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At least 73 records · Page 4Linked to original sources
PubMed1996

Projection of the S2 pedicle onto the posterolateral surface of the ilium. A technique for lag screw fixation of sacral fractures or sacroiliac joint dislocations.

STUDY DESIGN: This study analyzed the sacroiliac articulation at the level of the second sacral vertebra (S2). Anthropometric measurements were performed on 20 cadaveric pelves to determine the optimal starting point for lag screw fixation of the sacroiliac joint at S2. OBJECTIVES: The measurements were utilized to identify a region on the outer table of the posterior ilium which will provide a starting point for consistent safe placement of a lag screw across the sacroiliac joint into the ala of S2. SUMMARY OF BACKGROUND DATA: Previous studies have defined the optimal starting point on the outer table of the ilium for the projection of lag screws into the ala of S1. No data are available for lag screw fixation of the sacroiliac joint at S2. METHODS: Twenty human cadaveric pelves, disarticulated at the sacroiliac joint and fixed in a holding frame designed to maintain the sacrum and ilium in anatomic reduction, were utilized to identify a point on the outer table of the posterior ilium at which an interfragmentary screw could be inserted into the center of the pedicle of the second sacral vertebra. RESULTS: The starting point on the posterolateral ilium for screw insertion into the center of the S2 pedicle was found to exist 1.5 +/- 0.31 cm superior and 2.5 +/- 0.3 cm posterior to the apex of the greater sciatic notch only when the screw or guide pin was advanced at an angle perpendicular to the long axis of the sacrum. CONCLUSION: During lag screw fixation of posterior pelvic ring disruptions, aberrant screw placement may impose considerable risk to adjacent vascular, visceral, or neural structures. After anatomic reduction of the sacroiliac joint, safe and accurate screw fixation can be achieved by utilizing the starting point and insertion trajectory described in this paper.

Bone Screws↗
PubMed1996

The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome.

STUDY DESIGN: A prospective study was done to assess the diagnostic value of radionuclide imaging (bone scan) in the evaluation of sacroiliac joint syndrome OBJECTIVES: To determine the sensitivity and specificity of radionuclide imaging in establishing a diagnosis of sacroiliac joint syndrome in patients with low back pain. SUMMARY OF BACKGROUND DATA: There is no pathognomonic symptom or sign to establish the diagnosis of sacroiliac joint syndrome. It has been accepted that confirmation of sacroiliac joint syndrome requires relief of pain, a positive response to a sacroiliac joint block. Bone scanning has been proposed as a useful imaging technique to evaluate for sacroiliac joint syndrome. The authors explored the use of nuclear imaging as a cost-effective and noninvasive technique in the diagnostic algorithm of sacroiliac joint syndrome. METHODS: Patients presenting to the author's Spine Center with complaints of low back pain including the region of the sacral sulcus were screened for inclusion into this study. Positive response to three provocative Sacroiliac joint maneuvers was requisite, two of which had to be Patrick's test and pain with palpation over the sacral sulcus. Patients who met these criteria were entered into a physical therapy program comprised of lumbar spine stabilization techniques and excluded any interventions considered specific for sacroiliac joint syndrome. Those whose symptoms failed to improve with this program underwent bone scan and fluoroscopically guided sacroiliac joint block. Response to sacroiliac joint block was assessed with pre- and post-block visual analog scale scores completed by the patient. A reduction of the VAS rating by at least 80% was considered a positive response to sacroiliac joint block. RESULTS: Fifty consecutive patients met the author's criteria and underwent bone scan and sacroiliac joint block. Thirty-one patients who had positive responses to sacroiliac joint block comprised the positive sacroiliac joint block group. Nineteen patients had less than 80% pain reduction with sacroiliac joint block and were labeled the negative sacroiliac-joint block group. Four patients had positive bone scans, all of whom were in the positive sacroiliac joint group. CONCLUSIONS: The results demonstrated very low sensitivity and high specificity of nuclear imaging in the evaluation of sacroiliac joint syndrome. The authors do not recommend bone scan in the diagnostic algorithm for sacroiliac joint syndrome.

