ABSTRACT
El dolor sacroilíaco es una causa generalmente subdiagnosticada de dolor lumbar, que afecta del 15% a 30% de los pacientes con dolor lumbar bajo crónico no radicular. La articulación sacroilíaca (ASI) recibe continuo stress durante la bipedestación y marcha, siendo estabilizada por estructuras ligamentarias, capsulares y miofasciales fuertes, que reciben una abundante inervación. Destaca la dificultad en el diagnóstico del dolor sacroilíaco; debido a su naturaleza heterogénea. Éste se debe sospechar en todo paciente con síndrome de dolor lumbar no radicular, unilateral y no central. El examen físico debería descartar patología de cadera y columna lumbar. La realización de maniobras de provocación del dolor sacroilíaco aporta en el diagnóstico, teniendo la combinación de 3 o más maniobras positivas una sensibilidad de 85% y especificidad de 79%. Se ha recurrido a inyecciones diagnósticas con anestésicos locales, tanto intraarticulares como de ligamentos circundantes. El tratamiento del dolor sacroilíaco es multimodal e individualizado para cada paciente. El tratamiento conservadorbasado en terapia física y antiinflamatorios no esteroidales es la terapia de primera línea. Las infiltraciones esteroidales tanto intra como extraarticulares pueden proveer alivio en un grupo de pacientes con inflamación activa. La denervación de los ramos dorsales laterales con radiofrecuencia ha mostrado ser un tratamiento exitoso en pacientes con dolor sacroilíaco, logrando 6 meses a 1 año de alivio del dolor. En pacientes con dolor refractario, la fusión de la articulación sacroilíaca es una opción, prefiriéndose la técnica mínimamente invasiva de fijación trans-sacroilíaca.
Sacroiliac pain is an frecuent underdiagnosed source of low back pain, affecting 15% to 30% of individuals with chronic, non-radicular pain. The sacroiliac joint (SIJ) is subject to continuous stress during standing position and gait, being stabilized by strong ligament, capsular and myofascial structures with rich innervation. Due to its heterogeneous nature, SIJ pain is difficult to diagnose, and it should be suspected in all patients with non-radicular unilateral and non-central low back pain syndrome. Physical examination should rule out hip and lumbar spine pathology. SIJ provocation maneuvers are used for diagnosis, with the combination of 3 or more positive maneuvers resulting in a sensitivity of 85% and a specificity of 79%. Diagnostic injections of local anesthetics, both intra-articular and in the surrounding ligaments have been used. treatment of SIJ pain is multimodal and individualized for each patient. Conservative treatment, based on physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs) is the first line therapy. Both intra- and extra-articular steroid infiltrations can provide relief in a group of patients with active inflammation. Radiofrequency denervation of lateral dorsal branches has proven to be a successful treatment in SIJ pain patients, achieving 6 to 12 months of pain relief. In patients with refractory pain, SIJ fusion is an option, with minimally invasive trans-sacroiliac fixation being the preferred technique.
Subject(s)
Humans , Sacroiliac Joint/pathology , Low Back Pain/diagnosis , Low Back Pain/therapy , Low Back Pain/etiology , Low Back Pain/physiopathology , Diagnosis, DifferentialABSTRACT
Objective To explore the short-term efficacy of individualized motion control training for the patients with physiological sacroiliac joint dysfunction. Methods 58 patients were diagnosed as sacroiliac joint dysfunction by standing and sitting stoop test and single leg test. All the patients were randomly divided into two groups. Rotation of the iliac bone was adjusted by muscle energy technique and impact technique in all the patients. The study group received additional exercise control training including local muscle drafting,flexibility and stability. The short-term efficacy was observed. Results VAS and ODI in the two groups were improved significantly after treatment,and there was significant difference between the two groups before treatment(P < 0.01). Three weeks after treatment,the VAS score and ODI in the control group increased,while those in the study group did not change significantly. There was a significant difference in the continuous efficacy of treatment between the two groups(P < 0.05). Conclusions Motion control training based on manipulative exercise test evaluation has a better continuous efficacy for patients with no-specific low back pain and sacroiliac joint dysfunction. It is worth clinically popularizing.
ABSTRACT
Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders.Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was with ilium disorders) were selected.Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models,and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model.The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis.The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared.Results There was no significant difference in the stress of the two sides of L4,L5 disc and two sacroiliac joints in normal model,with a bimodal stress curve.However,in the models of sacrum disorders and ilium disorders,the bimodal stress curve peaks changed,even disappeared.The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa,respectively,the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa,respectively,and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa,respectively.Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line,and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides.The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.
