ABSTRACT
The purpose of this report is to demonstrate the creation of a 4-rod lumbosacral construct, when "stacked" sacral-2-alar-iliac (S2AI) screws are not possible due to a concurrent treatment of sacroiliitis with a posterior approach sacroiliac joint fusion device. This technique uses a combined S2AI and subcrestal iliac approach to achieve the 4-rod lumbosacral construct, while simultaneously biomechanically supporting the S2AI screws and treating the sacroiliitis.
Subject(s)
Sacroiliitis , Spinal Diseases , Spinal Fusion , Humans , Sacroiliac Joint/diagnostic imaging , Sacroiliac Joint/surgery , Sacroiliitis/diagnostic imaging , Sacroiliitis/surgery , Bone Screws , Spinal Fusion/methods , Ilium/surgery , Sacrum/diagnostic imaging , Sacrum/surgery , Spinal Diseases/surgeryABSTRACT
BACKGROUND: We reviewed 3 different types of tuberculous sacroiliitis via anterior and posterior approaches to determine the efficacy and safety of this surgical approach by describing clinical presentation, imaging, and surgical treatment. METHODS: We reviewed 33 patients with 3 different types of severe tuberculous sacroiliitis, of which 16 patients with anterior iliac abscess underwent anterior debridement. 17 patients underwent posterior debridement. Among them, 5 patients with lumbar tuberculosis underwent lesion debridement through fenestration, joint fusion, and interbody fusion and internal fixation. The mean postoperative follow-up was 16.9 months (12-25 months).Erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to judge the postoperative condition and functional recovery. RESULTS: All patients' hip, back and lower back pain symptoms were significantly relieved after surgical treatment. At 3 months after operation, the VAS and ODI scores of all patients decreased significantly. CONCLUSION: Surgical treatment of tuberculous sacroiliitis should be performed as soon as possible under the adjuvant chemotherapy of anti-tuberculosis drugs. According to the different characteristics of sacroiliac joint tuberculosis, appropriate surgical operations should be adopted according to our classification criteria.
Subject(s)
Sacroiliitis , Spinal Fusion , Tuberculosis, Osteoarticular , Tuberculosis, Spinal , Debridement/methods , Humans , Lumbar Vertebrae/surgery , Retrospective Studies , Sacroiliac Joint/surgery , Sacroiliitis/diagnosis , Sacroiliitis/surgery , Spinal Fusion/methods , Thoracic Vertebrae/surgery , Treatment Outcome , Tuberculosis, Osteoarticular/diagnosis , Tuberculosis, Osteoarticular/surgery , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/surgeryABSTRACT
Pelvic fixation is becoming an increasingly important caudal anchor point for long lumbar constructs, high-grade spondylolisthesis, fixation of sacral fractures, and support for 3-column osteotomies, by adding lumbosacral fixation anterior to the McCord pivot point. Iliac bolts were once common but have become less favorable due to screw head irritation and complications associated with connecting rods. S2-alar-iliac (S2AI) screws have been shown to achieve equivalent anchoring strength of constructs to the pelvis, while being lower profile and in line with the lumbar instrumentation. More recently, surgeons have noted the potential for S2AI screws to toggle and loosen, commonly in the softer sacrum, leading to caudal anchor failure and possible pseudarthrosis. The addition of triangular titanium implants to augment S2AI screws (bedrock technique) is a relatively new adaptation to reduce toggling on the S2AI screw and improve the overall stability of the pelvic fixation. Video 1 shows the placement of an S2AI screw and triangular titanium implant for pelvic fixation. The patient is a 68-year-old woman who presented with flat back syndrome, spinal stenosis, degenerative spondylolisthesis, pseudarthrosis of previously instrumented levels, and bilateral sacroiliitis. She underwent posterior instrumentation and fusion of L1 to S1 with pelvic fixation, open bilateral sacroiliac joint fusion, and multilevel Smith-Peterson osteotomies and transforaminal lumbar interbody fusions.
Subject(s)
Prostheses and Implants , Spinal Fusion/instrumentation , Titanium , Aged , Bone Screws , Female , Humans , Lumbar Vertebrae/surgery , Pelvis , Pseudarthrosis/surgery , Sacroiliitis/surgery , Sacrum/surgery , Spinal Fusion/methods , Spinal Stenosis/surgery , Spondylolisthesis/surgeryABSTRACT
Pyogenic sacroiliitis is a relatively rare condition that often leads to surgical treatment, including debridement and arthrodesis. Here we introduce a new surgical technique using bilateral dual iliac screws to secure early ambulation and maximal fusion success rate for the treatment of pyogenic sacroiliitis. We retrospectively reported a case and technical reports of pyogenic sacroiliitis treated by a new bilateral dual iliac screw fixation arthrodesis technique using radiologic outcomes, including plain X-rays and MRI scans, as well as outcomes based on the visual analogue scale for pain measurement. This technique improved uncontrolled pyogenic sacroiliitis with immediate stability that enabled ambulation and secured firm fixation for extensive evacuation of infected debris and subsequent autograft bone arthrodesis. In conclusion, we recommend bilateral dual iliac screw fixation for the treatment of pyogenic sacroiliitis, as this technique can improve uncontrolled pyogenic sacroiliitis with immediate stability.
