Treatment strategy for sacroiliac joint-related pain at or around the posterior superior iliac spine

Murakami, Eiichi; Kurosawa, Daisuke; Aizawa, Tadanori

doi:10.1016/j.clineuro.2017.12.017

Cited by 44 publications

(37 citation statements)

References 10 publications

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“…This patient population has historically been very difficult to treat, with an extremely high burden of cost on both a direct and indirect basis, often with frustrating outcomes and high rates of persistent disability. [3][4][5] The traditional focus of back pain has been on diagnosis and managing lumbosacral pathology as well as neuropathic pain. Sacroiliac evaluation is only more recently gaining traction.…”

Section: Discussionmentioning

confidence: 99%

“…1,3 While the traditional focus of healthcare providers has been on lumbosacral pathology, sacroiliac joint dysfunction is an underappreciated and underdiagnosed cause of low back pain. Previous studies [3][4][5][6][7][8] have suggested that 15-30% of chronic low back pain is due to pathology located in the sacroiliac joint. Historically, recognition of this pathology was difficult, limited by lack of standardized diagnostic criteria and disease-specific outcome measures.…”

Section: Introductionmentioning

confidence: 99%

“…Traditional treatment focused on conservative therapy, such as physical therapy with focus on core and pelvic stability, orthoses, pain and anti-inflammatory medication, weight loss, intra-or peri-articular injections, and radiofrequency ablation. 4,5,[9][10][11][12] Early surgical intervention came in the form of morbid open approaches often utilizing iliac crest autografting. More recently, minimally invasive techniques for sacroiliac fusion have been developed that allow for significant sparing of muscle dissection, shorter operating room times and blood loss, reduced length of stay, and fewer complications.…”

Section: Introductionmentioning

confidence: 99%

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Sacroiliac Joint Fusion – Impact of a New Image-Guidance Protocol on Safety and Complications

2019

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sacroiliac Joint Fusion – Impact of a New Image-Guidance Protocol on Safety and Complications

2019

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“…Some other reports have demonstrated that the posterior ligament region is a significant source of SIJP 17–19. In addition, a recent report showed that a periarticular SIJ injection should be given first to treat SIJ-related pain, and only if it is not effective should an intra-articular injection be administered 16. Therefore, we adopted the periarticular SIJ injection to evaluate the response to analgesic injections similarly to the original study.…”

Section: Discussionmentioning

confidence: 99%

“…MRI was used if the pain radiated to the lower limb or located in the buttock area below the posterior iliac crest. When we suspected SIJP, we performed an additional examination using an analgesic SIJ injection, which comprised a 3 mL injection of 1% lidocaine into the periarticular space of the SIJ with fluoroscopic control in reference to some previous studies 6,15,16. This method of the injection matched the original study that we had intended to evaluate the validity of the results 13.…”

Section: Methodsmentioning

confidence: 99%

Validation study of a diagnostic scoring system for sacroiliac joint-related pain

Tonosu¹,

Oka²,

Watanabe³

et al. 2018

JPR

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BackgroundThere are no specific radiological findings for the diagnosis of sacroiliac joint-related pain. A diagnostic scoring system had been developed in 2017. The score comprised the sum of scores of six items. The score ranged from 0 to 9 points, and the cutoff was calculated as 4.ObjectiveTo evaluate the validity of the diagnostic scoring system for sacroiliac joint-related pain.Patients and methodsThe sacroiliac joint-related pain group (n=31) comprised patients diagnosed with sacroiliac joint-related pain based on patient history, physical findings, and responses to analgesic periarticular injection. In addition, it was confirmed that they had no other lumbar or hip joint diseases. The non-sacroiliac joint-related pain group (n=123) comprised patients with low back pain due to a reason other than sacroiliac joint-related pain. We evaluated scores for all subjects. We analyzed the differences in each item between both groups and performed receiver-operating characteristic curve analysis to evaluate the score validity.ResultsThere were no significant differences in patient characteristics between groups. There were significant differences for the following four of six items: one-finger test results (P<0.0001), pain while sitting on a chair (P=0.0141), sacroiliac joint shear test results (P<0.0001), and tenderness of the posterosuperior iliac spine (P<0.0001). The cut-off value was 5 points, the area under the curve was 0.80239, sensitivity was 77.4%, and specificity was 76.4%.ConclusionThe score demonstrated moderate validity for diagnosing sacroiliac joint-related pain.

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Auricular surface morphology and surface area does not influence subchondral bone density distribution in the dysfunctional sacroiliac joint

et al. 2022

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Background: The subchondral lamella of the sacroiliac joint (SIJ) auricular surface is morphologically inconsistent, varying inter-individually and side-dependently. These variations have been well documented, however, the morpho-mechanical relationship to sacroiliac joint dysfunction (SIJD) remains unstudied to date. Here, the bone mineralisation density of the iliac and sacral auricular surface subchondral endplate is compared between morphological subtypes, as well as in large and small surfaces, in a cohort comprising SIJD joints and controls.Methods: Computed tomography (CT) datasets from 29 patients with bilateral or unilateral SIJD were subjected to CT osteoabsorptiometry. Sacral and iliac surface areas and posterior angles were calculated and surfaces were classi ed into small (<15 cm 3 ) and large (≥15 cm 3 ) joints and morphological types 1 (>160°), 2 (130-160°) and 3 (<130°), respectively. Mineralisation patterns were classi ed into four patterns, two marginal (M1 and M2) and two non-marginal (N1 and N2). Each sacral and iliac surface was subsequently classi ed into one of these mineralisation groups.Results: The surface area of all joints in the cohort averaged 15.0±2.4 cm 2 (males 16.2±2.5 cm 2 , females 13.7±1.6 cm 2 ). No age correlations with surface area were found nor differences in mean HU values when comparing sizes, sexes or morphology type when looking at painful joints (unilateral or bilateral) and contralateral non-painful joints. Comparisons of controls with the SIJD cohort revealed signi cant differences in female sacra (p=0.02) and small sacra (p=0.03). There was low conformity in marginal and non-marginal patterns, 26% for contralateral non-painful joints, and 46% conformity in painful joints.The majority of dysfunctional joints was of type 2 morphology (59%), equally distributed between small (49%) and large joints (51%). Larger joints had the highest frequency of painful joints (72%). Regarding the prominence of sub-patterns, M1C was more prominent in painful joints.Conclusions: Load distribution related to difference in auricular surface morphology seems to have little impact on pain-related subchondral bone adaptation in cases of SIJD. Larger joints may be predisposed to the onset of pain due to the weakening of the extracapsular structures. Pain-affected joints re ect common conformity patterns of sacral apex mineralisation with corresponding superior corner iliac mineralisation.

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Treatment strategy for sacroiliac joint-related pain at or around the posterior superior iliac spine

Cited by 44 publications

References 10 publications

Sacroiliac Joint Fusion – Impact of a New Image-Guidance Protocol on Safety and Complications

Sacroiliac Joint Fusion – Impact of a New Image-Guidance Protocol on Safety and Complications

Validation study of a diagnostic scoring system for sacroiliac joint-related pain

Auricular surface morphology and surface area does not influence subchondral bone density distribution in the dysfunctional sacroiliac joint

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