Longitud muscular, dolor y funcionalidad en adultos jóvenes con disfunción de la articulación sacroilíaca

Introducción: La disfunción de la articulación sacroilíaca es un trastorno patomecánico, en la cual se pierde la estabilidad y se altera el funcionamiento de la cintura pélvica; también se modifica la capacidad de trasmitir y disipar fuerzas desde los miembros inferiores hacia la columna y viceversa. El acortamiento de músculos como el dorsal ancho, isquiotibiales y espinales lumbares puede alterar el control motor y generar lumbalgia. Objetivo: Evaluar la longitud muscular del dorsal ancho, los isquiotibiales, los espinales lumbares, el dolor y la funcionalidad en adultos jóvenes a partir de la comparación de tres grupos de estudio: dolor lumbar, disfunción de la articulación sacroilíaca y control. Métodos: Se realizó un estudio de corte transversal. Se incluyeron 114 personas de ambos sexos. La longitud muscular se evaluó a través de pruebas específicas para cada músculo. La escala visual análoga y el Oswestry se utilizaron para medir el dolor y la funcionalidad, respectivamente. Las diferencias de las variables entre los grupos de estudio se calcularon con la prueba de Chi2. Resultados: No se observaron diferencias en cuanto a longitud muscular en los grupos de estudio. El grupo con disfunción de la articulación sacroilíaca presentó más personas con dolor y limitación funcional moderada-severa. Conclusiones: Las retracciones del dorsal ancho, los isquiotibiales y los espinales lumbares no se relacionaron con el dolor lumbar o la disfunción de la articulación sacroilíaca; sin embargo, los adultos jóvenes de este grupo presentaron más molestias y discapacidad.

Introduction: Sacroiliac joint dysfunction is a pathomechanical alteration, in which stability is lost and the functioning of the pelvic girdle is altered; the ability to transmit and dissipate forces from the lower limbs to the spine and vice versa is also modified. The shortening of muscles such as the latissimus dorsi, hamstrings and lumbar spinal muscles can alter motor control and generate low back pain. Objective: To evaluate the muscle length of latissimus dorsi, hamstrings and lumbar spinal muscles, pain and functionality in young adults by comparing three study groups: pain, sacroiliac joint dysfunction and control. Methods: A cross-sectional study was carried out. A total of 114 subjects of both sexes were included. Muscle length was assessed through muscle-specific tests. The Visual Analog Scale and the Oswestry were used to measure pain and functionality, respectively. Differences in variables between study groups were calculated with the Chi2 test. Results: No differences in muscle length were observed in the study groups. The group with sacroiliac joint dysfunction presented more individuals with pain and moderate-severe functional limitation. Conclusions: Latissimus dorsi, hamstring and lumbar spinal retractions were not related to low back pain or sacroiliac joint dysfunction; however, young adults in this group presented more discomfort and disability.

Posterior oblique technique for sacroiliac joint fusion leads to greater pain relief and similar improvement in function compared to the lateral technique: A retrospective, comparative study.

Background: Management of chronic sacroiliac joint (SIJ) pain among patients who do not respond to nonsurgical treatment is increasingly turning toward minimally invasive SIJ fusion. There are different techniques available to perform this procedure, with the lateral technique being more commonly studied than the posterior oblique technique. This study examined the effects of these techniques on pain relief and functional improvement, both preoperatively and at a 12-month follow-up. Methods: This retrospective cohort study analyzed data from 45 patients who underwent SIJ fusion. Included patients were ≥50 years old, nonresponsive to conservative treatment. Subjects were divided into 2 cohorts based on the SIJ fusion technique. Primary outcomes were pain relief, measured by Visual Analog Scale (VAS), and functional improvement, determined by the Oswestry Disability Index (ODI); both were recorded and assessed at baseline, postoperative, and the change from pre- to postoperative. Additionally, data regarding patient demographics, previous lumbar fusion, operative time, and duration of hospital stay were collected and analyzed. Results: Baseline demographic and clinical variables exhibited no significant differences in distribution between groups. The posterior oblique cohort demonstrated a substantial reduction in operative time (over 50%) and duration of hospital stay compared to lateral cohort. Pain relief (postoperative VAS: lateral 3.5±1.7 vs. posterior oblique 2.4±1.5 [p=.02]) and functional improvement (postoperative ODI: lateral 29.6±7.3 vs. posterior oblique 21±5.7 [p≤.001]) were significantly better in the posterior oblique group. Pre- to postoperative improvement analysis indicated greater reduction in pain (VAS: lateral -4.4±1.9 vs. posterior oblique -6.1±1.5 [p=.002]) in the posterior oblique group. Conclusions: Compared to the lateral technique group, patients undergoing minimally invasive SIJ fusion through the posterior oblique technique experienced greater pain relief and demonstrated a trend toward better functional improvement, with shorter operative times and duration of hospital stay. The posterior oblique technique may be more efficient and beneficial to manage patients suffering from chronic SIJ pain through joint fusion.

