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PubMed1997

A thickness map of iliac bone of Korean adults.

The iliac bone is one of the most common donor sites for bone graft. Despite such potential and clinical usefulness, the anthropometric data on the iliac bone are lacking. The purpose of this study is to construct a thickness map that provides the mean iliac bone thickness of its various points and their differences. We studied 58 hip bones (from 23 males and 35 females) from Korean adults. We measured the iliac bone thickness at 26 points, which were positioned at regular intervals on each given iliac bone, using a Techlock GM 21 caliper gauge. The mean thickness of each measuring point of the male and the female, and of the right and the left, was compared with each other through paired t-test; the measurements did not differ significantly. From the anteriorposterior perspective, the region between anterior superior iliac spine (ASIS) and iliac tubercle was relatively thick. However, it became progressively thinner before it reached the sacroiliac articulation. It became thicker again toward the posterior superior iliac spine (PSIS), the thickest area. From the superoinferior perspective of superior iliac crest and inferior acetabulum, the thickness became inferiorly thinner in the anterior part between ASIS and iliac tuberosity. However, in the posterior part between the sacroiliac joint and PSIS, there was no significant difference of thickness. We hope that our thickness map can serve as a practical guide to the choice of an ideal site of the iliac bone for bone graft to obtain desired thickness.

Adult↗

PubMed1996

Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain.

Epidemiologic studies found mechanical low back pain to be the fifth most common reason for visiting a physician. Proteoglycan production is altered with the age of the host and may explain the development of degenerative disk disease. Important clinical low back pain entities reviewed in the literature include exercise-associated degenerative disk disease, sciatica in adults less than 21 years of age, fibromyalgia, apophyseal and sacroiliac joint pain, and sacral insufficiency fractures. No consensus exists among physicians concerning appropriate therapy for low back pain. Return to usual activity is the most effective therapy, according to a recent study. The first decompression operation for spinal stenosis has the best opportunity for a good outcome. Chiropractors are the most expensive health care providers for low back pain patients.

Adult↗

PubMed1997

Diagnostic and classification criteria, clinical and functional assessment, and therapeutic advances for spondyloarthropathies.

Two sets of criteria have been proposed and widely accepted in the last few years for the classification of the whole spectrum of spondyloarthropathy, including the undifferentiated forms. These classification criteria--the Amor criteria and the European Spondyloarthropathy Study Group criteria--are not, however, particularly helpful for diagnosis because they do not include the milder and monosymptomatic forms. Outcomes research in spondyloarthritis is growing, and new instruments have been suggested. An international study group of experts is working to propose a core set of measures to be included in future clinical trials on ankylosing spondylitis. Intrasynovial corticosteroid injections in the sacroiliac joints may represent a valid alternative for patients with inflammatory low back pain that is unresponsive to nonsteroidal anti-inflammatory drugs. Sulfasalazine is an effective therapy for the psoriatic arthritis and peripheral arthritis of ankylosing spondylitis. A recent study has suggested its efficacy in reactive arthritis as well. In reactive arthritis, the use of long-term antibiotic therapy has been proposed and is under study.

Humans↗

PubMed1999

Rheumatologic manifestations of gastrointestinal disorders.

There are many different rheumatic symptoms of gastrointestinal (GI) disorders and a whole range of GI symptoms that occur in rheumatologic disorders. Spondyloarthropathies (SpA) are closely related to the GI tract. Bacterial DNA has been detected in peripheral but not the sacroiliac joints of patients, including enterobacteria; the significance of this finding is not clear yet because antibiotic therapy seems not to be effective. The synovial lymphocyte proliferation of reactive arthritis (ReA) patients to the 60-kD heat-shock protein of Yersinia plays a major role in the immune response. Anti-Klebsiella antibodies are associated with gut lesions in SpA; their significance for the pathogenesis of SpA remains uncertain. ReA patients seem to have an impaired TH1-cytokine response, which might contribute to disease persistence. HLA B27-positive subjects seem to have a low tumor necrosis factor-alpha secretor status, possibly leading to diminished immune responses against certain microbes. In patients with Whipple's disease, Tropheryma whippelii can be cultured from gut biopsy specimens when interleukin-4 is added. The gene for hemochromatosis has been identified. Hepatitis C virus DNA can be found in many patients with cryoglobulinemia. Treatment with interferon-alpha might help in some patients. Effective treatment for primary biliary cirrhosis with ursodeoxycholic acid is not helpful for rheumatic symptoms. The severity of esophageal dysfunction in systemic sclerosis does not correlate with symptoms. GI symptoms do, although not frequently, occur in vasculitides.

