Mobility and anthropometry of the sacroiliac joint: range of motion and morphological characteristics.

Purpose: The sacroiliac joint (SIJ), a synovial joint with irregular surfaces, is crucial for stabilizing the body and facilitating daily activities. However, recent studies have reported that 15-30% of lower back pain can be attributed to instability in the SIJ, a condition collectively referred to as sacroiliac joint dysfunction (SIJD). The aim of this study is to investigate how the morphological characteristics of the auricular surface may influence the SIJ range of motion (ROM) and to examine differences in SIJ ROM between females and males, thereby contributing to the enhancement of SIJD diagnosis and treatment. Methods: We measured SIJ ROM using motion-analysis cameras in 24 fresh cadavers of Korean adults (13 males and 11 females). Using three-dimensional renderings of the measured auricular surface, we investigated the correlations between the morphological characteristics of the auricular surface and the ROM of the SIJ. Results: The SIJ ROM was between 0.2° and 6.7° and was significantly greater in females (3.58° ± 1.49) compared with males (1.38° ± 1.00). Dividing the participants into high-motion (3.87° ± 1.19) and low-motion (1.13° ± 0.62) groups based on the mean ROM (2.39°) showed no significant differences in any measurements. Additionally, bone defects around the SIJ were identified using computed tomography of the high-motion group. In the low-motion group, calcification between auricular surfaces and bone bridges was observed. Conclusion: This suggests that the SIJ ROM is influenced more by the anatomical structures around the SIJ than by the morphological characteristics of the auricular surface.

Biomechanical, biochemical, and histological characterization of sacroiliac joint cartilage in the Yucatan minipig.

Although the sacroiliac (SI) joint can be a source of lower back and buttock pain, no comprehensive characterization studies on SI cartilage have been conducted. Using the minipig as a large animal model, this study conducted the first biomechanical, biochemical, and histological characterization of SI joint cartilage. Because previous literature has reported that sacral cartilage and iliac cartilage within the SI joint are histologically distinct, concomitantly it was expected that functional properties of the sacral cartilage would differ from those of the iliac cartilage. Creep indentation, uniaxial tension, biochemical, and histological analyses were conducted on the sacral and iliac cartilage of skeletally mature female Yucatan minipigs (n = 6-8 for all quantitative tests). Concurring with prior literature, the iliac cartilage appeared to be more fibrous than the sacral cartilage. Glycosaminoglycan content was 2.2 times higher in the sacral cartilage. The aggregate modulus of the sacral cartilage was 133 ± 62 kPa, significantly higher than iliac cartilage, which only had an aggregate modulus of 51 ± 61 kPa. Tensile testing was conducted in both cranial-caudal and ventral-dorsal axes, and Young's modulus values ranged from 2.5 ± 1.5 MPa to 13.6 ± 1.5 MPa, depending on anatomical structure (i.e., sacral vs. iliac) and orientation of the tensile test. The Young's modulus of sacral cartilage was 5.5 times higher in the cranial-caudal axis and 2.0 times higher in the ventral-dorsal axis than the iliac cartilage. The results indicate that the sacral and iliac cartilages are functionally distinct from each other. Understanding the distinct differences between sacral and iliac cartilage provides insight into the structure and function of the SI joint, which may inform future research aimed at repairing SI joint cartilage.

Assessment of the sacroiliac joint in patients with axial spondyloarthritis via three-dimensional ultrashort echo time magnetic resonance imaging.