Sacroiliac joint dysfunction and lumbar pain. Evaluation in a Brazilian population / Disfunción de la articulación sacroilíaca y dolor lumbar. Evaluación en una población brasileña

Abstract: The study intended to evaluate the incidence and evolution of sacroiliac joint dysfunction (SIJD). To reach 50 patients with SIJD diagnosis, 192 patients with low back pain and failure in conservative approach were consecutively examined (26% incidence). Initially patients underwent intra-articular (IA) corticosteroid sacroiliac joint (SIJ) block followed, if necessary, by cooled SIJ radiofrequency or referred to surgical intervention, in order of complexity. From the 50 patients submitted to IA SI block, 41 (82%) referred pain and quality of life improvement and lesser rescue analgesics consumption for 25 weeks. The block induced a prompt onset of pain relief and there was a drop in mean pain score from 8 to 2 cm (p < 0.001) maintained up to 25 weeks. Rescue analgesic consumption also significantly dropped (p < 0.05). However, nine patients (18%) did not refer long lasting improvement in the third week evaluation and underwent cooled radiofrequency. From this population of nine, seven were successful (78%) while two were recommended surgery. In view of the 50 patients, 82% were comfortable after IA block, 18% were submitted to radiofrequency, with a success rate of 78%. The final incidence of surgery suggestion was 4%.

Resumen: El estudio pretende evaluar la incidencia y evolución de la disfunción de la articulación sacroilíaca (DASI). Para llegar a 50 pacientes con diagnóstico de DASI, se examinaron consecutivamente 192 pacientes con dolor lumbar y fracaso en el abordaje conservador (26% de incidencia). Inicialmente, los pacientes se sometieron a un bloqueo de la articulación sacroilíaca (ASI) con corticosteroides intraarticulares (IA) seguido, si era necesario, de radiofrecuencia ASI enfriada o remitidos a una intervención quirúrgica, en orden de complejidad. De los 50 pacientes sometidos al bloqueo IA SI, 41 (82%) refirieron mejoría del dolor y de la calidad de vida y menor consumo de analgésicos de rescate durante 25 semanas. El bloqueo indujo un rápido inicio del alivio del dolor y hubo una caída en la puntuación media del dolor de 8 a 2 cm (p < 0.001) mantenida hasta 25 semanas. El consumo de analgésicos de rescate también disminuyó significativamente (p < 0.05). Sin embargo, nueve pacientes (18%) no refirieron una mejoría duradera en la evaluación de la tercera semana y se sometieron a radiofrecuencia fría. De esta población de nueve, siete tuvieron éxito (78%), mientras que a dos se les recomendó cirugía. De los 50 pacientes, 82% se sintió cómodo después del bloqueo IA, 18% fue sometido a radiofrecuencia, con una tasa de éxito de 78%. La incidencia final de sugerencia de cirugía fue de 4%.

Sacroiliac joint dysfunction and lumbar pain. Evaluation in a Brazilian population.

The study intended to evaluate the incidence and evolution of sacroiliac joint dysfunction (SIJD). To reach 50 patients with SIJD diagnosis, 192 patients with low back pain and failure in conservative approach were consecutively examined (26% incidence). Initially patients underwent intra-articular (IA) corticosteroid sacroiliac joint (SIJ) block followed, if necessary, by cooled SIJ radiofrequency or referred to surgical intervention, in order of complexity. From the 50 patients submitted to IA SI block, 41 (82%) referred pain and quality of life improvement and lesser rescue analgesics consumption for 25 weeks. The block induced a prompt onset of pain relief and there was a drop in mean pain score from 8 to 2 cm (p < 0.001) maintained up to 25 weeks. Rescue analgesic consumption also significantly dropped (p < 0.05). However, nine patients (18%) did not refer long lasting improvement in the third week evaluation and underwent cooled radiofrequency. From this population of nine, seven were successful (78%) while two were recommended surgery. In view of the 50 patients, 82% were comfortable after IA block, 18% were submitted to radiofrequency, with a success rate of 78%. The final incidence of surgery suggestion was 4%.

El estudio pretende evaluar la incidencia y evolución de la disfunción de la articulación sacroilíaca (DASI). Para llegar a 50 pacientes con diagnóstico de DASI, se examinaron consecutivamente 192 pacientes con dolor lumbar y fracaso en el abordaje conservador (26% de incidencia). Inicialmente, los pacientes se sometieron a un bloqueo de la articulación sacroilíaca (ASI) con corticosteroides intraarticulares (IA) seguido, si era necesario, de radiofrecuencia ASI enfriada o remitidos a una intervención quirúrgica, en orden de complejidad. De los 50 pacientes sometidos al bloqueo IA SI, 41 (82%) refirieron mejoría del dolor y de la calidad de vida y menor consumo de analgésicos de rescate durante 25 semanas. El bloqueo indujo un rápido inicio del alivio del dolor y hubo una caída en la puntuación media del dolor de 8 a 2 cm (p < 0.001) mantenida hasta 25 semanas. El consumo de analgésicos de rescate también disminuyó significativamente (p < 0.05). Sin embargo, nueve pacientes (18%) no refirieron una mejoría duradera en la evaluación de la tercera semana y se sometieron a radiofrecuencia fría. De esta población de nueve, siete tuvieron éxito (78%), mientras que a dos se les recomendó cirugía. De los 50 pacientes, 82% se sintió cómodo después del bloqueo IA, 18% fue sometido a radiofrecuencia, con una tasa de éxito de 78%. La incidencia final de sugerencia de cirugía fue de 4%.

