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PubMedDate not supplied

[Septic sacroiliitis: case report].

Bacterial pyogenic sacroiliitis is a relatively rare infection that may be difficult to diagnose. A delay in the diagnosis may be associated with marked toxemia and demanded surgical drainage of the septic joint. We report clinical and laboratorial findings in a 12-year-old white girl with onset low back and leg pain two weeks before admission to the hospital. Bone scintigraphy showed increased uptake in the right sacroiliac joint and radiologic changes were typical of sacroiliitis. Oxacilin-sensitive S. aureus was cultured from fluid of surgical biopsy. Antibiotic treatment leads to complete recovery after long time with low back pain. The diagnosis and treatment of this rare disease are discussed based upon our finding and the literature data.

English Abstract↗
PubMed1995

[Pseudo-sciatica of neoplastic origin: apropos of an unusual case].

The authors report a case of 'pseudosciatic' pain due to bone metastasis located in the sacroiliac joint secondary to breast cancer. Complementary investigations are mandatory in any case of sciatic pain starting at 80 years of age, even in the absence of the usual criteria suggesting a neoplastic origin. In this case our investigations revealed sacroiliac bone metastasis from the breast, explaining the clinical picture. Primary and secondary sacral tumors are uncommon. Their clinical manifestations are unspecific, consisting mainly of low back pain and sciatic pain. CT scan and MRI are the best tools to evaluate these lesions. Conservative management, combining radiotherapy and hormonal treatment, has been effective in terms of both pain and function.

Aged↗
PubMed1987

Delayed posterior internal fixation of unstable pelvic fractures.

Fifteen patients with unstable pelvic fractures were treated with immediate anterior external fixation followed by delayed posterior fixation, including five sacroiliac lag screws, six transiliac rods, and four iliac plates. Initial anterior external fixation aided in resuscitation of hemodynamically unstable patients and allowed early mobilization. Delayed posterior internal fixation avoided infection and hemorrhage but failed to achieve anatomic reduction of disrupted sacroiliac joints and sacral fractures. Followup examination confirmed maintenance of fixation and fracture healing but pain and persistent neurologic deficits were common findings. Lumbosacral nerve plexus injuries occurred in patients with fractures through the sacral foramina. Fixation of these fractures with sacroiliac screws and transiliac rods caused overcompression and the resulting foraminal encroachment may be a factor in the lack of neurologic recovery. In this study, delayed posterior internal fixation was not associated with perioperative morbidity and achieved better reductions than those obtained with external fixation alone. Delaying the fixation, however, increased the difficulty of obtaining anatomic reduction of certain posterior arch disruptions.

Adolescent↗
PubMed2005

[Surgical management of cervical radiculopathy in Forestier's disease. Case report and review].

Forestier's disease now called DISH (diffuse idiopathic skeletal hyperostosis) is a non inflammatory enthesopathy ossifying the anterolateral spine and sparing the disc and joint space in elderly men, mostly at thoracic levels. Radiology performed for minor trauma or to explore a stiff neck provides the diagnosis. The main differential diagnosis is ankylosing spondylitis presenting an inflammatory profile as well as previously existing alterations of the sacroiliac joint. Retinoic acid treatment or ossification of the posterior longitudinal ligament should also be discussed. Dysphagia is the most frequent symptom, but neurological signs are rarely observed. We report a case observed at the cervical level. Anterior decompression and cage-fusion was indicated. Ongoing hyperostosis was also documented. Surgery in DISH is mainly indicated for dysphagia and rarely after cervical trauma. Of note are associated lesions such as OPLL (ossification of the posterior longitudinal ligament) or synovial cysts responsible for the exceptional and severe myelopathy presentation. The neurosurgical community should become better aware of Forestier's disease.

Cervical Vertebrae↗
PubMed2002

General principles of diagnostic testing as related to painful lumbar spine disorders: a critical appraisal of current diagnostic techniques.