Bacterial Infections↗

PubMed2001

New treatment options in spondyloarthropathies: increasing evidence for significant efficacy of anti-tumor necrosis factor therapy.

Tumor necrosis factor-alpha is a major effector and regulatory cytokine, which seems to have an outstanding position in rheumatic and other inflammatory states. Because TNF-alpha has been detected in the inflamed gut and sacroiliac joints of patients with chronic inflammatory bowel diseases and spondyloarthritides, like ankylosing spondylitis, there was need for studies of the efficacy of the modern biologic anti-TNF agents infliximab and etanercept in these diseases. Infliximab is approved for the treatment of Crohn disease. In addition, there are now also positive data for infliximab in the treatment of ankylosing spondylitis and for etanercept and infliximab in the treatment of psoriatic arthritis.

Antibodies, Monoclonal↗

PubMed1998

Diagnostic value of bone and Ga-67 imaging in skeletal tuberculosis.

Tuberculosis (TB) remains a major cause of skeletal infection in many parts of the world. Bone scintigraphy is an excellent screening test for bone lesions and Ga-67 scintigraphy is a useful tool for detecting inflammatory lesions. This study determined the value of bone and Ga-67 scans in patients with skeletal TB. Tc-99m MDP and Ga-67 whole-body scans were performed in 24 patients with proved skeletal TB. Twenty-six TB lesions were found in these 24 patients, 8 in the spine, 5 in the knee, 5 in the wrist, 4 in the ankle, 2 in the elbow, 1 in the finger, and 1 in the sacroiliac joint. Of the 26 TB lesions, Tc-99m MDP bone imaging detected 24 and Ga-67 scans revealed 23. The sensitivity rates were 92% (24 of 26) and 88.5% (23 of 26) for bone scans and Ga-67 scans, respectively. When the scans were evaluated in combination, the detection sensitivity was 96.1% (25 of 26). Two lesions that the bone scan failed to detect were in the spine. Ga-67 imaging failed to detect two spinal lesions and one lesion in the knee. The detection sensitivities of bone and gallium scans were high for skeletal TB, although neither scan was specific for TB lesions. Either the bone or Ga-67 scan can be used in the clinical setting as a convenient screening test to detect multiple sites of bone involvement in TB, and to indicate the sites for further detailed evaluation by CT, MRI, or biopsy.

Bone and Bones↗

PubMed1999

Bone SPECT of the back after lumbar surgery.

PURPOSE: It may be difficult to evaluate back pain in patients who have undergone spinal surgery, because symptoms may be secondary to all the possible abnormalities in patients who have not had surgery plus postoperative complications, including infection, unstable fusion sites, or transfer of biomechanical stresses to other regions. MATERIALS AND METHODS: Sixty-three patients with back pain and a history of lumbar spinal surgery had bone SPECT examinations. Twenty-eight patients had laminectomies, 10 had laminectomies with fusion, 10 had laminectomies with fusion and metallic stabilization devices (3 of which were removed), 7 had fusion without laminectomy, 7 had discectomies, and 1 had a fusion with metallic stabilization but no laminectomy. Eighty-seven percent of the fusions were posterior. The results of SPECT scanning were correlated with surgery, clinical information, and diagnostic radiologic studies. RESULTS: Patients with fusions tended to be scanned further out from the time of surgery than were patients with laminectomy alone or especially discectomy. Bone SPECT excluded bony abnormalities in the operative site in 7 of 63 patients. One hundred thirty-two lesions were uncovered, with facet abnormalities (n = 51) the most common followed by disc space-centered conditions (n = 29), pseudarthrosis (n = 20), sacroiliac joint (n = 18), vertebral body lesions (n = 9), and miscellaneous sites (n = 5). Sixty percent of the abnormalities located in the facets, disc spaces, and vertebral bodies were located in the operative field, whereas 29% were above and 11% were below it. CONCLUSION: Bone SPECT was useful in evaluating these patients to exclude bony lesions or to identify pseudarthrosis, abnormal facets, disc space-centered lesions, and sacroilitis.

Adult↗

PubMed2000

Struma ovarii with hyperthyroidism.