Transfixation of the Sacroiliac Joint: Biomechanical Stability of a Dual-Implant Minimally Invasive Procedure.

BACKGROUND: Despite minimally invasive techniques for sacroiliac joint fixation, clinical challenges remain. The investigators hypothesized the studied technique will transfix the sacroiliac joint to a level comparable to the intact sacroiliac joint. OBJECTIVES: The study objective was to determine the dynamic stability of a square inter-joint implant using a triangular notch in opposing bone segments spanning the joint space. STUDY DESIGN: Stability was assessed by measuring micromotion using contralaterally placed transducers spanning the sacroiliac joint of a specimen during cyclic loading. SETTING: A porcine in-vitro model was equipped with micromotion transducers on the intact and surgically implanted sacroiliac joint. Cyclic loading was applied on the L4 vertebra and the recorded micromotion data at each sacroiliac joint was analyzed. METHODS: Porcine specimens from L3 to the sacrum including the pelvic ring were used to biomechanically evaluate the implantation technique. A novel technique consisting of a square inter-joint implant was placed so as to create a triangular stabilization notch within adjacent boney components of the sacroiliac joint. Displacement transducers were placed across implanted and contralateral porcine sacroiliac joint. Specimens were subjected to compressive loading between -10N and -100N followed by bending/rotation between 0.4Nm and 4.0Nm. Tests were conducted at 0.5Hz for 200 cycles. For each loading mode, transducer deflections (or rotations) were averaged at five-cycle intervals. Student's t-tests were used to compare fitted parameters between implanted and intact sacroiliac joint. RESULTS: In compression, implanted SIJ displayed reduced deflection compared to intact sacroiliac joint (P < 0.0001). In bending/rotation, initial rotation for the intact sacroiliac joint was increased compared to implanted sacroiliac joint (P < 0.0001). The computed Half-Life parameter represents the number of cycles at which the initial rotation decreases by 50% and was found to be statistically reduced for implanted sacroiliac joint as compared to intact sacroiliac joint. LIMITATIONS: The use of porcine specimens resulted in uniform and good quality bone purchase. Further study may be required to evaluate the technique in older patients where bone quality is reduced. CONCLUSIONS: Compared to the intact sacroiliac joint, the implant and procedure in this study demonstrated decreased motion under cyclic compression. Under rotation, the implanted sacroiliac joint displayed increased initial stability that subsequently normalized to intact sacroiliac joint values.

Sacroiliac joint beyond sacroiliitis-further insights and old concepts on magnetic resonance imaging.

The sacroiliac joint (SIJ) is an amphiarthrosis composed of a posterior syndesmosis and an anterior cartilaginous portion, with limited yet present mobility. Its main function is to transmit the load from the axial skeleton to the lower limbs and vice-versa; it is susceptible to early mechanical and degenerative changes which are much more common than inflammatory sacroiliitis. Magnetic resonance imaging (MRI) has increasingly been used to evaluate these changes, and while subchondral bone marrow edema (BME) is a common finding related to both, care must be taken when applying the ASAS research MRI definition for sacroiliitis without considering lesion BME topography, size and depth, concomitant structural damage and, of course, the clinical picture. In this review, we will discuss the anatomy and biomechanics of the SIJ, the noninflammatory causes of SIJ subchondral BME, and how these concepts combined can be used to increase our diagnostic confidence.

Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review.

The sacroiliac joint is a diarthrodial synovial joint in the pelvis. Anatomically, it is described as a symphysis, its synovial joint characteristics being limited to the distal cartilaginous portion on the iliac side. It is a continuous ligamentous stocking comprising interconnecting ligamentous structures and surrounding fascia. Its ligaments, the primary source of its stability, include the anterior, interosseous and dorsal sacroiliac, the iliolumbar, sacrotuberous, and sacrospinous. Structural reinforcement is also provided by neighboring fascia and muscles. Lower back pain is a common presentation of sacroiliac joint disease, the best-established treatments being corticosteroid injections, bipolar radiofrequency ablation, and sacroiliac joint fusion.

An independent inter- and intra-observer agreement assessment of the Eno classification of sacroiliac joint degeneration.