ABSTRACT
[Objective]To summarize the clinical experience of Professor FAN Binghua in treating sacroiliac joint dysfunction. [Method] From following Professor FAN Binghua's clinical and studying experienced cases ,summarizing the academic viewpoints and methods of Professor FAN Binghua in treating sacroiliac joint dysfunction, and with one classical case for experiencing details and methods when Professor FAN Binghua cures sacroiliac joint dysfunction. [Result]Based on theory of relationship between symptoms and etiology, Professor FAN comes up with concept of where there is symptom, there is reason and curing etiology should be put forward,starting with clinical symptoms to cure sacroiliac joint dysfunction, applying examinations of specialty to find out the internal close relationship between symptom and etiology and eliminate the similar disease, then curing the etiology in right way.[Conclusion]Pro.FAN has flexible thoughts, clear pertinence, and strong practicality, and histhree principls in cliniccan be guidence in clinic, and it is worth drawing reference and learning.
ABSTRACT
Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders. Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was ilium disorders) were selected. Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models, and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model. The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis. The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared. Results There was no significant difference in the stress of the two sides of L4, L5 disc and two sacroiliac joints in normal model, with a bimodal stress curve. However, in the models of sacrum disorders and ilium disorders, the bimodal stress curve peaks changed, even disappeared. The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa, respectively, the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa, respectively, and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa, respectively. Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line, and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides. The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.
ABSTRACT
Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders.Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was with ilium disorders) were selected.Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models,and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model.The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis.The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared.Results There was no significant difference in the stress of the two sides of L4,L5 disc and two sacroiliac joints in normal model,with a bimodal stress curve.However,in the models of sacrum disorders and ilium disorders,the bimodal stress curve peaks changed,even disappeared.The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa,respectively,the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa,respectively,and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa,respectively.Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line,and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides.The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.
ABSTRACT
Objective To explore the biomechanical mechanisms of correlation between lumbar disc degeneration and sacroiliac joint disorder though investigating the biomechanical characteristics of lumbar disc degeneration with sacroiliac joint disorders.Methods One normal healthy volunteer and two patients with lumbar disc herniation and sacroiliac joint disorders (one was with sacrum disorders and the other was with ilium disorders) were selected.Their CT data were collected to establish three corresponding lumbar-pelvis finite-element models,and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model.The muscle force around the lumbar and pelvis as well as the hip joint force were acquired as loading condition for finite element analysis.The stress changes in L4 and L5 intervertebral discs and sacroiliac joints of the patients and normal volunteer were compared.Results There was no significant difference in the stress of the two sides of L4,L5 disc and two sacroiliac joints in normal model,with a bimodal stress curve.However,in the models of sacrum disorders and ilium disorders,the bimodal stress curve peaks changed,even disappeared.The peak stress differences in left and right side of L4 disc were 0.55 MPa and 0.80 MPa,respectively,the peak stress differences in left and right side of L5 disc were 4.05 MPa and 2.08 MPa,respectively,and the peak stress differences in left and right side of sacroiliac joints were 0.96 MPa and 3.32 MPa,respectively.Conclusions The lumbar disc degeneration with sacroiliac joint disorder leads to the tilt of the body loading line,and sacroiliac joint disorder can aggravate the imbalances of stress on the body sides.The impact of sacroiliac joint dysfunction cannot be ignored in the treatment of lumbar disc herniation.
ABSTRACT
La articulación sacroilíaca es una fuente de dolor lumbar y dolor referido en la extremidad inferior. Aún no existen rasgos históricos, clínicos o radiológicos definitivos para hacer un diagnóstico preciso del dolor originado en la articulación sacroilíaca. La inervación de esta articulación continúa siendo objeto de debate y en la literatura se describen muchos abordajes diferentes. Los bloqueos diagnósticos son la herramienta diagnóstica más precisa pues la reducción del dolor confirma el rol de la articulación sacroilíaca como generadora del mismo. En muchos pacientes, cuando la reducción del dolor se logra luego de bloqueos intraarticulares únicos o consecutivos, se realiza una denervación por radiofrecuencia, con el objetivo de obtener una analgesia de larga duración. El propósito de este artículo es describir las técnicas disponibles actualmente para la denervación por radiofrecuencia.
The sacroiliac joint is a source of low back pain and referred pain in the lower extremity. There are still no definite historical, clinical or radiological features to make a precise diagnosis of pain originating from the sacroiliac joint. The innervation of the sacroiliac joint remains a subject of much debate and different approaches are described in the literature. Diagnostic blockades are the most accurate diagnostic tool, since pain reduction confirms the role of sacroiliac joint as a generator of it. In many patients, when pain reduction is achieved after single or consecutive intra-articular blockades, a radiofrequency denervation is performed for the purpose of obtaining a long term analgesia. The purpose of this paper is to describe the techniques currently available for radiofrequency denervation.