Background: Bone erosion in the sacroiliac joint (SIJ) is highly specific for the diagnosis of axial spondyloarthritis (axSpA) and may indicate early disease progression. The 3D ultrashort echo time (3D-UTE) technique excels in providing clear contrast between the articular cartilage and the bone cortex interface. Additionally, it is emerging as a promising quantitative tool for detecting early cartilage changes. Therefore, this study aimed to evaluate the diagnostic performance of 3D-UTE sequences in identifying bone erosion in the SIJ of patients with axSpA and to clarify the potential of cartilage T2* values as a quantitative biomarker for axSpA. Methods: This prospective study employed convenience and consecutive sampling methods to recruit patients diagnosed with axSpA in Peking University Third Hospital who met the Assessment of Spondyloarthritis International Society (ASAS) criteria and also an equal number of healthy volunteers. After providing informed consent, all participants underwent 3D-UTE sequences and conventional T2* mapping of the SIJs. Two radiologists separately interpreted the bone erosion of each SIJ on 3D-UTE sequences. Erosion detection of SIJs via computed tomography (CT) served as the standard of reference. The T2* values of the cartilage were measured and compared, and the diagnostic efficacy of the T2* value for axSpA diagnosis was evaluated. Results: A total of 32 patients and 32 healthy volunteers were included. The 3D-UTE sequence, as separately assessed by two reviewers in terms of its ability to detect erosions, exhibited a notable level of accuracy. For the two reviewers, the respective diagnostic sensitivities were 94.7% and 92.9%, the specificities were 97.4% and 96.5%, positive predictive values were 96.7% and 95.4%, the negative predictive values were 95.9% and 94.5%, the accuracies were 96.2% and 94.9%, and the areas under the curve (AUCs) were 96.1% and 94.7%. For the detection of erosions, the interreader κ value was 0.949. The T2* values of the SIJ cartilage were significantly higher in patients with axSpA than in healthy volunteers. The intraobserver intraclass correlation coefficients (ICCs) for T2* measurements ranged between 80.5% and 82.2%. Meanwhile, the interobserver ICCs for UTE-T2* and gradient echo T2* measurements were 81.5% and 80.8%, respectively. The AUCs of the UTE-T2* values for discriminating patients with axSpA from the healthy volunteers of the two readers were 73.3% and 71.6%, respectively. Conclusions: 3D-UTE sequences can be used as a reliable morphological imaging technique for detecting bone erosion in the SIJ. Additionally, UTE-T2* values of the cartilage may offer a quantitative method for identifying patients with axSpA.

Sacropelvic Fixation with Porous Fusion/Fixation Screws: A Technical Note and Retrospective Review.

OBJECTIVE: The goal of this study was to analyze our initial experience using a novel porous fusion/fixation screw (PFFS) for pelvic fixation, and to determine our rate of screw malposition requiring intraoperative repositioning. METHODS: We reviewed 83 consecutive patients who underwent sacropelvic fixation with PFFS at our institution from 6/1/2022-6/30/2023 using intraoperative CT-based computer-assisted navigation (CAN) via an open posterior approach. Following PFFS insertion, intraoperative CT scans were obtained to assess screw positioning. Demographic data was collected, and operative reports and patient images were reviewed to determine what implants were used and if any PFFS required repositioning. RESULTS: 74 patients (26M:48F) were included, and 57 (77.0%) had a prior sacroiliac joint or lumbar spine surgery. A stacked screw configuration was used in 62/74 cases (83.8%). A total of 235 PFFS were used and six (2.6%) were malpositioned. Of 88 cephalic screws placed in stacked configuration, 4 were malpositioned (4.5%); and 1/123 caudal screws were malpositioned (0.8%). One of 24 SAI screws placed in a stand-alone configuration was malpositioned (4.2%). Malpositions included four medial, one lateral, and one inferior; and all were revised intraoperatively without major sequela. CONCLUSIONS: Although PFFS are larger than traditional sacropelvic fixation screws, stacked SAI instrumentation can be done safely with CAN. We found a low malposition rate in our initial series of patients, the majority being the cephalad screw in a stacked configuration. This isn't surprising, as these are placed after the caudal screws which reduces the available corridor size and increases the placement difficulty.

A Comparative Study of Functional Outcomes in Unstable Pelvic Ring Fractures Treated With Internal Fixator (INFIX) With and Without Sacroiliac Joint Screw Fixation.