A case of hyperthyroid disease after total thyroidectomy is reported. An initial scintigraph with Tc-99m sodium pertechnetate confirmed the absence of uptake in the neck. The view of the pelvis revealed a rounded area of increased uptake on the left, near the sacroiliac joint (results of bone scintigraphy were negative). A wholebody scan with iodine-131 confirmed a struma ovarii that was bilateral, which occurs in 5% to 10% of patients with this condition.

Aged↗

PubMed2001

Bladder diverticulum simulating a pelvic metastasis on a Tc-99m HDP bone scan.

Carcinoma of the prostate was diagnosed in a 74-year-old man. A Tc-99m HDP bone scan was performed as part of the initial staging process. The findings on the bone scan were normal except for an area of increased tracer uptake projected over the left sacroiliac joint, which was seen best on the anterior view. When this was investigated further, the findings of a plain radiograph were inconclusive. Computed tomography showed a large diverticulum projecting from the left side of the bladder; the tracer retained within this diverticulum had produced the findings on the bone scan.

Aged↗

PubMed2004

Young athletes with low back pain: skeletal scintigraphy of conditions other than pars interarticularis stress.

PURPOSE: Skeletal scintigraphy is an important method for showing evidence of stress injuries affecting the partes interarticulares of young athletes with low back pain. Other etiologies of low back pain may also cause uptake abnormalities in these patients. How often do the results of skeletal scintigraphy support diagnoses other than stress injuries to the partes interarticulares and what are these diagnoses? MATERIALS AND METHODS: We retrospectively reviewed the records of 209 young patients (149 females, 60 males; age range: 8-21 years, mean: 15.7 years) with low back pain and no previously treated vertebral condition who were consecutively referred from a sports medicine clinic to skeletal scintigraphy. RESULTS: Sites of high uptake supportive of diagnoses other than pars interarticularis stress were shown in 36 (17%) of the 209 patients. Other diagnoses supported by skeletal scintigraphy included stress at the articulation between a transitional vertebra and the sacrum, injuries to the vertebral body ring apophysis, sacral fracture, spinous process injury, and sacroiliac joint stress. CONCLUSION: Skeletal scintigraphy shows uptake abnormalities supportive of diagnoses other than pars interarticularis stress in a significant number of young patients with low back pain. The uptake abnormalities shown are usually stress-related in this select population.

Adolescent↗

PubMed1996

Techniques for reduction and posterior fixation through the anterior approach.

Pelvic fractures, especially those of a Malgaigne type, frequently occur in patients who are polytraumatized. Sacroiliac disruption reflects a massive, disruptive energy force with concurrent soft tissue injury. Fixation through an anterior approach facilitates the accurate and stable fixation and avoids many soft tissue wound problems associated with open anterior approaches. The absolute indication for the approach is a posterior disruption of the sacroiliac joint with or without an iliac wing fracture that is unreducible by closed reduction techniques.

Bone Plates↗

PubMed1999

Bilateral posterior pelvic resection osteotomies in patients with exstrophy of the bladder.

This paper describes a modification of bilateral posterior iliac osteotomies for bladder exstrophy, in which a strip of ilium is resected subperiosteally lateral to the sacroiliac joints, allowing easier anterior closure with less breakdown compared with traditional osteotomies. Thirty-one children underwent repair of bladder exstrophy between 1974 and 1994. Orthopaedic procedures included: closed reduction and cast application in the newborn period (four patients), classic bilateral posterior iliac osteotomies (12 patients), and bilateral posterior resection osteotomies (15 patients). Dehiscence occurred after one closed reduction, five classic osteotomies, and one resection osteotomy. Urinary continence was obtained in four patients who underwent closed reduction, nine patients who underwent classic posterior osteotomies, and nine patients who underwent posterior resection osteotomies.

Bladder Exstrophy↗

PubMed2002

Computer-assisted fracture reduction of pelvic ring fractures: an in vitro study.

A newly developed software module for computer-assisted surgery based on a commercially available navigation system allows simultaneous, independent registration of two fragments and real-time navigation of both fragments while reduction occurs. To evaluate the accuracy three fracture models were used: geometric foam blocks, a pelvic ring injury with disruption of the symphysis and the sacroiliac joint, and a pelvic ring fracture with symphysis disruption and a transforaminal sacral fracture. One examiner did visual and navigated reduction and in all experiments the end point was defined as anatomic reduction. Residual displacement was measured with a magnetic motion tracking device. The results revealed a significantly increased residual displacement with navigated reduction compared with visual control. The differences were low, averaging 1 mm for residual translation and 0.7 degrees for the residual rotation, respectively. Residual displacement was small in both set-ups and may not be clinically relevant. Additional development of the software prototype with integration of surface registration may lead to improved handling and facilitated multifragment tracking. Use in the clinical setting should be possible within a short time.