Adolescent↗
PubMed1996

The value of medical history and physical examination in diagnosing sacroiliac joint pain.

STUDY DESIGN: This prospective study evaluated the diagnostic utility of historically accepted sacroiliac joint tests. A multidisciplinary expert panel recommended 12 of the "best" sacroiliac joint tests to be evaluated against a criterion standard of unequivocal gain relief after an intra-articular injection of local anesthetic into the sacroiliac joint. OBJECTIVES: To identify a single sacroiliac joint test or ensemble of test that are sufficiently useful in diagnosing sacroiliac joint disorders to be clinically valuable. SUMMARY OF BACKGROUND DATA: No previous research has been done to evaluate any physical test of sacroiliac joint pain against an accepted criterion standard. METHODS: Historical data was obtained, and the 12 tests were performed by two examiners on 85 patients who subsequently underwent sacroiliac joint blocks. Ninety percent or more relief was considered a positive response, and less then 90% relief was considered a negative response. RESULTS: There were 45 positive and 40 negative responses. No historical feature, none of the 12 sacroiliac joint tests, and no ensemble of these 12 tests demonstrated worthwhile diagnostic value. CONCLUSION: Sacroiliac joint pain is resistant to identification by the historical and physical examination data from tests evaluated in this study.

Adolescent↗
PubMed1996

Anatomic considerations for posterior approach to the sacroiliac joint.

STUDY DESIGN: This anatomic study describes a new intraosseous, posterior approach to the sacroiliac joint. OBJECTIVES: To define a transosseous approach to the sacroiliac joint in which a triangular bony window is raised on the posterosuperior aspect of the ilium that provides improved access to the sacroiliac joint for posterior fusion. SUMMARY OF BACKGROUND DATA: A posterior approach to the sacroiliac joint has been widely used for debridement of infectious diseases and for fusion. Most conventional approaches to the sacroiliac joint are interosseous, and there is a relative lack of information on transiliac approaches. METHODS: The projection of the sacroiliac joint on the outer table of the ilium and the thickness of the posterior ilium forming part of the sacroiliac joint were determined in 15 cadaveric pelves. A right angle, triangular bony window was raised from the posterior ilium to investigate the suitability of a transiliac approach in performing sacroiliac debridement and arthrodesis. A horizontal reference line 3-3.5 cm in length was drawn between a point 1 cm anterosuperior to the posteroinferior iliac spine and a point 1.5 cm superior to the superior border of the greater sciatic notch. A vertical reference line was extended superiorly for 2-2.5 cm perpendicular to and beginning at the anterior end of the horizontal reference line. The oblique arm of the right triangle was created by joining the superior end of the vertical reference line to the posterior end of the horizontal line. RESULTS: Thirty percent to fifty percent of the articular surface of the iliac bone was removed with this triangular segment of bone, and a corresponding area of the sacral articular surface was visualized directly. It was possible to remove the rest of the articular cartilage with angled curettes in all specimens. CONCLUSIONS: This approach facilities improved access to the sacroiliac joint for debridement and arthrodesis with minimal soft tissue dissection and iliac bone resection.

Adult↗
PubMed2000

Sensory innervation of the sacroiliac joint in rats.

