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PubMed2002

[A morphologic evaluation of the sacroiliac joint and plate fixation on a pelvic model using a S1 pedicular screw, transiliosacral screws, and a compression rod for sacroiliac joint injuries].

OBJECTIVES: Morphological measurements were performed, of the articular surfaces and adjacent bone structures of the sacroiliac joint on dry bone specimens to determine the projection of the sacroiliac joint on the outer table of the posterior ilium. In addition, the effect of plate fixation using transiliosacral screws and a pedicular screw on S1 attached via a compression rod was evaluated on pelvic models to be applied in sacroiliac joint injuries. METHODS: Quantitative caliper measurements of dry bone specimens including 20 os coxae and 10 sacrum were made on the articular surfaces of the sacrum and the posterior ilium, thickness of the posterior iliac bone at different levels, and the distance from the outer walls of S1 and S2 foramina to the sacral facies articularis. After the construction of a plate matching the projection of the lateral sacral mass on the outer table of the posterior ilium, four transiliosacral screws were applied lateral to the sacral foramina on pelvic models. A pedicular screw sent to S1 was attached to the plate with a threaded compression rod. RESULTS: The mean values for the articular surface of (i) the posterior ilium were 53.3 mm (base length), 38.5 mm (height), and 56.2 mm (the distance from the anterior margin of the articular surface to the spina iliaca posterior superior); and (ii) the sacrum, 57.2 mm (base length), and 34.6 mm (height). The mean thickness of the posterior ilium was 19.2 mm, and the mean distance from the lateral walls of the sacral foramina at S1 and S2 levels to the articular surface was 21.7 mm. For the deduced projection, the perpendicular line from the middle of the base was found to be the safe zone for screw applications. CONCLUSION: Through a plate applied matching the projection area, multiple screws may be sent lateral to S1 and S2 foraminal levels without damage to the sacral neural and surrounding vital structures. A stable fixation can be achieved by combining the plate/screw system with a S1 pedicular screw.

Bone Plates↗
PubMedDate not supplied

Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint.

BACKGROUND CONTEXT: The sacroiliac joint is known to be a possible cause of chronic low back pain, but the diagnosis and treatment of disorders of the sacroiliac joint have been difficult and controversial. PURPOSE: To describe the outcome of sacroiliac joint arthrodesis for sacroiliac joint disorders, with the hypothesis that sacroiliac arthrodesis leads to improved postoperative function. STUDY DESIGN/SETTING: Consecutive case series performed in an academic medical institution. PATIENT SAMPLE: The patient population consisted of 20 patients undergoing sacroiliac joint arthrodesis between December 1994 and December 2001. Patients undergoing concomitant procedures at the time of sacroiliac joint arthrodesis were excluded. The 3 men and 17 women in the study group had an average age of 45.1 years (range 21.8-66.4 years), a mean duration of symptoms of 2.6 years (range 0.5-8.0 years), and a mean follow-up period of 5.8 years (range 2.0-9.0 years). OUTCOME MEASURES: Outcome measures included general health and function, clinical evaluation, and radiographic assessment. METHODS: For all 20 patients, nonoperative treatment had failed, and for all, the diagnosis was confirmed by pain relief with intraarticular sacroiliac joint injections under fluoroscopic guidance. Sacroiliac joint arthrodesis (via a modified Smith-Petersen technique) was recommended only when a positive response to the injection was noted, and patients had recurrence of symptoms after the initial positive response. Preoperative and postoperative general health and function were assessed via the 36-item Short-Form (SF-36) Health Survey and American Academy of Orthopaedic Surgeons (AAOS) Modems Instrument, which were collected prospectively. Medical records and plain radiographs were reviewed retrospectively to determine the clinical and radiographic outcome. RESULTS: Multiple etiologies of sacroiliac symptoms were observed: sacroiliac joint dysfunction (13 patients), osteoarthritis (5 patients), and spondyloarthropathy and sacroiliac joint instability (1 each). Seventeen patients (85%) had solid fusion. Fifteen patients (75%) completed preoperative and postoperative SF-36 forms. Significant (p< or =.05) improvement occurred in the following categories: physical functioning, role physical, bodily pain, vitality, social functioning, role emotional, and neurogenic and pain indices. Improvement (not statistically significant) was also noted in general and mental health. CONCLUSIONS: For carefully selected patients, sacroiliac arthrodesis appears to be a safe, well-tolerated, and successful procedure, leading to significant improvement in functional outcome and a high fusion rate. To the authors' knowledge, the current report is the largest series to document the functional and radiographic outcome of sacroiliac joint arthrodesis.