Subject(s)
Arthrodesis , Bone Screws , Bone Transplantation , Ilium/surgery , Sacroiliitis/surgery , Anatomic Landmarks , Female , Humans , Magnetic Resonance Imaging , Retrospective Studies , Sacroiliitis/diagnostic imaging , Transplantation, Autologous , Young AdultABSTRACT
Pain coming from the sacroiliac (SI) joints can explain up to 25% of all chronic low back pain. A careful differential diagnosis is required to avoid misdiagnosis of low back pain. In addition to historical findings, positive findings on physical examination maneuvers that stress the SI joint are a key component diagnosis. The SI joint is confirmed as a pain generator when intraarticular injection of local anaesthetics provides acute back pain relief. Minimally invasive SI joint fusion is clearly superior to invasive open surgical procedures, with decreased blood loss and tissue disruption, shorter procedure times and shorter hospital stays. Especially well documented are the results of minimally invasive SI joint fusion using iFuse Implant System®. The device's triangular profile, combined with a titanium plasma spray coating, ensures both an immediate and long-lasting joint stabilization.
Subject(s)
Minimally Invasive Surgical Procedures , Sacroiliac Joint/diagnostic imaging , Sacroiliac Joint/surgery , Sacroiliitis/diagnostic imaging , Sacroiliitis/surgery , Arthrodesis/instrumentation , Biocompatible Materials , Bone Morphogenetic Protein 2/administration & dosage , Diagnosis, Differential , Equipment Design , Humans , Low Back Pain/diagnosis , Low Back Pain/etiology , Low Back Pain/surgery , Outcome and Process Assessment, Health Care , Pain Measurement , Physical Examination , Prostheses and Implants , Recombinant Proteins/administration & dosage , Transforming Growth Factor beta/administration & dosageABSTRACT
We report a case of Aggregatibacter aphrophilus sacroiliitis in a young sportsman, presenting 48 hours after endoscopy and biopsy. Microbiological diagnosis was made only after repeated attempt at joint aspiration. The patient was cured after radiologically guided drainage and a prolonged course of directed antibiotics.
Subject(s)
Aggregatibacter aphrophilus/isolation & purification , Gastroscopy/adverse effects , Pasteurellaceae Infections/etiology , Postoperative Complications/microbiology , Sacroiliitis/microbiology , Anti-Bacterial Agents/administration & dosage , Ceftriaxone/administration & dosage , Drainage , Football , Humans , Male , Pasteurellaceae Infections/drug therapy , Pasteurellaceae Infections/surgery , Sacroiliitis/drug therapy , Sacroiliitis/surgery , Young AdultABSTRACT
CASE: A 43-year-old man with a history of well-controlled HIV (human immunodeficiency virus) infection presented with sacroiliac joint destruction from a Mycobacterium gordonae infection. A sacroiliac joint arthrodesis was performed using a minimally invasive technique utilizing both biologic fusion (allograft bone with rhBMP-2 [recombinant human bone morphogenetic protein-2]) and fixation with titanium ingrowth rods. CONCLUSION: To our knowledge, this is the first reported case of infectious sacroiliitis from a nontubercular mycobacterium (M. gordonae) treated with a combination of joint debridement, biologic fusion with bone graft, and nonbiologic functional fusion using titanium ingrowth rods, all performed in a minimally invasive fashion. This strategy effectively alleviated pain and preserved function at 2 years of follow-up.
Subject(s)
Arthrodesis/methods , Mycobacterium Infections, Nontuberculous/surgery , Nontuberculous Mycobacteria/isolation & purification , Sacroiliac Joint/surgery , Sacroiliitis/surgery , Adult , HIV Infections/complications , Humans , Male , Mycobacterium Infections, Nontuberculous/microbiology , Sacroiliitis/microbiologySubject(s)
Anti-Bacterial Agents/administration & dosage , Arthritis, Rheumatoid/drug therapy , Etanercept , Glucocorticoids , Injections, Intra-Articular , Sacroiliac Joint/diagnostic imaging , Sacroiliitis , Antirheumatic Agents/administration & dosage , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/physiopathology , Etanercept/administration & dosage , Etanercept/adverse effects , Female , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Humans , Injections, Intra-Articular/adverse effects , Injections, Intra-Articular/methods , Middle Aged , Orthopedic Procedures/methods , Radiography , Sacroiliac Joint/pathology , Sacroiliitis/diagnosis , Sacroiliitis/drug therapy , Sacroiliitis/etiology , Sacroiliitis/surgery , Treatment Outcome , Tumor Necrosis Factor InhibitorsABSTRACT
Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults' patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC).Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.
