Tuberculous Sacroiliitis: A Study of the Diagnosis, Therapy and Medium-Term Results of 15 Cases

Abstract

This report reviews the diagnosis, treatment and follow-up of 15 Chinese patients with tuberculous sacroiliitis (TBS) from 1997 to 2007. Buttock pain and lower back pain were the main complaints. All patients received antituberculosis chemotherapy treatment for at least 18 months; 10 also underwent surgery, with seven undergoing modified Smith-Petersen arthrodesis (evaluated using a visual analogue scale [VAS] for pain and the Oswestry Disability Index [ODI]). No simplex tuberculous synovitis existed at diagnosis. Bone-marrow oedema, cold abscess and soft-tissue oedema responded to antituberculosis treatment. Thirteen patients (86.7%) had satisfactory outcomes. There were also significant improvements in VAS and ODI scores post-operatively. In the chemotherapy plus surgery group, eight patients had solid bony fusions at 24 months post-operatively, while the five on chemotherapy alone presented with fibrous ankylosis at 24 months. Chemotherapy is the main treatment for TBS and modified arthrodesis is a feasible and effective method for treating severe joint destruction.

The efficacy of negative pressure wound therapy in treating sacroiliac joint tuberculosis with a chronic sinus tract: a case series

“…The diagnosis of tuberculosis of the sacroiliac joint in the early stages is difficult due to the vague presenting symptoms, and thus the diagnosis is delayed in many cases [3, 11, 28]. …”

“…The formation of paraspinal tuberculous abscesses is seen in 50 to 75 % of spinal tuberculosis cases [7, 18, 26]. Kim [17] and Gao [11] reported similar results in that almost 50 % of patients with sacroiliac joint tuberculosis had gluteal and inguinal abscesses. In the late stages of infection, sacroiliac joint abscesses destroyed the capsule, spread into the adjacent subcutaneous tissues, and finally form sinus tracts.…”

“…Treatment can be challenging. Traditional surgeries include curettage, curettage plus arthrodesis, and the modified Smith-Petersen arthrodesis method [11, 17]. Negative pressure wound therapy (NPWT) is an advanced wound treatment protocol developed in recent years.…”

Sacroiliitis preceding disseminated pelvic and peritoneal tuberculosis

“…Poncet's arthritis, [4] TB arthritis, [5] peripheral septic arthritis, [6] TB spondylodiscitis and SI are some forms of presentation of extrapulmonary tuberculosis. [7][8][9][10] Even without any pathognomonic radiologic sign of TB SI, nuclear resonance showing subchondral bone marrow edema and irregularity of articular surface on an asymmetric distribution confirms unilateral SI. [11,12] Asymmetric SI without any other findings suggestive of spondiloarthropathy should be promptly investigated for infectious disease.…”

“…[14,15] Despite ovarian TB usually presents together with peritoneal involvement, SI due to TB generally occurs without other involved sites. [8,9] Balci et al reported a case of a 32-year-old female admitted with pelvic pain and abdominal distension. Pelvic sonography revealed diffuse pelvic ascites and a simple cystic lesion measuring up to 3 cm × 4 cm in the right adnexal area.…”