STUDY DESIGN: The segmental levels of dorsal root ganglions innervating the sacroiliac joint in rats were investigated using the retrograde transport method. The pathways and functions of the nerve fibers supplying the sacroiliac joint were determined by immunohistochemical detection of transported tracer. OBJECTIVES: To study the sensory innervation of the sacroiliac joint and to elucidate the neural pathways of low back pain originating from the sacroiliac joint. SUMMARY OF BACKGROUND DATA: The sacroiliac joint is a possible source of low back pain. The L4-S4 spinal nerves have been regarded as the nerves innervating the sacroiliac joint in humans. However, the origins of nerve fibers have not been analyzed experimentally with tracer methods. METHODS: Cholera toxin B subunit, a neural tracer, was injected into the left sacroiliac joint of adult rats, and the bilateral dorsal root ganglions were immunohistochemically examined 4 days after injection. In another rat group, the dorsal root ganglions were examined using the same methods after resection of the left sympathetic trunk from L2 to the most caudal level. Thus, the pathways of the nerve fibers supplying the sacroiliac joint were investigated. RESULTS: Labeled neurons were mainly located in the ipsilateral dorsal root ganglions from L1 to S2 of the unsympathectomized rats and in the ipsilateral dorsal root ganglions from L4 to S2 of the sympathectomized rats. CONCLUSIONS: The sacroiliac joint was innervated by sensory neurons in dorsal root ganglions ipsilateral to the joint from L1 to S2. Sensory fibers from the L1 and L2 dorsal root ganglions passed through the paravertebral sympathetic trunk.

Adrenergic Fibers↗
PubMed1996

A new in vitro measurement technique for small three-dimensional joint motion and its application to the sacroiliac joint.

A new experimental technique for the measurement of three-dimensional (3-D), six degrees of freedom motion of a human joint is described. The apparatus consists of a solid cube and an orthogonal frame. Six spring-loaded linear variable differential transformers (LVDTs) are held by the frame in contact with three adjacent orthogonal surfaces of the cube. Three of the six LVDTs are positioned non-colinearly in contact with the first surface of the cube, two with the second surface, and one with the third surface. With the cube mounted on one of the moving bodies of a joint and the frame on the other one relative 3-D motion of the joint can be obtained from the six LVDT measurements based on the rigid body kinematics. An algorithm was developed to compute three Euler rotation angles and the 3-D translational components of a reference point on the body segment. The system was calibrated and applied to an in vitro study of sacroiliac joint motion. It has a rotational accuracy of 0.04 degree (with a S.D. of 0.07 degree) and a translational accuracy of 0.01 mm (with a S.D. of 0.01 mm). The possibility of adding a redundant seventh LVDT has also been explored and improvements in accuracy are reported. The main advantages of this technique are its compact size, accuracy, and low overall cost.

Biomechanical Phenomena↗
PubMed1987

Anterior approach and stabilization of the disrupted sacroiliac joint.

Pelvic fractures with disruption of the important weight-bearing sacroiliac area can lead to impaired gait due to malunion or pelvic obliquity, back or buttock pain arising from the sacroiliac joint, and permanent neurologic damage. In eight patients with sacroiliac joint dislocation, an anterior retrofascial approach and stapling of the sacroiliac joint was performed. Six of these patients maintained an anatomic reduction of the sacroiliac joint and their results were rated as excellent. Two of the eight patients had a slight loss of reduction and because of intermittent mild pain were rated as having fair results. In another eight patients, plate fixation of the anterior sacroiliac joint was done. New stabilization methods utilizing dynamic compression plates, reconstruction plates, and a new four-hole plate have been developed to provide more secure fixation of these unstable injuries.

Adult↗
PubMed1998

The sacroiliac joint. Nothing is sacred.

One hundred years ago, the sacroiliac joint was considered to be the most common cause of sciatica; over time, however, it became increasingly apparent that the major back enterprise lay in disc extractions. Still, despite the lack of specific clinical tests, the same clinical symptoms suggesting lumbar disc and lumbar facet joint pathology may also justify consideration of the sacroiliac joint as the pain generator. Treatment approaches, including manual therapies, bracing, and exercises, may benefit both the facet and sacroiliac joints as well as intradiscal pathologies. The possibility of utilizing specific local intra-articular steroid injections into the sacroiliac joint may add another useful tool to the armamentarium of back pain relief strategies.

Biomechanical Phenomena↗
PubMedDate not supplied

Degenerative disease of the sacroiliac joint.