Adult↗
PubMed2005

A systematic review of sacroiliac joint interventions.

BACKGROUND: The sacroiliac joint is an accepted source of low back pain with or without associated lower extremity symptoms. The diagnosis and management of sacroiliac joint pain and the role of interventional techniques have been controversial. OBJECTIVE: To evaluate the clinical usefulness of sacroiliac joint interventions in the diagnosis and management of sacroiliac joint pain. STUDY DESIGN: A systematic review using the criteria as outlined by the Agency for Healthcare Research and Quality (AHRQ), Cochrane Review Group Criteria, and QUADAS criteria for diagnostic studies. METHODS: The databases of EMBASE and MEDLINE (1966 to November 2004), and Cochrane Review were searched. The searches included systematic reviews, narrative reviews, prospective and retrospective studies, and cross-references from articles reviewed. The search strategy included sacroiliac joint pain and dysfunction, sacroiliac joint injections, interventions, and radiofrequency. RESULTS: The results of this systematic evaluation showed that for diagnostic purposes, there is moderate evidence showing the accuracy of comparative, controlled local anesthetic blocks. Prevalence of sacroiliac joint pain was demonstrated to be 10% to 19% by a double block paradigm. The false-positive rate of single, uncontrolled, sacroiliac joint injections was reported as 20%.For therapeutic purposes intraarticular sacroiliac joint injections with steroid and radiofrequency neurotomy were evaluated. Based on this review, there was moderate evidence for short-term and limited evidence for long-term relief with intraarticular sacroiliac joint injections. Evidence for radiofrequency neurotomy in managing sacroiliac joint pain was limited or inconclusive. CONCLUSIONS: The evidence for the specificity and validity of diagnostic sacroiliac joint injections was moderate.The evidence for therapeutic intraarticular sacroiliac joint injections was limited to moderate. The evidence for radiofrequency neurotomy in managing chronic sacroiliac joint pain was limited.

Journal Article↗
PubMedDate not supplied

Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint.

OBJECTIVE: To investigate the efficacy of periarticular corticosteroid treatment of the sacroiliac joint (SIJ) in non-spondylarthropathic patients with chronic low back pain in the region of the SIJ in a double blind, controlled study. METHODS: Twenty-four consecutive non-spondylarthropathic patients with chronic pain in the region of the SIJ entered the study. Thirteen patients were treated with a periarticular injection of methylprednisoloneacetate and lidocaine (MP group) of the SIJ, whereas 11 patients received isotonic sodium chloride and lidocaine. Clinical assessment at the onset of the study and after one month included the patient's estimation of pain in the region of the SIJ by the visual analogue scale (VAS) and by a pain index, which was calculated from tenderness and stressing tests on the SIJ. RESULTS: At the one month's follow-up examination both the VAS (p = 0.047) and the pain index (0.017) had improved significantly in the MP group compared with the non-MP group. CONCLUSION: These results suggest that periarticular injection of methylprednisolone may be effective in the treatment of pain in the region of the SIJ in non-spondylarthropathic patients.

Adult↗
PubMedDate not supplied

Sacroiliac joint pain.