BACKGROUND: Recently, a scoring system to grade sacroiliac joint (SIJ) degeneration using computed tomography (CT) scans was described. No independent evaluation has determined the inter- and intra-observer agreement using this scheme. PURPOSE: To perform an independent inter- and intra-observer agreement assessment using the Eno classification and determining gas in the SIJ. MATERIAL AND METHODS: We studied 64 patients aged ≥60 years who were evaluated with abdominal and pelvic computed tomography scans. Six physicians (three orthopaedic spine surgeons and three musculoskeletal radiologists) assessed axial images to grade SIJ degeneration into grade 0 (normal), grade 1 (mild degeneration), grade 2 (significant degeneration), and grade 3 (ankylosis). We also evaluated the agreement assessing the presence of gas in the SIJ. After a four-week interval, all cases were presented in a random sequence for repeat assessment. We determined the agreement using the kappa (κ) or weighted kappa coefficient (wκ). RESULTS: The inter-observer agreement was moderate (wκ = 0.50 [0.44-0.56]), without differences among surgeons (wκ = 0.53 [0.45-0.61]) and radiologists (wκ = 0.49 [0.42-0.57]). The agreement evaluating the presence of gas was also moderate (κ = 0.45 [0.35-0.54]), but radiologists obtained better agreement (κ = 0.61 [0.48-0.72]) than surgeons (κ = 0.29 [0.18-0.39]). The intra-observer agreement using the classification was substantial (wκ = 0.79 [0.76-0.82]), without differences comparing surgeons (wκ = 0.75 [0.70-0.80]) and radiologists (wκ = 0.83 [0.79-0.87]). The intra-rater agreement evaluating gas was substantial (κ = 0.77 [0.72-0.82]), without differences between surgeons (κ = 0.71 [0.63-0.78]) and radiologists (κ = 0.84 [0.78-0.90]). CONCLUSION: Given the only moderate agreement obtained using the Eno classification, it does not seem adequate to be used in clinical practice or in research.

Construct validity and reliability of tests for sacroiliac dysfunction: standing flexion test (STFT) and sitting flexion test (SIFT).

CONTEXT: Sacroiliac dysfunction is characterized by a hypomobility of the range of motion of the joint, followed by a positional change regarding the relationship between the sacrum and the iliac. In general, the clinical tests that evaluate the sacroiliac joint (SIJ) and its dysfunctions lack validity and reliability values. OBJECTIVES: This article aims to evaluate the construct validity and intra- and inter-rater reliability of the standing flexion test (STFT) and sitting flexion test (SIFT). METHODS: In this prospective study, the sample consisted of 30 individuals of both sexes, and the evaluation team was composed of five researchers. The evaluations took place on two different days: first day, inter-rater reliability and construct validity; and second day, intra-rater reliability. The reference standard for the construct validity was 3-dimensional measurements obtained utilizing the BTS SMART-DX system. For statistical analysis, the percentage (%) agreement and the kappa statistic (K) were utilized. RESULTS: The construct validity was determined for STFT (70% agreement; K=0.49; p<0.01) and SIFT (56.7% agreement; K=0.29; p<0.05). The intra-rater reliability was determined for STFT (66.3% agreement; K=0.43; p<0.01) and SIFT (56.7% agreement; K=0.38; p<0.01). The inter-rater reliability was determined for STFT (10% agreement; K=-0.02; p=0.825) and SIFT (13.3% agreement; K=0.01; p=0.836). CONCLUSIONS: The STFT confirmed the construct validity and was reliable when applied by the same rater to healthy people, even if the rater had no experience. It was not possible to achieve minimum scores using the SIFT either for construct validity or reliability. We suggest that further studies be conducted to investigate the measurement properties of palpatory clinical tests for SIJ mobility, especially in symptomatic patients.

REPRODUCIBILITY OF S2-ALAR ILIAC SCREW MORPHOMETRIC ANALYSIS.

OBJECTIVE: To evaluate the reproducibility of a S2-alar iliac (S2AI) screw parameters measurement method by inter and intraobserver reliability. METHODS: Cross-sectional study, considering computed tomography exams. Morphometric analysis was performed by multiplanar reconstructions. Screw length, diameter and trajectory angles were the studied variables. To analyze the measurements reproducibility, intraclass correlation coefficient (ICC) was used. RESULTS: Interobserver reliability was classified as strong for screw shortest length (ICC: 0.742) and diameter (ICC: 0.699). Interobserver reliability was classified as moderate for screw longest length (ICC: 0.553) and for screw trajectory angles in the axial plane for the longest (ICC: 0.478) and for the shortest lengths (ICC: 0.591). Intraobserver reliability was interpreted as excellent for screw shortest (ICC: 0.932) and longest lengths (ICC: 0.962) and diameter (ICC: 0.770) and screw trajectory angles in the axial plane for the screw longest (ICC: 0.773) and shortest lengths (ICC: 0.862). There were weak interobserver and strong intraobserver reliabilities for trajectory angle in sagittal plane, but no statistical significance was found. CONCLUSION: Inter and intraobserver reliability of S2AI screw morphometric parameters were interpreted from moderate to excellent in almost all studied variables, except for the screw trajectory angle in the sagittal plane measurement. Level of Evidence IV, Diagnostic Studies - Investigating a Diagnostic Test.