Introduction Despite constituting only 3-8% of orthopedic trauma cases, pelvic injuries are associated with high mortality rates, emphasizing the critical need for stable fixation rather than merely anatomical alignment. The use of an anterior, subcutaneous, internal pelvic fixator (INFIX), a novel technique, has shown promise in treating these injuries. Posterior pelvic ring injuries are challenging because they require a significant level of surgical training and technical expertise, and each treatment method has disadvantages. The aim of this study is to compare the clinical and biomechanical outcomes of INFIX with and without sacroiliac screw fixation for unstable pelvic fractures. Methods and methodology Retrospectively, we selected 20 patients with unstable pelvic ring injuries who had come to a high-volume tertiary care hospital and medical college in the state of Maharashtra, India. All the patients were operated on with INFIX; 10 with a sacroiliac joint screw and 10 without a sacroiliac joint screw. We followed up with the patients for six months and evaluated them according to the Majeed score. Results Functional outcomes differed little between INFIX patients operated on with and without a sacroiliac joint screw. However, morbidity, hospital stay, the need for ICU, radiation exposure, and technical ease of surgery were improved in INFIX patients without the sacroiliac screw procedure. We noted an average Majeed score of 78 in the INFIX-alone group and 77.2 in the group that received INFIX with a sacroiliac joint screw. Six months after the surgery, the patients showed signs of a stable bony union, had achieved a full range of motion, and reported no problems in their day-to-day work. Conclusion Although this was a short-term study, we conclude that INFIX without a sacroiliac joint screw showed a comparable functional outcome compared to INFIX with a sacroiliac joint screw. Patients with INFIX alone showed better results; they had reduced surgical time, reduced radiation exposure, and less evidence of neurological harm to the L5-S1 nerve root. The procedure was less complicated and easier for surgeons to learn. Its simplicity and speed were especially beneficial for obese patients.

Standing versus supine pelvic incidence in adult spinal deformity patients.

PURPOSE: Pelvic incidence (PI) is commonly used to determine sagittal alignment. Historically, PI was believed to be a fixed anatomic parameter. However, recent studies have suggested that there is positionally-dependent motion that occurs through the sacroiliac joint (SIJ) resulting in changes in PI. METHODS: We reviewed 100 consecutive adult spinal deformity (ASD) patients seen at our academic tertiary referral center. Two reviewers measured pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) on standing radiographs and scout computed tomography scans (CT). Unilateral, bilateral, or absent SIJ vacuum sign (VS) was determined using CTs. RESULTS: Eighty-six patients (42 M:44 F) were included with an average age of 64.1 years and BMI of 28.8 kg/m2. Standing PI was low (< 50°) in 35 patients (40.7%), average (50°-60°) in 22 (25.6%), and high (> 60°) in 29 (33.7%). Average and high PI patients had significant PI changes of 3.0° (p = 0.037) and 4.6° (p = 0.005), respectively. Bilateral SIJ VS was seen in 68 patients, unilateral VS in 9, and VS was absent in 9. The average change in PI between standing and supine was 2.1° in bilateral SIJ VS patients (p = 0.045), 2.2° in unilateral SIJ VS (p = 0.23), and - 0.1° in patients without SIJ VS (p = 0.93). The average absolute difference in PI between supine and standing was 5.5° ±5.5° (p < 0.001). CONCLUSION: There is a change in PI from supine to standing. In patients with high PI and bilateral VS on CT, the change from supine to standing is significant, perhaps representing instability of the SIJ.

Assessing the Impact of Radiographic Realignment on Adult Spinal Deformity Patients with Sacroiliac Joint Pain at Presentation.

Background: Adult spinal deformity (ASD) patients with concurrent sacroiliac joint (SIJ) pain are susceptible to worse postoperative outcomes. There is scarce literature on the impact of ASD realignment surgery on SIJ pain. Methods: Patients undergoing ASD realignment surgery were included and stratified by the presence of SIJ pain at the baseline (SIJP+) or SIJ pain absence (SIJP-). Mean comparison tests via ANOVA were used to assess baseline differences between both cohorts. Multivariable regression analyses analyzed factors associated with SIJ pain resolution/persistence, factoring in BMI, frailty, disability, and deformity. Results: A total of 464 patients were included, with 30.8% forming the SIJP+ cohort. At the baseline (BL), SIJP+ had worse disability scores, more severe deformity, higher BMI, higher frailty scores, and an increased magnitude of lower limb compensation. SIJP+ patients had higher mechanical complication (14.7 vs. 8.2%, p = 0.024) and reoperation rates (32.4 vs. 20.2%, p = 0.011) at 2 years. SIJP+ patients who subsequently underwent SI fusion achieved disability score outcomes similar to those of their SIJ- counterparts. Multivariable regression analysis revealed that SIJP+ patients who were aligned in the GAP lordosis distribution index were more likely to report symptom resolution at six weeks (OR 1.56, 95% CI: 1.02-2.37, p = 0.039), 1 year (OR 3.21, 2.49-5.33), and 2 years (OR 3.43, 2.41-7.12). SIJP- patients who did not report symptom resolution by 1 year and 2 years were more likely to demonstrate PI-LL > 5° (OR 1.36, 1.07-2.39, p = 0.045) and SVA > 20 mm (OR 1.62, 1.24-1.71 p = 0.017). Conclusions: SIJ pain in ASD patients may result in worsened pain and disability at presentation. Symptom resolution may be achieved in affected patients by adequate postoperative lumbar lordosis restoration.