STUDY DESIGN: The literature on diagnostic tests available to the spine clinician for the evaluation of chronic low back pain was reviewed. OBJECTIVES: To review critically the available information and data on invasive diagnostic tests used for evaluation of chronic low back pain. SUMMARY OF BACKGROUND INFORMATION: Numerous published studies have described the technique and clinical results of diagnostic blocks for chronic low back pain. There are various methodologies, but most lack of an adequate "gold standard" with which to compare the results of the diagnostic test. METHODS: The available published studies of diagnostic tests commonly used in the evaluation of chronic low back pain were reviewed, with a focus on invasive techniques. The techniques were evaluated on the basis of the data available to support the conclusions that could be drawn for each of these techniques. The principles of diagnostic testing, including specificity and sensitivity, were reviewed and applied in the context of the data available for each of these invasive tests. RESULTS: The essential features the clinician seeks in a diagnostic test are accuracy, safety, and reproducibility. It is essential to have a gold standard with which to compare the accuracy of a given diagnostic test. There is no completely reliable gold standard with which to compare a diagnostic test (or injection) when the absence of pain is the end point. The clinical setting in which the test is used directly affects the test results. The prevalence of the disease therefore affects the meaningfulness of the test results. Imaging studies have their greatest value in the exclusion of other conditions. These studies alone were not adequate for predicting the patients who would respond to controlled diagnostic blocks of the facet joint. Facet joint diagnostic blockade probably is most accurately performed by median nerve branch block. The greatest specificity for a positive response to a facet denervation procedure is achieved when the diagnosis is established via highly controlled anesthetic blocks. Over the past few decades, the sacroiliac joint has received varying degrees of interest as an important pain generator of low back pain. Despite testimonials to the contrary, no diagnostic physical examination has correlated with sufficient specificity to diagnose this condition reliably from a clinical standpoint. Lumbar discography has been one of the single most controversial subjects in the management of degenerative, painful lumbar spine conditions. The specificity and sensitivity are high for the diagnosis of disc degeneration. The question that revolves around discography concerns the accuracy of this test for the diagnosis of discogenic pain. An integral part of the problem is the lack of an adequate gold standard. In a comparison of nerve root blockade, sciatic nerve block, posterior ramus block, and subcutaneous injection in a cohort of patients with sciatica, the sensitivity of nerve root block was very high, with only a moderate level of specificity. In the case of diagnostic selective nerve blocks used for evaluation of complex or protean nerve compression, surgical confirmation and clinical results should be a reliable gold standard. Conflicting results have been presented depending on the target lesion and method of study. CONCLUSIONS: There are inherent limitations in the accuracy of all diagnostic tests. The tests used to diagnose the source of a patient's chronic low back pain require accurate determination of the abolition or reproduction of the patient's painful symptoms.

Back Pain↗
PubMed1990

[Hematogenous bone and joint infections in children].

Not all children with osteomyelitis or septic arthritis will present with the characteristic findings, i.e. localized pain and swelling, fever and generalized malaise. Diagnostic problems arise in case of the following four special forms or locations of the diseases: neonatal osteomyelitis, because neonates frequently have no signs of infection; osteomyelitis of the spine and septic arthritis of the sacroiliac joint; subacute hematogenous osteomyelitis; chronic osteomyelitis. Acute bone and joint infections are diagnosed clinically. Positive blood cultures are found in only about half of all cases. Cultures of joint fluid or bone cultures are positive in 50 to 90%. The aim of therapy is to avoid destruction of bones or joints or even invalidity. Effective treatment consists of sufficient antibiotics for an adequate period of time and of immobilization. Surgical drainage is mandatory in case of abscess formation in soft tissue, of intramedullary or joint abscess, mainly hip-joint and shoulder, of persistent fever and in all chronic forms of osteomyelitis where areas of sequestra, dead tissue and abscesses may be assumed.

Abscess↗
PubMed1993

[Follow-up and prognosis of neurologic sequelae of pelvic ring fractures with involvement of the sacrum and/or the iliosacral joint].

The extent of neurological lesions following an injury of the pelvic ring is often not initially recognized, as interest is then focused on the treatment of the pelvic ring fracture. Once the fracture has healed, the patient suffers from the sequelae of the neurological injury. Our series of 323 pelvic ring injuries includes 161 sacral fractures and 12 complete disruptions of the sacroiliac joint. Twenty-three patients sustained an injury of the lumbosacral plexus, and 20 patients were examined retrospectively. The different parts of the lumbosacral plexus showed variable recovery potential. An important or complete recovery was noted in 8 of 9 patients suffering from a motor deficit of the lumbar plexus, the obturator nerve, the superior gluteal nerve or the inferior gluteal nerve. Four out of 8 patients with a motor deficit of the sacral plexus had an important or complete improvement. In contrast to these results was the poor recovery of lesions of the lumbosacral trunk. Eight out of 11 patients showed no or only minor recovery, although the pelvic ring was stabilized by operative means in 9 patients. In 2 patients the lumbosacral trunk was directly decompressed by a dorsal approach. In both cases the recovery was complete. In 6 patients the sphincter function was damaged. Recovery was dependent on the localization of the sacral fracture. If the fracture traversed the sacral canal, no neurological improvement was noted.

Adult↗
PubMed1990

Osteoarticular brucellosis in children.