OBJETIVO: Avaliar a reprodutibilidade, por meio da concordância inter e intraobservador, de um método de aferição dos parâmetros sacropélvicos do parafuso S2-asa do ilíaco (S2AI). MÉTODOS: Estudo transversal, considerando exames de tomografia computadorizada. A análise morfométrica foi feita por meio de reconstruções multiplanares. As variáveis estudadas foram: comprimento, diâmetro e ângulos de trajetória do parafuso S2AI. Para análise da reprodutibilidade das medidas, utilizou-se o coeficiente de correlação intraclasse (ICC). RESULTADOS: A confiabilidade interobservador foi classificada como forte para o menor comprimento (ICC: 0,742) e diâmetro (ICC: 0,699). Em relação ao maior comprimento (ICC: 0,553) e aos ângulos de trajetória axial para o maior (ICC: 0,478) e para o menor comprimento (ICC: 0,591), a confiabilidade interobservador foi classificada como moderada. A confiabilidade intraobservador foi excelente para o menor (ICC: 0,932) e maior comprimentos (ICC: 0,962), diâmetro (ICC: 0,770) e ângulos de trajetória axial (ICC: 0,773 - maior comprimento; ICC: 0,862 - menor comprimento). Houve confiabilidade interobservador fraca e intraobservador forte para o ângulo de trajetória sagital, porém sem significância estatística. CONCLUSÃO: A correlação inter e intraobservador dos parâmetros morfométricos do parafuso S2AI mostrou-se de moderada a excelente em quase todas as variáveis estudadas, exceto para o ângulo de trajetória sagital. Nível de Evidência IV, Estudos diagnósticos - Investigação de um exame para diagnóstico.

Retrospective Study of the Analgesic Effect of Sacroiliac Joint Radiofrequency Denervation.

BACKGROUND: Interventional radiofrequency (RF) ablation techniques are indicated when an adequate effect is not obtained with conservative measures. OBJECTIVES: The primary objective of this study was to evaluate pain relief after RF denervation of the sacroiliac joint. The secondary objective was to evaluate pain intensity and relief duration. STUDY DESIGN: The study was retrospective. SETTING: The study was conducted at Vera Cruz Hospital, Campinas, Brazil. METHODS: Data were collected from the medical records of patients undergoing RF denervation for low back pain originating in the sacroiliac joint, from January 2015 to December 2017. There were 78 patients studied, between 18 and 65 years old, of both genders, ASA I or II, who underwent knee arthroscopic meniscectomy. The patients were submitted to denervation of sacroiliac joint by 3 types of RF (conventional, pulsed, and cooled). The following parameters were evaluated, number of patients who obtained ? 50% pain relief; pain intensity, measured using the visual analog scale (before the procedure and 15, 30, 90 and 180 days after, performed by the same evaluator); and the use of complementary analgesic for 2 weeks. RESULTS: Of the 78 included patients, 56 (71.8%) underwent conventional RF, 9 (11.5%) underwent pulsed RF, and 13 (16.7%) underwent cooled RF. There were losses to follow-up including 40 patients who underwent conventional RF, 5 who underwent pulsed RF, and 12 who underwent cooled RF, who were retained for 6 months. There was significant pain relief with the three types of RF for up to 6 months of follow-up, with no difference among the types. After 6 months, 90.2% of patients who underwent conventional RF, 100% who underwent pulsed RF, and 91.7% who underwent cooled RF maintained ≥ 50% pain relief. Complementary analgesics were used by 95% of the patients who underwent conventional RF, 80% who underwent pulsed RF, and 91% who underwent cooled RF 2 weeks after the procedure. There were mild adverse effects, such as edema, hematoma, and local pain, without complications. LIMITATIONS: As for limitations, the number of pulsed and cooled RF is low and in a retrospective study some data may be missing, especially from follow-up. CONCLUSIONS: RF denervation of the sacroiliac joint is effective and promotes a long-lasting analgesic effect.

Subluxación sacroilíaca en un equino criollo colombiano / Sacroiliac subluxation in a horse in Colombia

Resumen La subluxación sacroilíaca es una enfermedad claudiocógena de los miembros posteriores que se puede presentar de forma aguda o crónica. La causa de esta patología se debe principalmente a resbalones, tropezones o caídas de los miembros posteriores, el diagnóstico es difícil de realizar debido a la profunda ubicación anatómica de la articulación, métodos como la ecografía y pruebas de estrés entre otros, son los procedimientos más usados en el diagnóstico de la subluxación sacroiliaca. Por tratarse de una alteración que fácilmente puede confundirse con otras condiciones patológicas de la columna, la pelvis y/o de los miembros posteriores, el diagnóstico muchas veces se realiza por eliminación de otras causas de cojera. Los tratamientos convencionales aún se proponen en la literatura, sin embargo, cada vez como opción para el tratamiento de esta patología. El presente reporte describe el caso de un equino criollo que padeció una subluxación sacroiliaca aguda del lado derecho, la cual fue diagnosticada con un examen clínico que incluía ecografía percutánea y transrectal, y tratada con infiltraciones ecoguiadas de corticoides y aspirado de médula ósea. Un mes después de la última terapia, el caballo mostró una mejoría clínica en un 80% a 90% aproximadamente y retoma actividad física controlada.