Safety and Preliminary Effectiveness of Lateral Transiliac Sacroiliac Joint Fusion by Interventional Pain Physicians: A Retrospective Analysis.

Introduction: Minimally invasive sacroiliac (SI) joint fusion has become the mainstay treatment for chronic refractory sacroiliac joint dysfunction. Multiple procedures are now available including transfixing procedures with implants placed in the lateral or posterolateral transiliac trajectories, and intra-articular procedures with devices and/or allograft placed via a dorsal approach. To date, the published literature on the lateral approach has been primarily by surgeons. This retrospective chart review aims to evaluate the safety and preliminary effectiveness when the procedure is performed by physicians trained in interventional pain management. Methods: Retrospective analysis of patients who underwent lateral SI joint fusion using a lateral transiliac approach between December 2022 and September 2023 by a single physician. Data on demographics, perioperative details, complications, and postoperative outcomes were collected and analyzed. The study was reviewed by WCG IRB and received an exemption authorization. Results: Medical charts were reviewed for the first 49 consecutive cases performed. Mean (SD, range) age was 64 (11, 34-83), BMI was 32.5 (8.4), 59% were female, 35% were smokers, and 82% were on opioids at baseline. Mean (SD) operative time was 40 (11) minutes and all procedures were performed at an ambulatory surgery center under monitored anesthesia care. No device- or procedure-related complications occurred. Mean follow up was 175 days; Mean (SD) baseline reported pain was 9 (1.5) on a 0-10 numerical rating scale. At follow up, 88% of the patients reported ≥50% pain relief. Six patients who reported 0% relief suffer from multiple pain generators and are on long term opioids. Conclusion: Results of this single center experience support the safety of lateral SI joint fusion using a threaded implant when performed by interventional pain management physicians. However, further prospective studies with larger sample sizes and longer follow-ups are warranted to validate these findings.

Biomechanical Predictors of Sacroiliac Joint Uptake on Single-Photon Emission Computed Tomography/Computed Tomography.

OBJECTIVE: Single-photon emission computed tomography/computed tomography (SPECT/CT) is an emerging imaging modality that identifies sites of heightened bone metabolism in response to increased stresses. The relationship between sacroiliac (SI) joint radiotracer uptake and anatomic biomechanical parameters is poorly understood. METHODS: Adult patients with SPECT/CT scans performed at our institution between 2021 and 2023 for the workup of low back pain were included. Patient charts were reviewed for demographic factors including age, gender, and prior thoracolumbar fusion history. Biomechanical spinopelvic parameters were measured from standing scoliosis radiographs. SPECT/CT scans were reviewed for uptake at the SI joint. Patients were stratified into 2 cohorts; patients with SI uptake greater than iliac crest uptake were designated "hot," whereas those with less or equal uptake were labeled "cold." RESULTS: One-hundred and sixty patients met inclusion criteria. Patients were slightly more male (55%) with average age 55 ± 14.9 years. Sixty-eight patients (43%) had evidence of increased SI activity. Interrater reliability showed substantial agreement (kappa = 0.62). The hot cohort demonstrated greater pelvic incidence (54.8 ± 14.0 degrees vs. 51.0 ± 11.0 degrees, P = 0.031) and pelvic tilt (20.8 ± 9.5 degrees vs. 18.4 ± 8.6 degrees, P =0.047) compared with the cold cohort. Patients were otherwise similar between cohorts (P > 0.05). CONCLUSIONS: Increased pelvic incidence and pelvic tilt angles are associated with SPECT/CT uptake at the SI joint, which may reflect altered biomechanics at the spinopelvic junction. SPECT/CT may be a valuable tool to assess SI degeneration. Future studies are warranted to better characterize the clinical applications of these findings.

