Anatomy of the sacroiliac joints in children and adolescents by computed tomography

Abstract

BackgroundDiagnosing sacroiliitis by magnetic resonance imaging (MRI) in children/adolescents can be difficult due to the growth-related changes. This study analyzed the normal osseous anatomy of the sacroiliac joints (SIJ) in a juvenile population using computed tomography (CT).MethodsThe anatomy of the SIJ was retrospectively analyzed in 124 trauma patients aged 9 months – <18 years by CT, based on 2 mm slices in axial, semi-axial and semi-coronal planes. The following anatomical features were recorded: intersegmental fusion of the sacral vertebral segments 1–3 (S1-S3), ossified nuclei (antero-superior at S1, lateral to the intervertebral spaces and lateral to S1 and S2) and joint facet defects larger than 3 mm.ResultsFusion of S1/S2 started at the age of 6 years and was complete after the age of 13 years in most girls and after the age of 14 years in most boys. Fusion of S2/S3 started at the age of 9 years, but could remain incomplete up to 18 years in both genders. Ossified nuclei antero-lateral at S1 and/or in the joint space were observed until the age of 18 years and occurred in 77% of individuals ≥13 years with intraarticular localization in 64% of girls and 60% of boys. Joint facet defects >3 mm occurred in 21 children/adolescents (17%) located to both the iliac and sacral joint facets.ConclusionsNormal osseous SIJ structures in children and adolescents vary considerably. Attention to these normal anatomical structures during growth may help to avoid false positive findings by MRI.

Management of Instability following Pyogenic Sacroiliitis: Technical Case Report

“…Many authors recommend 2-3 months of non-weight-bearing [2]. Long-term outcome is lacking in most of the series and case reports [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Chronic SI-joint pain is reported in a high proportion of cases (33% to 43.5%) [3,22,23].…”

Sacroiliac joint morphologic changes from infancy to adulthood

“…Such values are then difficult to compare to the results presented here. Regarding the paediatric population, Zejden A. and Jurik G. 7 studied the bone anatomy of this area by tomodensimetry during growth (124 patients between 9 months and 18 y/o) describing mainly the ossification kernel/core and the fusion of segments according with age and gender. Those two studies did not provide 3D-analysis of the morphology of the SIJ.…”

“…Even after skeletal maturity, the pelvic width was found to increase by 20 mm. [ref Berger 2011] For the sacrum, three intersegmental fusions of the sacral vertebral segments (S1, S2, S3) occur: S1-S2 fusion occurs between 6 and 13 years old (y/o), while S2-S3 fusion occurs between 9 to 18 y/o 7 . Anthropology and archeo-biology have been defining SIJ and bridging for skeleton age assessment 8,9 .…”

“…A large portion of low back pain (10 to 40% 7 ) is reported to come from the SIJ 21 . Report of the SIJ morphology changes during growth in the literature is limited and the interest of such morphology and its consequence for surgery is increasing with the 310% increase of interventions per 100 000 insured person from to 2011 22 .…”

Sacroileítis: evaluación por resonancia magnética según criterios ASAS

“…La tomografía computada (TC) es superior a la RM para visualizar la anatomía ósea detallada, los cambios estructurales patológicos, y puede mostrar cambios óseos crónicos en la sacroileítis, pero no signos de actividad inflamatoria. La TC emite radiación ionizante, por lo que no se usa como método diagnóstico en sacroileítis, especialmente en niños y adolescentes 22 .…”