The findings in 40 children (24 female, 16 male) with osteoarticular complications of brucellosis are presented. Raw milk was the main source of infection. Most patients had acute onset of fever, arthralgia, and myalgia. Arthritis was the presenting symptom in all patients, of whom two also had osteomyelitis. Arthritis was monoarticular in 28 (70%) of 40 cases with predilection for large weight-bearing joints. Spine and small joints were spared. Brucella melitensis was detected in 23/31 (74%) cases. Mild anaemia, leucopenia, increased liver enzymes, positive acute phase reactants, and low titres of autoantibodies were prominent non-specific laboratory findings. Bone scintigraphy was more helpful than conventional radiography in detecting hip and sacroiliac joint disease. Treatment with a combination of antibiotics for six weeks or more resulted in a cure rate of 92.5%. Early recognition of infection, prolonged treatment, and long term follow up should improve the outcome of patients.

Adolescent↗
PubMedDate not supplied

A short-term follow-up of enthesitis and arthritis in the active phase of juvenile onset spondyloarthropathies.

OBJECTIVE: To describe the characteristics of enthesitis and arthritis in the active inflammatory stage of juvenile onset spondyloarthropathies (SpA) during a short-term follow-up. PATIENTS AND METHODS: The study group included data of 33 patients with juvenile-onset SpA with enthesitis in > or = 3 sites, arthritis in > or = 4 joints, and erythrocyte sedimentation rate (ESR) of > or = 25 mm/h despite treatment, who participated in a 26-week, double-blind, sulfasalazine versus placebo trial that showed no significant differences between groups in regard to enthesitis and arthritis. RESULTS: Twenty-seven boys and 6 girls (mean age: 15.3 +/- 3.5 years; mean disease duration: 4.1 +/- 2.7 years) with the seronegative enthesopathy and arthropathy (SEA) syndrome (n = 20) or ankylosing spondylitis (AS; n = 13) comprised the group. Throughout the study, the mean (+/- SD) number of swollen joints and tender entheses were 4.6 +/- 2.5 and 8.3 +/- 5.4. The entheses and joints most frequently involved were the calcaneal attachments of the plantar fascia (87.9%) and Achilles tendon (81.8%) and the ankle (87.9%) and knee (72.7%), respectively. There was pain in the cervical, thoracic, and lumbar spine in 39.4%, 69.7%, and 63.6% of patients and in the sacroiliac joints in 48.5%. Mid-foot involvement (or tarsitis) occurred in 29 patients (87.9%). Except for the feet, the simultaneous occurrence of enthesitis and arthritis in other sites was rare. Overall, there were no significant differences between SEA syndrome and AS patients. CONCLUSIONS: Disease activity shows a significant trend for entheses and joints of the feet and a significant prevalence of axial enthesitis in juvenile onset SpA. Mid-foot involvement appears to be the most characteristic and potentially, the most severe form of disease in these patients.

Adolescent↗
PubMedDate not supplied

[Joint involvement in polymyalgia rheumatica/temporal arteritis].

The coincidence of arthritis with polymyalgia rheumatica (PMR) or temporal arteritis (TA) is not well established. After reviewing the literature we found that 22% of patients suffering from PMR/TA present with additional signs of inflammatory joint involvement. Joints predominantly affected are the sternal junctions, knee and shoulder joints, and the wrists, involvement of the latter frequently resulting in carpal tunnel syndrome. With the exception of sternal junctions, bony erosions are rarely seen. In most cases, synovitis is mild, pauciarticular, asymmetrical, transient and not destructive. Little evidence for inflammatory involvement of spine or sacroiliac joints was found, thus, back pain in these patients should be considered as caused by osteoporosis of the spinal column, mostly due to prolonged corticosteroid treatment.

Arthritis↗
PubMed2004

Interventional radiology and the musculoskeletal system.

Imaging-guided interventional procedures are becoming increasingly important in clinical rheumatology, since arthrocentesis of peripheral joints and the spine, as well as soft tissue injections, have a high rate of para-articular localisation when performed as blind techniques. Ultrasound-guided needle placement is the method of choice for interventional procedures on peripheral joints and for soft tissue injections. Fluoroscopy and computed tomography (CT) are not recommended for these indications due to the application of ionising radiation and the high procedural effort. By contrast, CT and magnetic resonance imaging are preferred for a variety of percutaneous procedures on the spine and sacroiliac joints. The increasing use of these methods for interventional purposes should improve both technical and procedural quality, thus ensuring cost-effectiveness and patient safety.

Humans↗
PubMed1954

[Sacrocoxites].

Explore the source record for details and available documents.

Arthritis↗
PubMed1994

Percutaneous computed tomography-guided stabilization of posterior pelvic fractures.