American Society of Pain and Neuroscience Best Practice (ASPN) Guideline for the Treatment of Sacroiliac Disorders.

Clinical management of sacroiliac disease has proven challenging from both diagnostic and therapeutic perspectives. Although it is widely regarded as a common source of low back pain, little consensus exists on the appropriate clinical management of sacroiliac joint pain and dysfunction. Understanding the biomechanics, innervation, and function of this complex load bearing joint is critical to formulating appropriate treatment algorithms for SI joint disorders. ASPN has developed this comprehensive practice guideline to serve as a foundational reference on the appropriate management of SI joint disorders utilizing the best available evidence and serve as a foundational guide for the treatment of adult patients in the United States and globally.

Injective Treatments for Sacroiliac Joint Pain: A Systematic Review and Meta-analysis.

Background: The most effective injective treatment approach for sacroiliac joint (SIJ) pain remains unclear. Aim of this study was to quantify the safety and effectiveness of the available injective strategies to address SIJ pain. Methods: A systematic review and meta-analysis of the literature was conducted on PubMed, Scopus, and Embase databases from inception until January 2023. Inclusion criteria were studies written in English, comparative and non-comparative studies regardless of the minimum follow-up, and case series on SIJ injections. Safety and efficacy of the different injection therapies for the SIJ were quantified. A meta-analysis was conducted on the available data of the documented injective therapies. The "Checklist for Measuring Quality" by Downs and Black was used to assess the risk of bias and the quality of papers. Results: The literature search retrieved 43 papers (2431 patients): 16 retrospective case series, 2 retrospective comparative studies, 17 prospective case series, 3 prospective comparative studies, and 5 randomized controlled trials. Of the selected studies, 63% examined the effect of steroid injections, 16% of PRP injections, while 21% reported other heterogeneous treatments. The failure rate was 26% in steroid injections and 14% in PRP injections. The meta-analysis showed a statistically significant reduction in pain with the VAS score for both steroids and PRP: steroids improvement at mid-term 3.4 points (p < 0.05), at long-term 3.0 (p < 0.05), PRP improvement at mid-term 2.2 (p = 0.007), at long-term 2.3 points of the VAS pain scale (p = 0.02). Conclusions: Steroids are the most documented injective approach, with studies showing an overall safety and effectiveness. Still, the high number of failures underlined by some studies suggest the need for alternative procedures. Early PRP data showed promise, but the limitations of the current literature do not allow to clearly define the most suitable injective approach, and further studies are needed to identify the best injective treatment for SIJ patients.

Recurrent Radiculopathy Following Transforaminal Lumbar Interbody Fusion: Successful Management with Endoscopic Sacroiliac Joint Ablation.

Introduction: Low back pain persisting after spine surgery presents diagnostic and treatment complexities for spine surgeons. Failed back syndrome is a term usually used to characterize chronic back or leg pain following spine surgery. Research has indicated a range of persistent pain occurrences after spine surgery. The sacroiliac joint (SIJ) has been recognized as a potential source of pain for a long time but has not received sufficient attention in subsequent years. Dysfunctions in the SIJ can result in a spectrum of clinical conditions, such as low back pain and lower limb radiculopathy. Traditional treatment approaches for SIJ disorders often involve conservative measures such as physical therapy, medications, intra-articular injections, and surgical options. In the past decade, endoscopic SIJ ablation has emerged as a minimally invasive alternative for managing SIJ pain and dysfunction. This approach combines minimal invasiveness with precise targeting, potentially reducing morbidity and enabling quicker recovery compared to open surgical procedures. Case Report: A 60-year-old female patient with grade 2 L5-S1 lytic listhesis initially underwent lumbar interbody fusion to address chronic low back pain and radiculopathy, resulting in significant symptom resolution for a brief period. The patient experienced a resurgence of symptoms within a short duration that proved refractory to conventional medical management and interventional pain management procedures. Ultimately, the patient achieved sustained relief after undergoing endoscopic SIJ ablation. Conclusion: This case report highlights the importance of endoscopic SIJ ablation as an innovative treatment for recurrent lower limb radiculopathy. Focusing on the SIJ, often neglected in lumbar spine surgery, this minimally invasive procedure shows promise in alleviating symptoms and enhancing patient outcomes.