Subject(s)
Catheter Ablation/methods , Denervation/methods , Sacroiliac Joint/innervation , Sacroiliitis/surgery , Adult , Aged , Female , Follow-Up Studies , Humans , Low Back Pain/surgery , Male , Middle Aged , Pain Management , Pain Measurement , Prospective Studies , Radiography , Reproducibility of Results , Sacrococcygeal Region/diagnostic imaging , Time Factors , Treatment OutcomeABSTRACT
Sacroiliac joint (SIJ) pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS). Secondary outcome measure was Patient Global Impression of Change Scale (PGIC).Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001). Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.
A Sacroileíte pode ser responsável por até 40% dos casos de dor lombar crônica. Objetivo Análise da eficácia da denervação por radiofrequência na articulação sacro-ilíaca em seis, doze e dezoito meses.Método Trinta e dois pacientes com diagnóstico de sacroileíte foram incluídos em estudo prospectivo. O prognóstico primário foi avaliado pela escala visual analógico (NRS). O prognóstico secundário foi avaliado pela escala de impressão global de mudança pelo paciente (PGIC).Resultados Melhora a curto prazo da dor foi observada, com redução media na NRS de 7,7 ± 1,8 para 2,8 ± 1,2 após 1 mês e para 3,1 ± 1,9 em 6 meses do procedimento (p < 0,001). Após 12 e 18 meses, o NRS manteve-se 3,4 ± 2,1 e 4,0 ± 2,7, respectivamente.Conclusão A denervação da articulação sacro-ilíaca por radiofrequência pode reduzir significativamente a dor em pacientes com sacroileíte.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Catheter Ablation/methods , Denervation/methods , Sacroiliac Joint/innervation , Sacroiliitis/surgery , Follow-Up Studies , Low Back Pain/surgery , Pain Management , Pain Measurement , Prospective Studies , Reproducibility of Results , Sacrococcygeal Region , Time Factors , Treatment OutcomeABSTRACT
INTRODUCTION: Spinal epidural abscess (SEA) is a very rare condition in pediatric patients. Varicella zoster infection could be a predisposing factor, and SEA should be suspected in patients with signs of secondary bacterial infection and even mild neurological signs. CLINICAL CASE: We describe here a case of a 30-month-old girl with a history of remitting varicella infection, diagnosed for a lumbar epidural abscess and sacro-ileitis, secondary to group A Streptococcus (GAS). DISCUSSION: This is the third case of SEA from GAS reported in the literature in a pediatric population with varicella infection. We discuss here the clinical presentation and the diagnostic challenges for SEA in childhood through a review of the literature.
Subject(s)
Chickenpox/diagnosis , Epidural Abscess/diagnosis , Opportunistic Infections/diagnosis , Streptococcal Infections/diagnosis , Streptococcus pyogenes , Anti-Bacterial Agents/therapeutic use , Child, Preschool , Combined Modality Therapy , Delayed Diagnosis , Diagnosis, Differential , Epidural Abscess/surgery , Female , Humans , Lumbar Vertebrae/pathology , Lumbar Vertebrae/surgery , Magnetic Resonance Imaging , Opportunistic Infections/surgery , Osteomyelitis/diagnosis , Osteomyelitis/surgery , Sacroiliitis/diagnosis , Sacroiliitis/surgery , Streptococcal Infections/surgerySubject(s)
Abscess/diagnostic imaging , Community-Acquired Infections/diagnostic imaging , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Myositis/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Tomography, X-Ray Computed , Abscess/drug therapy , Abscess/microbiology , Abscess/surgery , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Community-Acquired Infections/surgery , Debridement , Drainage , Drug Therapy, Combination , Female , Humans , Immunocompetence , Middle Aged , Myositis/drug therapy , Myositis/microbiology , Myositis/surgery , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Osteomyelitis/surgery , Periosteum/microbiology , Periosteum/surgery , Psoas Abscess/diagnostic imaging , Psoas Abscess/drug therapy , Psoas Abscess/microbiology , Psoas Abscess/surgery , Recurrence , Sacroiliitis/drug therapy , Sacroiliitis/microbiology , Sacroiliitis/surgery , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcal Infections/surgery , ThighABSTRACT
BACKGROUND: Sacroiliac joint infection is rare and frequently missed; purpose of this study is to describe the clinical presentations, comorbidities, laboratory and imaging findings, surgical options and outcomes of this rare condition. MATERIALS AND METHODS: We reviewed all cases of surgical treatment of sacroiliac joint infection operated at our institution between January 1994 and December 2011. Twenty-two patients were included: 14 females and 8 males, with mean age of 50 years. The mean follow-up period was 34 months. Twenty-four operations were performed. Coinciding infection was found in 11 cases (50 %). Twelve patients (54.5 %) presented acutely, while ten patients (45.5 %) had chronic infection. RESULTS: Tuberculous infection was diagnosed in 5 cases and nonspecific infection in 13 cases. In four cases, no organism was isolated. Eleven cases were subjected to debridement only, while debridement and arthrodesis was needed in 11 cases. Eight patients had excellent clinical results, five good, three fair and four poor; one patient was lost to follow-up, and one patient died after 2 weeks. The operative technique depended on the course of the infection, bone destruction and general condition of the patient. There was a significant change in C-reactive protein and erythrocyte sedimentation rate preoperatively and 6 weeks postoperatively, while the difference in white blood cell count was nonsignificant. CONCLUSIONS: In acute cases, the primary aim should be to save joint integrity by early debridement, depending on joint destruction and general patient condition. When it is chronic, it is not secure only to debride the joint, which should be fused.