Abstract Sacroiliac subluxation is a claudiogenic disease of the hind limbs that can present acutely or chronically. The cause of this pathology is mainly due to slipping, tripping, or falling of the hind limbs, the diagnosis is difficult to make due to the deep anatomical location of the joint, methods such as ultrasound and stress tests among others, are the procedures most used in the diagnosis of sacroiliac subluxation. As it is an alteration that can easily be confused with other pathological conditions of the spine, pelvis and / or the hind limbs, the diagnosis is often made by eliminating other causes of lameness. Conventional treatments are still proposed in the literature, however regenerative therapy is increasingly used as an option for the treatment of sacroiliac joint injuries. This report describes the case of a Creole horse that suffered an acute sacroiliac subluxation on the right side, which was diagnosed with a clinical examination that included percutaneous and transrectal ultrasound and treated with ultrasound-guided infiltrations of corticosteroids and cells of the bone marrow of the sternum without processing. One month after the last therapy, the horse showed an 80% to 90% recovery and resumed controlled physical activity.

Relationship of the mobility of the sacroiliac joint with foot plant pressure.

[Purpose] To evaluate mobility of the sacroiliac joint and plantar pressure changes. [Participants and Methods] This was an analytical study comprised of 300 participants, using a functional kinetic evaluation involving the test of standing flexion (SFT), the test of Downing, the test of Gillet, and the analysis of baropodometry. [Results] There was an association between mobility of the sacroiliac joint and the standing center of gravity. However, the mobility of this joint was not associated with plantar pressure and the plantar contact area. [Conclusion] These data suggest that sacroiliac mobility is linked to the center of gravity. This connection may precede sacroiliac dysfunction and may help to improve the accuracy of the tests.

Reproducibility of s2-alar iliac screw morphometric analysis / Reprodutibilidade da análise morfométrica do parafuso s2-asa do ilíaco

ABSTRACT Objective: To evaluate the reproducibility of a S2-alar iliac (S2AI) screw parameters measurement method by inter and intraobserver reliability. Methods: Cross-sectional study, considering computed tomography exams. Morphometric analysis was performed by multiplanar reconstructions. Screw length, diameter and trajectory angles were the studied variables. To analyze the measurements reproducibility, intraclass correlation coefficient (ICC) was used. Results: Interobserver reliability was classified as strong for screw shortest length (ICC: 0.742) and diameter (ICC: 0.699). Interobserver reliability was classified as moderate for screw longest length (ICC: 0.553) and for screw trajectory angles in the axial plane for the longest (ICC: 0.478) and for the shortest lengths (ICC: 0.591). Intraobserver reliability was interpreted as excellent for screw shortest (ICC: 0.932) and longest lengths (ICC: 0.962) and diameter (ICC: 0.770) and screw trajectory angles in the axial plane for the screw longest (ICC: 0.773) and shortest lengths (ICC: 0.862). There were weak interobserver and strong intraobserver reliabilities for trajectory angle in sagittal plane, but no statistical significance was found. Conclusion: Inter and intraobserver reliability of S2AI screw morphometric parameters were interpreted from moderate to excellent in almost all studied variables, except for the screw trajectory angle in the sagittal plane measurement. Level of Evidence IV, Diagnostic Studies - Investigating a Diagnostic Test.

RESUMO Objetivo: Avaliar a reprodutibilidade, por meio da concordância inter e intraobservador, de um método de aferição dos parâmetros sacropélvicos do parafuso S2-asa do ilíaco (S2AI). Métodos: Estudo transversal, considerando exames de tomografia computadorizada. A análise morfométrica foi feita por meio de reconstruções multiplanares. As variáveis estudadas foram: comprimento, diâmetro e ângulos de trajetória do parafuso S2AI. Para análise da reprodutibilidade das medidas, utilizou-se o coeficiente de correlação intraclasse (ICC). Resultados: A confiabilidade interobservador foi classificada como forte para o menor comprimento (ICC: 0,742) e diâmetro (ICC: 0,699). Em relação ao maior comprimento (ICC: 0,553) e aos ângulos de trajetória axial para o maior (ICC: 0,478) e para o menor comprimento (ICC: 0,591), a confiabilidade interobservador foi classificada como moderada. A confiabilidade intraobservador foi excelente para o menor (ICC: 0,932) e maior comprimentos (ICC: 0,962), diâmetro (ICC: 0,770) e ângulos de trajetória axial (ICC: 0,773 - maior comprimento; ICC: 0,862 - menor comprimento). Houve confiabilidade interobservador fraca e intraobservador forte para o ângulo de trajetória sagital, porém sem significância estatística. Conclusão: A correlação inter e intraobservador dos parâmetros morfométricos do parafuso S2AI mostrou-se de moderada a excelente em quase todas as variáveis estudadas, exceto para o ângulo de trajetória sagital. Nível de Evidência IV, Estudos diagnósticos - Investigação de um exame para diagnóstico.

Anatomical variations of the sacro-iliac joint: a computed tomography study.