Analysis of 46 sacroiliac joints removed in toto at random during routine autopsies was undertaken to define the pathologic and radiographic alterations of this joint in middle-aged and elderly patients. Each joint was sectioned, photographed and radiographed and large microscopic slides were prepared. Sacroiliac osteoarthrosis resulted in progressive cartilage degeneration, particularly on the ilial side of the joint, with eventual cartilaginous fusion. Para-articular bony ankylosis was produced by bridging osteophytes on the anterior and inferior surfaces. Sacroiliac intra-articular bony ankylosis was confined to cadavers with ankylosing spondylitis. In some patients radiographic differentiation of osteoarthrosis and ankylosing spondylitis may require tomography.

Adult↗
PubMed2004

[Imaging of bacterial infections of the sacroiliac joint].

Infection of the sacroiliac joint can be pyogenic or granulomatous and is usually unilateral. There are a number of predisposing conditions including drug abuse and intra articular steroid injection, but in 44% of cases, no definite predisposing factors can be identified. Considerable delay between presentation and diagnosis is recognized. The clinical picture may be non-specific and variable, and clinical suspicion may be low due to the relatively low incidence of the condition. This is compounded by difficulties in clinical examination of the SUs. The diagnosis is based on a history suggestive of infection, clinical or radiographic localization to the SUs, and a positive blood culture or joint aspirate. The pathology of pyogenic sacroiliitis is reviewed with respect to the anatomy of the SU, and the differential diagnoses considered. The imaging findings, and relative merits of all the modalities are discussed with particular consideration given to changes over the course of the disease. Imaging strategies are evaluated and proposed. As the commonest presenting symptom is low back pain, consideration should be given to the addition of a STIR sequence covering the SUs on all routine lumbar spine MR examinations. MR imaging is the most sensitive and specific imaging modality, while CT-guided arthrocentesis improves diagnostic confidence. Tc99MDP blood pool imaging mirrors the clinical features of resolution, and scintigraphy may be the best method to monitor response to treatment. Targeted antibiotic therapy usually leads to a full recovery. A high incidence of clinical suspicion, with MR imaging at an early stage are the essential prerequisites to an accurate diagnosis of bacterial sacroiliitis.

Arthritis, Infectious↗
PubMed2000

A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test.

STUDY DESIGN: The standing hip flexion test was evaluated by using a radiostereometric analysis. OBJECTIVES: To evaluate whether the commonly used standing hip flexion test reflects movement in the sacroiliac joints, or whether the increased load of one sacroiliac joint also reduces the mobility of the other sacroiliac joint according to the theory of form and form closure in the sacroiliac joints. SUMMARY OF BACKGROUND DATA: The standing hip flexion test, used frequently to analyze sacroiliac joint mobility, is advocated as a test for study of normal or impaired motion in the sacroiliac joint. METHODS: In this study, 22 patients considered to have sacroiliac pain were analyzed with radiostereometric analysis when standing and when performing the standing hip flexion test on the right and left sides. RESULTS: Very small movements were registered in the sacroiliac joints. When provoking one side, the rotations were small on both sides. CONCLUSIONS: The small movements registered support the theory of form and force closure in the sacroiliac joints. The self-locking mechanism that goes into effect when the pelvis is loaded in a one-leg standing position probably obstructs the movements in the sacroiliac joints. Therefore, the standing hip flexion test cannot be recommended as a diagnostic tool for evaluating joint motion in the sacroiliac joints.

Adult↗
PubMed2003

Percutaneous computed tomographic stabilization of the pathologic sacroiliac joint.

Metastases to the sacroiliac joint region can be a source of significant pain in many patients who are terminally ill. Six patients with metastatic lesions in the sacroiliac region who presented with significant posterior pelvic pain were treated with computed tomography-guided insertion of iliosacral screws. All patients reported excellent pain control in the early postoperative period. Computed tomography-guided insertion of iliosacral screws in an area of relatively preserved bone stock provides good purchase of the screws. It is a safe percutaneous procedure and it helps alleviate pain in patients with sacroiliac metastases.

Aged↗