The sacroiliac joint is a source of pain in the lower back and buttocks in approximately 15% of the population. Diagnosing sacroiliac joint-mediated pain is difficult because the presenting complaints are similar to those of other causes of back pain. Patients with sacroiliac joint-mediated pain rarely report pain above L5; most localize their pain to the area around the posterior superior iliac spine. Radiographic and laboratory tests primarily help exclude other sources of low back pain. Magnetic resonance imaging, computed tomography, and bone scans of the sacroiliac joint cannot reliably determine whether the joint is the source of the pain. Controlled analgesic injections of the sacroiliac joint are the most important tool in the diagnosis. Treatment modalities include medications, physical therapy, bracing, manual therapy, injections, radiofrequency denervation, and arthrodesis; however, no published prospective data compare the efficacy of these modalities.

Arthralgia↗
PubMed2001

Sacroiliac joint syndrome.

The sacroiliac joint has long been considered to be a potential source of low back and/or buttock pain with or without lower extremity symptoms. Until recently, supportive evidence for this disorder has been empirical as it was solely derived from information garnered from patients who obtained successful treatment for a constellation of signs, symptoms and examination findings believed to be indicative of sacroiliac joint syndrome. Due to this fallacious reasoning, successful treatment denotes a correct diagnosis; many of the concepts espoused during the past few decades have been predicated upon spurious data. With the advent of and systematic utilization of fluoroscopically guided diagnostic sacroiliac joint blockade specific epidemiologic, symptomatic, examination, diagnostic, and outcome data have been derived. This review describes current concepts and provides information that expounds and, in some instances, supplants prior held notions about this disorder.

Journal Article↗
PubMedDate not supplied

Morphometric analysis of the sacroiliac joint.

The sacroiliac (SI) joint is the point of articulation between the sacrum and the innominate bone of the pelvis. The anterior portion is synovial, and the posterosuperior portion is a typical syndesmosis. The SI joint may be affected by inflammatory or degenerative changes which include narrowing, minor sclerosis and erosion. Alterations in the anatomy of this joint may be involved in causing lower back pain. Radiodiagnosis of the width of the articular space is one of the tools utilized to evaluate the normal state of any joint. Scanty data is available on the morphometric characteristics of the SI joint. Therefore, the articular width space of the SI joint was measured to define its normal size in relation to age and sex. The study included 198 x-rays of the abdomen, in anteroposterior projection, of 112 males and 86 females (age range: 17 to 91 yrs). Individual films were divided into four classes according to age (< 50; 50-59; 60-69; > 70). The articular space of the SI joint is made up of a lateral and a medial part: the first representing the anterior articular space; the latter the posterior one. The anterior articular space of both the right and left joint, which was more easily visible and measurable was measured at the medium and inferior levels. Measurements were taken from the radiograms using a semiautomatic computerized system (Videoplan II, Image Analysis system-Kontron). The mean value of the articular space width a the medium and inferior levels, according to age group, was measured in both the males and females. The values obtained were studied using variance analysis. No significant differences were found in the mean values of the articular space width at the SI joint, when males and females were compared in relation to age. Moreover, the articular space width diminished with increasing the age. This fact was not always statistically significant.

Adolescent↗
PubMed1993

Sacroiliac joint pyarthrosis.

Sacroiliac (SI) joint infection is rare, and symptoms are idiosyncratic and often confusing. This paper reviews six cases of SI joint infection with regard to their clinical manifestations, diagnostic imaging, and treatment. The six patients were seen over a 15-year period and had a mean age of 16.2 years and a mean follow-up of 44.2 months. The most common presenting symptom was fever (71.4%). The most common physical findings were elevated temperature and limited ipsilateral hip motion. In most cases the white blood cell count and erythrocyte sedimentation rate were elevated, and 71% of the cases had positive blood cultures. The most specific imaging study was the technetium bone scan. All patients were treated with 3 to 6 weeks of appropriate antibiotics and were asymptomatic and had a normal physical examination on follow-up. Routine anteroposterior roentgenograms of the pelvis demonstrated sclerosis of the affected SI joint in one third of the cases. There appeared to be no long-term sequelae in this group of patients.

Acute Disease↗
PubMed2003

Is fluoroscopy necessary for sacroiliac joint injections?

