INTERVENTION AND OUTCOME: A specific contact sacroiliac adjustment that uses the innominate as the short lever arm was administered to the patient in the side-posture position. Two adjustments were administered over 2 days. The patient developed sciatic pain after the second adjustment and subsequently referred herself to a medical orthopedist. Additional plain films were obtained, and a diagnosis of a zone 2 sacral fracture was made. The patient was prescribed bed rest; at 6 wk, her symptoms resolved and she returned to normal activity levels. CONCLUSION: Fractures of the spine and pelvis need to be considered in a patient who suffers blunt trauma. An adequate radiographic examination is necessary to make the appropriate diagnosis. Failure to diagnose the fracture may lead to complications, because the adjustment is not administered with regard to the biomechanics of the trauma or the actual clinical entity under scrutiny. This case study represents the first report of a complication after a sacroiliac adjustment in a patient who had a zone 2 sacral fracture that was missed in the diagnosis.

Adult↗
PubMed1998

Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors.

OBJECTIVE: To determine the overall prevalence of spondylarthropathy (SpA) among whites. METHODS: To screen for SpA symptoms, such as inflammatory back pain (IBP), joint swelling, psoriasis, and uveitis, or a specific family history, questionnaires were mailed to 348 blood donors (174 HLA-B27 positive and 174 HLA-B27 negative). From the responding 273 persons (78%; 140 B27 positive, 133 B27 negative), 126 were selected for further evaluation based on the symptoms reported. Of this group, 90 persons agreed to undergo physical examination (71.4%; 46 B27 positive, 44 B27 negative). There was no difference between the B27-positive and -negative groups in terms of age (mean +/- SD 38.4 +/- 10 versus 39.5 +/- 11 years) and sex ratio (67% versus 68% were men). In addition, 58 donors (32 B27 positive, 26 B27 negative) agreed to undergo magnetic resonance imaging (MRI) of the sacroiliac joints. A diagnosis of SpA and ankylosing spondylitis (AS) was made according to the European Spondylarthropathy Study Group criteria and the New York criteria. RESULTS: SpA was diagnosed in 20 persons: 19 of 140 B27-positive (13.6%) and 1 of 133 B27-negative (0.7%) subjects (15 male and 5 female). AS was diagnosed in 9 persons (7 male and 2 female; 45%), undifferentiated SpA (USpA) in 7 (5 male and 2 female; 35%), psoriatic arthritis (PsA) in 3 (2 male and 1 female; 15%), and chronic reactive arthritis (ReA; Reiter's syndrome) in 1 (male; 5%). On the basis of a B27 frequency of 9.3% among the population of Berlin (3.47 million persons), the estimated prevalence of SpA was 1.9%, AS was 0.86%, USpA was 0.67%, and PsA was 0.29%. The relative risk of developing SpA in B27-positive subjects was calculated as 20.7 (95% confidence interval 4.6-94.2; P = 0.001). Of 58 persons with IBP, sacroiliitis was detected by MRI in 15 of 32 B27-positive (46.9%) and 1 of 26 B27-negative (3.9%) subjects (P = 0.002). Four of these 16 donors did not fulfill diagnostic criteria for SpA. CONCLUSION: With a calculated prevalence of 1.9%, spondylarthropathies are among the most frequent rheumatic diseases in the white population. HLA-B27 positive persons carry a 20-fold increased risk of developing SpA. AS and USpA are the most frequent SpA subtypes. Persons with IBP who are B27 positive have a 50% likelihood of having sacroiliitis.

Adult↗
PubMed2002

Radiologic case study. Pyogenic left sacroiliac infection.

A wide variety of inflammatory, infectious, metabolic, and neoplastic diseases can affect the sacroiliac joints. Early in their course, some of these diseases produce only subtle and nonspecific signs and symptoms. Demonstration of characteristic joint changes, knowledge of specific clinical manifestations, and familiarity with imaging modalities can lead to early diagnosis and treatment of these patients.

Adolescent↗
PubMed1999

Transitional lumbosacral vertebral anomaly in the dog: a radiographic study.

Transitional lumbosacral vertebral anomalies have for some time been suggested as a possible cause of cauda equina syndrome (especially in the German shepherd dog [GSD]), a condition recently thought to be inherited. The frequency of this condition within a large clinical population and the radiographic features used in its detection are reported. In a group of 143 patients, the sexes were similarly represented and the GSD was greatly overrepresented. The anomaly is characterised by separation of the first sacral segment that was identified on the lateral view by the presence of a radiolucent disc space between what are normally the first and second sacral segments. On the ventrodorsal view, the anomaly was characterised by separation of the spinous processes between what are normally the first and second sacral segments. In the presence of the transitional segment, the nature of the sacroiliac joint at the level of the anomalous segment varies from a strong ilial attachment, with the presence of a wing-like lateral process, to a weakened ilial attachment because of the presence of a lateral process, shaped as that seen on a lumbar segment. These patterns were present unilaterally or bilaterally and result in symmetrical or asymmetrical patterns. The effect of the weakening of the sacroiliac attachment was thought to result in premature disc degeneration, which, together with spinal canal stenosis, resulted in potential compression of the overlying spinal nerves and creation of a cauda equina syndrome. The condition is thought to have clinical significance and should be selected against in breeding, especially in the GSD.

Animals↗