PURPOSE: To identify, describe, and compare the prevalence of sacroiliac joint anatomical variants. METHODS: A retrospective study was performed on computed tomography scans. Joint space was measured, and variants were classified as accessory joint, ileosacral complex, bipartite bony plate, semicircular defect, iliac bony plate, and ossification centers. RESULTS: 400 scans were analyzed. Mean age was 49 years, 180 men (45%), and 220 women (55%). 209 (52.2%) patients presented an anatomical variant with higher prevalence in women (65.4% vs 36.2%), and those older than 40 years of age (60% vs 40%). Mean joint space was similar bilaterally (right 2.41 ± 0.65 mm vs. left 2.37 ± 0.65 mm). Prevalence was: 19.8% accessory joint, 6.5% ileosacral complex, 12.3% bipartite bony plate, 8% semicircular defect, 5% iliac bony plate, and 0.8% for ossification centers. CONCLUSION: Prevalence of anatomical variants of the SIJ is higher in the Hispanic population, women, and those older than 40 years.

Description of the Sacropelvic Parameters Measurement Method for S2-alar iliac Screw Insertion.

Objective Description of the sacropelvic parameters measurement method for S2-alar iliac (S2AI) screw insertion. Methods Descriptive study of the method for measuring sacropelvic parameters for the insertion of the S2AI screw using computed tomography (CT). The data evaluated in multiplanar reconstructions were the parameters of the screw trajectory, including length, diameter and angles of the trajectory in the axial and sagittal planes. Results From the sagittal reconstruction, the axis of the series of axial slices is angled three-dimensionally so that it is possible to visualize the S2 vertebra, the screw entry point, and the anteroinferior iliac spine (AIIS) in the same plane. The entry point is demarcated at the midpoint between the dorsal foramina of S1 and S2. To measure the length of the screw, lines are drawn tangent to the inner and outer cortices of the iliac. The diameter is determined by the shortest distance between the inner and outer iliac faces minus half of the diameter of the screw chosen medially and laterally. The path angle in the axial plane is formed by the anteroposterior midline of the sacrum and the line of the screw length. The craniocaudal inclination angle in relation to the S1 plateau corresponds to the degree of inclination made in the sagittal plane to find the image in which the entry point and the AIIS are seen in the same plane. Conclusion It was possible to adequately assess, through multiplanar CT reconstructions, the sacropelvic parameters necessary for the safe insertion of the S2AI screw.

Description of the Sacropelvic Parameters Measurement Method for S2-alar iliac Screw Insertion / Descrição do método de aferição dos parâmetros sacropélvicos para a inserção do parafuso S2-asa do ilíaco

Abstract Objective Description of the sacropelvic parameters measurement method for S2-alar iliac (S2AI) screw insertion. Methods Descriptive study of the method for measuring sacropelvic parameters for the insertion of the S2AI screw using computed tomography (CT). The data evaluated in multiplanar reconstructions were the parameters of the screw trajectory, including length, diameter and angles of the trajectory in the axial and sagittal planes. Results From the sagittal reconstruction, the axis of the series of axial slices is angled three-dimensionally so that it is possible to visualize the S2 vertebra, the screw entry point, and the anteroinferior iliac spine (AIIS) in the same plane. The entry point is demarcated at the midpoint between the dorsal foramina of S1 and S2. To measure the length of the screw, lines are drawn tangent to the inner and outer cortices of the iliac. The diameter is determined by the shortest distance between the inner and outer iliac faces minus half of the diameter of the screw chosen medially and laterally. The path angle in the axial plane is formed by the anteroposterior midline of the sacrum and the line of the screw length. The craniocaudal inclination angle in relation to the S1 plateau corresponds to the degree of inclination made in the sagittal plane to find the image in which the entry point and the AIIS are seen in the same plane. Conclusion It was possible to adequately assess, through multiplanar CT reconstructions, the sacropelvic parameters necessary for the safe insertion of the S2AI screw.

Resumo Objetivo Descrever como aferir os parâmetros sacropélvicos para a inserção segura do parafuso S2-asa do ilíaco (S2AI). Métodos Estudo descritivo do método de aferição dos parâmetros sacropélvicos para a inserção do parafuso S2AI por meio de tomografia computadorizada (TC). Os dados avaliados em reconstruções multiplanares foram os parâmetros da trajetória do parafuso, incluindo comprimento, diâmetro e ângulos de trajetória nos planos axial e sagital. Resultados A partir da reconstrução sagital, angula-se tridimensionalmente o eixo da série de cortes axiais de modo que seja possível visualizar a vértebra S2, o ponto de entrada do parafuso e a espinha ilíaca anteroinferior (EIAI) no mesmo plano. O ponto de entrada é demarcado no ponto médio entre os forames dorsais de S1 e S2. Para medir o comprimento do parafuso, traçam-se linhas tangenciando as corticais interna e externa do ilíaco. O diâmetro é determinado pela menor distância entre as tábuas interna e externa do ilíaco subtraindo metade do diâmetro do parafuso escolhido medialmente e lateralmente. O ângulo de trajetória no plano axial é formado pela linha média anteroposterior do sacro e a linha do comprimento do parafuso. O ângulo de inclinação craniocaudal em relação ao platô de S1 corresponde ao grau de inclinação feito no plano sagital para encontrar a imagem em que o ponto de entrada e a EIAI são vistos no mesmo plano. Conclusão Foi possível aferir adequadamente, por meio de reconstruções multiplanares de TC, os parâmetros sacropélvicos necessários para a inserção segura do parafuso S2AI.