The use of sacroiliac joint injection has been a steadily increasing for therapeutic and diagnostic purposes in the United States. Because of the conceivably easy accessibility of sacroiliac joint and reported low incidence of morbidity, the sacroiliac joint injection is felt to be a procedure that maybe performed easily in the office based setting. While this procedure may be common, the sacroiliac joint injection is not performed accurately without the aide of imaging. Further complicating the issue of sacroiliac joint injections is the lack of specific and reliable diagnostic testing. Clinical evaluation and imaging studies are often unreliable and practitioners often mistakenly assume that pain over the posterior superior iliac spine is pathognomonic for sacral joint pain. In addition, referral patterns are unreliable and bedside testing is often non-diagnostic. Sixty patients undergoing sacroiliac joint injections were studied. Sacroiliac joint injections were placed blindly then examined under fluoroscopy for accurate needle placement. The needle was placed by a single this experienced spinal injectionist. Results of blind needle placement revealed that only 5 of 60 patients were felt to have needle placement approximating a therapeutic point of contact with the sacroiliac joint. Furthermore, the posterior superior iliac spine, was found to be a poor indicator of sacroiliac joint anatomic access. The results of this study show that accurate placement of sacroiliac joint injections is successful without fluoroscopy in only 12% of the patients, even in experienced hands.

Journal Article↗
PubMed2003

Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests.

Research suggests that clinical examination of the lumbar spine and pelvis is unable to predict the results of diagnostic injections used as reference standards. The purpose of this study was to assess the diagnostic accuracy of a clinical examination in identifying symptomatic and asymptomatic sacroiliac joints using double diagnostic injections as the reference standard. In a blinded concurrent criterion-related validity design study, 48 patients with chronic lumbopelvic pain referred for diagnostic spinal injection procedures were examined using a specific clinical examination and received diagnostic intraarticular sacroiliac joint injections. The centralisation and peripheralisation phenomena were used to identify possible discogenic pain and the results from provocation sacroiliac joint tests were used as part of the clinical reasoning process. Eleven patients had sacroiliac joint pain confirmed by double diagnostic injection. Ten of the 11 sacroiliac joint patients met clinical examination criteria for having sacroiliac joint pain. In the primary subset analysis of 34 patients, sensitivity, specificity and positive likelihood ratio (95% confidence intervals) of the clinical evaluation were 91% (62 to 98), 83% (68 to 96) and 6.97(2.70 to 20.27) respectively. The diagnostic accuracy of the clinical examination and clinical reasoning process was superior to the sacroiliac joint pain provocation tests alone. A specific clinical examination and reasoning process can differentiate between symptomatic and asymptomatic sacroiliac joints

Adult↗
PubMed2006

Multifocal skeletal tuberculosis involving the lumbar spine and a sacroiliac joint: MR imaging findings.

Sacroiliac joint tuberculosis is rare; its coexistence with vertebral tuberculosis is even rarer, with only a few such patients reported in the literature. We present magnetic resonance (MR) imaging findings of a patient with vertebral and sacroiliac joint tuberculosis, who had paravertebral, iliopsoas, and buttock abscesses accompanied by a gluteal pus-draining sinus tract. MR imaging is the most sensitive and specific imaging modality for diagnosing sacroiliitis at its early stage. Sacroiliac joint tuberculosis can reach advanced stages with extensive joint destruction and periarticular abscesses if diagnosis and treatment are delayed. A high index of clinical suspicion is required for an early diagnosis. The addition of a coronal SPIR T2-weighted sequence to the routine MR imaging evaluation of patients studied for lumbar disk disease may be useful for recognizing sacroiliac joint pathology at an earlier stage.

Aged↗
PubMed1997

Radiology of the sacroiliac joint.