Subject(s)
Arthrodesis , Debridement , Sacroiliac Joint , Sacroiliitis/surgery , Tuberculosis, Spinal/surgery , Adult , Comorbidity , Debridement/methods , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Sacroiliitis/complications , Sacroiliitis/diagnosis , Sciatica/etiology , Young AdultSubject(s)
Abscess/diagnostic imaging , Community-Acquired Infections/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Myositis/diagnostic imaging , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Tomography, X-Ray Computed , Psoas Abscess/surgery , Psoas Abscess/diagnostic imaging , Psoas Abscess/microbiology , Psoas Abscess/drug therapy , Abscess/surgery , Abscess/microbiology , Abscess/drug therapy , Anti-Bacterial Agents/therapeutic use , Thigh , Debridement , Drainage , Female , Humans , Immunocompetence , Community-Acquired Infections/surgery , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Staphylococcal Infections/surgery , Staphylococcal Infections/microbiology , Staphylococcal Infections/drug therapy , Myositis/surgery , Myositis/microbiology , Myositis/drug therapy , Osteomyelitis/surgery , Osteomyelitis/microbiology , Osteomyelitis/drug therapy , Periosteum/surgery , Periosteum/microbiology , Middle Aged , Drug Therapy, Combination , Recurrence , Sacroiliitis/surgery , Sacroiliitis/microbiology , Sacroiliitis/drug therapy , Combined Modality TherapyABSTRACT
The paper deals with the estimation of the capabilities and role of different radiation techniques in the detection of late postradiation therapy local tissue responses that are evident as radionecrosis. To specify the nature of changes, it is necessary to take into account clinicoanamnestic data, results of laboratory and instrumental studies (standard X-ray study, multislice computed tomography, and magnetic resonance imaging) at any examination stage. A set of the studies can provide the means of significantly analyzing the bone structures and soft tissues and the degree of injury and identifying complications.
Subject(s)
Osteoradionecrosis , Pelvic Bones/pathology , Radiotherapy, Adjuvant , Uterine Cervical Neoplasms/radiotherapy , Anti-Bacterial Agents/therapeutic use , Female , Humans , Hysterectomy , Magnetic Resonance Imaging/methods , Middle Aged , Orthopedic Procedures/methods , Osteoradionecrosis/diagnosis , Osteoradionecrosis/etiology , Osteoradionecrosis/physiopathology , Osteoradionecrosis/surgery , Radionuclide Imaging/methods , Radiotherapy, Adjuvant/adverse effects , Radiotherapy, Adjuvant/methods , Sacroiliitis/diagnosis , Sacroiliitis/etiology , Sacroiliitis/physiopathology , Sacroiliitis/surgery , Severity of Illness Index , Tomography, Spiral Computed/methods , Treatment Outcome , Uterine Cervical Neoplasms/surgerySubject(s)
Abscess/diagnostic imaging , Community-Acquired Infections/diagnostic imaging , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Myositis/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Tomography, X-Ray Computed , Abscess/drug therapy , Abscess/microbiology , Abscess/surgery , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Community-Acquired Infections/surgery , Debridement , Drainage , Drug Therapy, Combination , Female , Humans , Immunocompetence , Middle Aged , Myositis/drug therapy , Myositis/microbiology , Myositis/surgery , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Osteomyelitis/surgery , Periosteum/microbiology , Periosteum/surgery , Psoas Abscess/drug therapy , Psoas Abscess/microbiology , Psoas Abscess/diagnostic imaging , Psoas Abscess/surgery , Recurrence , Sacroiliitis/drug therapy , Sacroiliitis/microbiology , Sacroiliitis/surgery , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcal Infections/surgery , ThighABSTRACT
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.