Nineteen patients with 21 unstable fractures of the posterior pelvic complex were treated with percutaneous computed tomography (CT)-guided posterior stabilization. CT allowed satisfactory visualization of the fracture and direction and length of the screw. It also allowed the authors to perform the procedure percutaneously, while causing only minimal blood loss. CT cuts that showed the best and safest sites for screw placement were selected. The length and direction of the screw was identified, and the skin entry site was determined. The guide pin was inserted across the fracture or disrupted sacroiliac joint; its correct position was confirmed and a cannulated screw was inserted over the pin. In the majority of patients, a pelvic external fixator was applied in the CT suite. Although assessing the deformity was possible, reduction was difficult but ultimately acceptable. All patients maintained reduction of their sacroiliac complex without loss of fixation, and all fractures healed without clinical or radiographic signs of pelvic instability. This technique was not associated with neurologic injury or deep infection. All but 2 patients returned to preinjury levels of activity and function. Two patients had associated injuries that affected their final functional outcome.

Adolescent↗
PubMed1980

A clinical and experimental investigation of occult injuries of the pelvic ring.

Apparently isolated fractures of the pubic rami must be associated with damage elsewhere in the pelvic ring. In a clinical review of 20 patients it was demonstrated that radiographic evidence of isolated fractures of the pubic rami was associated with the increased uptake of technetium polyphosphate on bone scans in either the sacroiliac joints or the acetabulum. The nature of the injury causing increased uptake was evaluated by means of an experimental study creating pelvic injuries in rabbits. Radiographs, bone scans, autoradiographs and histological sections of the pelves of these animals all showed evidence of microavulsion fractures of the subchondral bone mediated through the sacroiliac ligaments and Sharpey's fibres. The associated injuries account for the clinical picture in patients who complain of pain in the hip and sacroiliac region following fractures of the pubic rami. The clinical and radiographic evidence presented clearly demonstrates that an injury at one site in the pelvic ring must be associated with another on the other side of the ring. Furthermore, the technique developed for autoradiography of the animal pelves provides a new and useful tool for further study of injury to bones and ligaments.

Animals↗
PubMed1999

[Radical-preserving surgery in pelvic tumors].

Application of radically-preserving operations for pelvic tumours, including malignant, permits not only to save or prolong the severely ill patients life, but to preserve in majority of them the supportive and motor functions of pelvis. The methods proposed on osteoplastic replacement of the acetabular cavity zone permits to restore the supportive and articulation functions of hip joint even after total resection of the bodies of iliac, pubic and ischiatic bones. According to the clinico-biomechanical investigations data there was established the preservation of static-dynamical functions of pelvis after performance of the branches resection of pubic and ischiatic bones due to compensation possibilities of the sacroiliac joints ligaments, what made possible to leave the performance of osteoplasty after making of radical-preserving tumoral resection, disturbing the pelvic ring integrity in its anterior part.

Acetabulum↗
PubMed2007

A cadaver study of the trochanteric pelvic clamp for pelvic reduction.

OBJECTIVE: The purpose of this study is to evaluate the ability of the trochanteric pelvic clamp to reduce anterior-posterior compression pelvic ring disruptions. DESIGN: Eight fresh-frozen cadavers underwent sequential disruption of the pelvic ring to represent both anterior-posterior compression type II (APC II) and anterior-posterior compression type III (APC III) injury patterns. Reduction with the trochanteric pelvic clamp was performed. Prereduction and postreduction anterior/posterior pelvic displacements were determined radiographically. SETTING: Institutional research laboratory. INTERVENTION: Application of a trochanteric pelvic clamp to reduce a pelvic ring disruption. MAIN OUTCOME MEASURE: Radiographic measurements of anterior and posterior pelvic displacement were evaluated and compared to similar values after reduction with the trochanteric pelvic clamp. RESULTS: The application of the trochanteric pelvic clamp to simulated APC II and APC III pelvic injuries in a cadaver model demonstrated a significant reduction of the anterior pubic diastasis and the posterior disruption of the sacroiliac joint. Anterior pelvic vertical displacement did not improve with application of the trochanteric pelvic clamp. Measurement of symphysis diastasis for APC II injuries was 4.07 cm (+/-0.31) prereduction and 0.38 cm (+/-0.18) postreduction, (P < 0.001); for APC III injuries, 6.32 cm (+/-0.84) prereduction and 1.24 cm (+/-1.01) postreduction, (P < 0.001). For posterior sacroiliac disruptions, APC II injury measurements were 1.81 cm (+/-0.35) prereduction and 0.69 cm (+/-0.32) postreduction (P < 0.001); for APC III injuries, 3.81 cm (+/-1.06) prereduction and 1.86 cm (+/-0.82) postreduction (P = 0.002). At the symphysis pubis, APC II vertical displacement was 0.32 cm (+/-0.36) prereduction and 0.30 cm (+/-0.38) postreduction (P < 0.740); for APC III injuries, 0.5 cm (+/-0.31) prereduction and 0.88 cm (+/-0.53) postreduction (P < 0.098). CONCLUSIONS: The application of the trochanteric pelvic clamp is reliable for obtaining reduction of anterior-posterior compression pelvic injuries in a cadaver model.

Aged↗