STUDY DESIGN: Radiology of the sacroiliac joint was investigated by obtaining different and multiple radiographs of cadaveric pelves marked with solder metal wire and radiopaque paint. OBJECTIVES: To demonstrate the orientation of the sacroiliac joint on various, radiographic views. SUMMARY OF BACKGROUND DATA: Interpretation of the sacroiliac joint projection on plain radiography is difficult. It requires an understanding and appreciation of its components and their orientation. Emphasizing the definition of the orientation of the plane of the joint on the different projection views of the sacroiliac joints can aid the orthopaedic surgeon in obtaining the proper radiographs and in the proper interpretation of the different radiographic views. METHODS: Nineteen sacroiliac joints from 10 cadaveric pelves, 5 male and 5 females were studied. Each joint was found to be composed of three portions: anterosuperior, middle, and posteroinferior portions, each lying in a different plane. Each sacroiliac joint was marked with solder wires and radiopaque paint to define the orientation of each of the three portions of the joint on radiographs. The following radiographic projection views were taken for each joint anteroposterior, lateral, inlet, craniocaudal axial, outlet, lithotomy and oblique views. For the oblique views, the angulation of the x-ray tube needed to view each portion of the joint tangentially was recorded. RESULTS: There was a wide variation in the orientation of the planes of the joint portions between the right and the left sides as well as between different pelves. Although the twisting of the plane of the whole joint produced by the successive examination of the portions could be either internal or external, it was the same bilaterally in a given specimen. The outlet and lithotomy views provided the best tangential representation of the two sacroiliac joints on one film. CONCLUSION: The sacroiliac joint is composed of three portions oriented in different planes. To study the sacroiliac joints, it seems desirable to obtain an anteroposterior view of the pelvis with the patient in a lithotomy position; then, if needed, each joint can be radiographed separately by using oblique views. It is important to not that the plane of the articular portion of the joint can be directed from anterolateral to posteromedial, and therefore, the oblique views should be obtained accordingly.

Aged↗
PubMed2004

Development and validation of a periarticular injection technique of the sacroiliac joint in horses.

REASONS FOR PERFORMING STUDY: Sacroiliac joint osteoarthritis has been recognised as a significant cause of poor performance in competition and racehorses. Reliable diagnostic tools are currently lacking. The diagnosis has been based typically on exclusion of other possible causes of poor performance, back pain and hindlimb lameness. OBJECTIVES: To develop a safe, reliable and minimally invasive periarticular or intra-articular injection technique of potential use for diagnosis and therapy of sacroiliac joint disease in horses. METHODS: Twenty-six horses were used to develop and assess a medial approach to the sacroiliac joint with a 15 gauge, 25 cm long spinal needle. In Part I, the cadaveric study, the spinal needle was introduced cranial to the contralateral tuber sacrale and advanced along the medial aspect of the ipsilateral iliac wing until the dorsal surface of the sacrum was encountered. One ml methylene blue (MB) was injected in both sacroiliac joint regions of the sacropelvic specimens. The location of MB-stained tissues relative to the sacroiliac joints was recorded after dissection and disarticulation of the sacroiliac joint. In Part II, the in vivo study, 18 horses were used to validate the in vivo application of the sacroiliac joint injection technique. Horses were restrained in stocks and sedated in preparation for needle placement. One ml MB was injected bilaterally prior to euthanasia. Stained tissues were identified and recorded at necropsy. Successful joint injections were characterised as having MB located intra-articularly or < or = 2 cm periarticularly from the sacroiliac joint margin and localised to the middle or caudal third of the sacroiliac joint. RESULTS: Intra-articular MB was not observed in any specimen. However, MB-stained tissue was identified periarticularly in all injection sites (n = 48). Based on the predetermined success criteria, 96% of the methylene blue depots were located at the middle or caudal third of the sacroiliac joint. Dye-stained tissue was located < or = 2 cm from the sacroiliac joint margins in 88% of the specimens. Median distance of the MB from the sacroiliac joint margins was 1.0 cm (range 0.2-3.8 cm). The overall success rate considering both location and distance of the MB-stained tissue relative to sacroiliac joint margins was 83% (40 of 48 joints). CONCLUSIONS: The injection technique provides a reliable, easy to perform and consistent access to the medial periarticular aspect of the sacroiliac joint. POTENTIAL RELEVANCE: The described injection technique has the potential for both diagnostic and therapeutic applications in the medical management of equine sacroiliac joint disease. Further investigation is necessary to evaluate clinical efficacy and potential adverse effects.