Comparison between STIR and T2-weighted SPAIR sequences in the evaluation of inflammatory sacroiliitis: diagnostic performance and signal-to-noise ratio.

OBJECTIVE: To compare two different fat-saturated magnetic resonance imaging (MRI) techniques-STIR and T2 SPAIR-in terms of image quality, as well as in terms of their diagnostic performance in detecting sacroiliac joints (SIJ) active inflammation. MATERIALS AND METHODS: We included 69 consecutive patients with suspected spondyloarthritis undergoing MRI between 2012 and 2014. The signal-to-noise ratio (SNR) was calculated with the method recommended by the American College of Radiology. Two readers evaluated SIJ MRI following ASAS criteria to assess diagnostic performance regarding the detection of active SIJ inflammation. T1 SPIR Gd+ sequence was used as the reference standard. RESULTS: The mean SNR was 72.8 for the T1 SPIR Gd+ sequence, compared with 14.1 and 37.6 for the STIR and T2 SPAIR sequences, respectively. The sensitivity and specificity of STIR and SPAIR T2 sequences did not show any statistically significant differences, for the diagnosis of sacroiliitis with active inflammation. CONCLUSION: Our results corroborate those in the recent literature suggesting that STIR sequences are not superior to T2 SPAIR sequences for SIJ evaluation in patients with suspected spondyloarthritis. On 1.5-T MRI, T2-weighted SPAIR sequences provide better SNRs than do STIR sequences, which reinforces that T2 SPAIR sequences may be an advantageous option for the evaluation of sacroiliitis.

OBJETIVO: O objetivo deste estudo foi comparar a qualidade da imagem das técnicas de saturação de gordura T2 SPAIR e STIR e, adicionalmente, comparar o desempenho diagnóstico das duas sequências para detecção de inflamação ativa nas imagens de ressonância magnética (RM) das sacroilíacas. MATERIAIS E MÉTODOS: Foram incluídos 69 pacientes consecutivos que realizaram RM das articulações sacroilíacas no período de 2012 a 2014. O cálculo da relação sinal/ruído (RSR) foi realizado pelo método do Colégio Americano de Radiologia. O desempenho diagnóstico foi realizado utilizando os resultados da leitura das imagens da sequência T1 SPIR Gd+ como referência. RESULTADOS: A avaliação da RSR mostrou média de 72,8 para a sequência T1 SPIR Gd+. A sensibilidade e a especificidade das sequências STIR e SPAIR 2 para o diagnóstico de sacroiliite com inflamação ativa não apresentaram diferenças estatisticamente significantes. CONCLUSÃO: Nossos resultados reforçam a literatura recente sugerindo que não há superioridade da sequência STIR em relação à sequência SPAIR T2 para a avaliação das sacroilíacas em pacientes com espondiloartrite. A sequência SPAIR T2 apresenta melhor RSR em relação à sequência STIR em imagens de RM de 1,5 T, o que reforça que a sequência SPAIR T2 possa ser utilizada como opção vantajosa na avaliação da sacroiliite inflamatória.

Are Anterior Plates More Effective than Iliosacral Screws to Fix the Sacroiliac Joint? Biomechanical Study.

Introduction Sacroiliac joint dislocations are caused by high energy trauma and commonly treated with the iliosacral screw fixation or the anterior plating of the sacroiliac joint (SIJ). However, there is a lack of consensus regarding which procedure is the most successful in treating sacroiliac joint dislocations. This aims to compare stiffness and maximum load of pelvises with sacroiliac joint dislocations treated with both procedures in a synthetic bone model. Methods Synthetic pelvises were mounted and divided into 2 treatment groups ( n = 5): a model with two orthogonal plates placed anteriorly to the SIJ (PPS group) and another with two iliosacral screws fixating the SIJ (SPS group), both with pubic symphysis fixation. The maximum load supported by each sample was observed and the stiffness was calculated from the curve load vs displacement. The mean values of load to failure and stiffness for each group were compared with the Mann-Whitney U test ( p < 0.05 was considered significant for all analysis). Results The mean load to failure supported by the PPS group was 940 ± 75 N and the SPS was 902 ± 56 N, with no statistical difference. The SPS group showed higher values of stiffness (68.6 ± 11.1 N/mm) with statistical significant difference in comparison to the PPS sample (50 ± 4.0 N/mm). The mode of failure was different in each group tested. Conclusion Despite lower stiffness, the anterior plating fixation of the sacroiliac joint can be very useful when the iliosacral screw fixation cannot be performed. Further studies are necessary to observe any differences between these two procedures on the clinical and surgical setting.