Biomechanical Phenomena↗

PubMedDate not supplied

Transiliac exposure of the sacrum: a new surgical approach.

Biopsy or surgical approach of the midsacrum is difficult from the anterior, posterior, or superior approaches. I describe a lateral approach removing a piece of posterior ilium and entering the midsacrum through the sacroiliac joint. The approach was successfully used in an 8-year 7-month-old girl for the removal of an osteoid osteoma. The patient was monitored for 9 years 6 months until skeletally mature (age 18 years 1 month). This approach is applicable for biopsy or removal of benign tumors in the midsacrum in adults. Some developmental asymmetry of the pelvis may develop if it is used in children.

Bone Neoplasms↗

PubMedDate not supplied

Sacral pneumatocysts: CT appearance.

OBJECTIVE: CT findings of pneumatocyst of the sacrum have been evaluated. MATERIALS AND METHODS: Eight patients, six men and two women, with pneumatocysts of the sacrum were studied. Selective CT with 4 and 2 mm thickness was performed, and the intralesional attenuation coefficients were measured. RESULTS: All patients showed subchondral pneumatocysts of the sacrum with sclerotic margins related to the synovial portion of the sacroiliac joint. Intraarticular gas was found in six cases, and evidence of communication between the lesion and the joint was observed in two patients. Signs of bone degeneration were present in all cases. CONCLUSION: Pneumatocyst of the sacrum is a benign bone lesion associated with arthritic changes.

Adult↗

PubMed1988

Pull-out strengths of bone screws at various sites about the pelvis--a preliminary study.

The pull-out strength of both cortical and cancellous screws from bone at various sites about cadaveric pelves was examined. No significant differences were seen between cortical or cancellous screws at similar sites with the possible exception of the sacroiliac joint. Pull-out strengths were best correlated to the depth of bone at a particular screw hole. For practical purposes, the strongest sites are in the thick buttress of bone along the iliopubic column.

Acetabulum↗

PubMed1993

Fixation of transforaminal sacrum fractures: a biomechanical study.

A transforaminal fracture of the sacrum usually represents the posterior part of an unstable pelvic ring fracture and is associated with a high rate of neurological complications. Nerve root decompression combined with open reduction and internal fixation (ORIF) can be beneficial. Present fixation methods have the disadvantage of extensive bilateral posterior approaches and fixation across the sacroiliac joint. Three methods of internal fixation of the sacrum were compared in a biomechanical study using six fresh pelvic specimens. A fracture model consisting of a transforaminal osteotomy combined with a symphysis disruption in a single-leg stance was used. Standard Harrington sacral bars, an internal fixator, and a newly developed stabilization technique using adapted standard AO/ASIF small-fragment implants ("local osteosynthesis") were compared. Three-dimensional measurement of the fragment movement (goniometer system) showed a maximum displacement of 4.0-4.5 mm after maximal loading (990-1,181 N) and no differences among the implants. The failure load related to body weight was 85% for sacral bars, 74% for the local osteosynthesis, and 58% for the internal fixator. Major displacement under loading was observed in the direction of the foramen axis. The new osteosynthesis technique showed strength comparable to the clinically successfully applied method of stabilization with sacral bars. It adds the theoretical advantage of a minimized approach, without fixation and thus without involvement of the SI joints.

Biomechanical Phenomena↗

PubMed1993

A case of traumatic spino-pelvic dissociation.

A case of traumatic spino-pelvic dissociation is reported. The unusual fracture pattern (grade III-B open left sacroiliac joint fracture dislocation, Denis type I longitudinal right sacral fracture, transverse sacral fracture at the S3-4 level, and a left comminuted pelvic wing fracture) led to a complete dislocation of the spine from the pelvis, transection of the left S1 and S2 nerve roots, and intrusion of the cranial portion of the spine into the pelvis. The patient underwent open reduction internal fixation of the spine and the pelvis in combination with general surgical management. Two years postinjury, the patient lives independently and walks with one cane.

Adult↗