Animals↗
PubMed1998

Mechanical behavior of the female sacroiliac joint and influence of the anterior and posterior sacroiliac ligaments under sagittal loads.

OBJECTIVE: The purpose of this study was to examine the mechanical behaviour of the female sacroiliac joint and the effects of its two major ligaments to joint stability. DESIGN: A cadaveric model was used to study the mechanical behaviour of the sacroiliac joints, and sequential dissection was performed to examine the contribution of the anterior and posterior sacroiliac ligaments in joint stability. BACKGROUND: Instability of the sacroiliac joints have been suspected as a possible cause of low back pain. Despite several investigations on joint anatomy and joint mobility, its stabilising mechanism is still not clear. METHODS: Four fresh cadaveric specimens of the female pelvis were tested on an Instron material testing machine. Eccentric compressive force of 60% of the subject's body weight was applied to the pelvis through the sacrum. Relative three-dimensional six-degree-of-freedom movement at the left sacroiliac joints was recorded with a specially designed motion tracking device. The device has an accuracy of 0.01 mm and is compact enough to be mounted across the joint. The test was repeated after sequential selective dissection of the bilateral anterior, and then posterior sacroiliac ligaments. RESULTS: Rotation up to 1.2 degrees and translation up to 0.9 mm were measured from the intact specimens. Lateral rotation, which tended to open the top portion of the joint, and sacral nutation were the primary rotations. On average, the rotation angles increased 10% when either the anterior or posterior ligaments were cut, and 30% when both ligaments were cut. CONCLUSIONS: Lateral rotation and nutation rotation of the sacrum were found to be the predominant motion, though the values were limited to less than 1.2 degrees. Both the anterior and posterior sacroiliac ligaments were found to play an important role in resisting rotations at the joints.

Journal Article↗
PubMed2006

The sacroiliac joint: anatomy, physiology and clinical significance.

The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and function, diagnostic indicators of SIJ-mediated pain, and therapeutic considerations. The SIJ is a true diarthrodial joint with unique characteristics not typically found in other diarthrodial joints. The joint differs with others in that it has fibrocartilage in addition to hyaline cartilage, there is discontinuity of the posterior capsule, and articular surfaces have many ridges and depressions. The sacroiliac joint is well innervated. Histological analysis of the sacroiliac joint has verified the presence of nerve fibers within the joint capsule and adjoining ligaments. It has been variously described that the sacroiliac joint receives its innervation from the ventral rami of L4 and L5, the superior gluteal nerve, and the dorsal rami of L5, S1, and S2, or that it is almost exclusively derived from the sacral dorsal rami. Even though the sacroiliac joint is a known putative source of low back and lower extremity pain, there are few findings that are pathognomonic of sacroiliac joint pain. The controlled diagnostic blocks utilizing the International Association for the Study of Pain (IASP) criteria demonstrated the prevalence of pain of sacroiliac joint origin in 19% to 30% of the patients suspected to have sacroiliac joint pain. Conservative management includes manual medicine techniques, pelvic stabilization exercises to allow dynamic postural control, and muscle balancing of the trunk and lower extremities. Interventional treatments include sacroiliac joint, intra-articular joint injections, radiofrequency neurotomy, prolotherapy, cryotherapy, and surgical treatment. The evidence for intra-articular injections and radiofrequency neurotomy has been shown to be limited in managing sacroiliac joint pain.

Biomechanical Phenomena↗
PubMed2002

Facet blocks and sacroiliac joint injections.

Facet and sacroiliac joint pathology are not an uncommon cause of back or neck pain. Imaging-guided techniques provide ready access to these synovial joints. Percutaneous injection of the facet or sacroiliac joints yields important diagnostic information as to whether or not the interrogated joint is involved in the patient's pain syndrome. The injection of a steroid-anesthetic mixture into these joints is capable of providing significant, albeit temporary, pain relief.

Back Pain↗