Computed tomography assessment of robotic versus fluoroscopic implant accuracy in sacroiliac joint fusion.

OBJECTIVE: Computed tomography is considered the gold-standard imaging tool to evaluate spinal implant accuracy. However, there are no studies that evaluate the accuracy of robotic sacroiliac joint (SIJ) implant placement using CT to date. The aim of this study was to compare the accuracy of implant placement on CT between robotic and fluoroscopic navigation for SIJ fusion and the subsequent complications and clinical outcomes of suboptimally placed screws. METHODS: A retrospective analysis of SIJ fusions utilizing either robotic or fluoroscopic guidance at a single institution was conducted from 2014 to 2023. Implant placement accuracy was evaluated on intra- or postoperative CT. Primary endpoints were SIJ screw placement accuracy and complications. Secondary endpoints were pain status at the first and second follow-ups and rates of 2-year revision surgery. Statistical analysis was performed using chi-square tests. RESULTS: Sixty-nine patients who underwent 78 SIJ fusions were included, of which 63 were robotic and 15 were fluoroscopic. The mean age of the cohort at the time of surgery was 55.9 ± 14.2 years, and 35 patients (50.7%) were female. There were 135 robotically placed and 34 fluoroscopically placed implants. A significant difference was found in implant placement accuracy between robotic and fluoroscopic fusion (97.8% vs 76.5%, p < 0.001). When comparing optimal versus suboptimal implant placement, no difference was found in the presence of 30-day complications (p = 0.98). No intraoperative complications were present in this cohort. No difference was found in subjective pain status at the first (p = 0.69) and second (p = 0.45) follow-ups between optimal and suboptimal implant placement. No patients underwent 2-year revision surgery. CONCLUSIONS: Use of robotic navigation was significantly more accurate than the use of fluoroscopic navigation for SIJ implant placement. Complications overall were low and not different between optimally and suboptimally placed implants. Suboptimally placed implants did not differ in degree of subjective pain improvement or rates of revision surgery postoperatively.

[Intraoperative slide rail CT assistance in percutaneous sacroiliac joint screws for the treatment of pelvic posterior ring injury].

OBJECTIVE: To compare the clinical efficacy of intraoperative slide rail CT combined with C-arm X-ray assistance and just C-arm for percutaneous screw in the treatment of pelvic posterior ring injury. METHODS: A retrospective analysis was performed on the patient data of 76 patients with posterior pelvic ring injury admitted to the Department of Orthopedic Trauma from December 2018 to February 2022. Among them, 39 patients in the CT group were treated with C-arm combined with slide rail CT-assisted inline fixation including 23 males and 16 females with an average age of (44.98±7.33) years old;and the other 37 patients in the C-arm group were treated with intraline fixation treatment under only C-arm fluoroscopy including 24 males and 13 females with an average age of (44.37±10.82) years old. Among them, 42 patients with anterior ring fractures were treated with percutaneous inferior iliac spines with internal fixation (INFIX) or suprapubic support screws to fix the anterior pelvic ring. Postoperative follow-up time, operation time, complications of the two groups were compared. Results of Matta reduction criteria, Majed efficacy evaluation, the CT grading and the rate of secondary surgical revision were compared. RESULTS: The nailing time of (32.63±7.33) min in CT group was shorter than that of (52.95±10.64) min in C-arm group (t=-9.739, P<0.05). The follow-up time between CT group (11.97±1.86) months and C-arm group (12.03±1.71) months were not statistically significant(P>0.05). The postoperative complication rates between two groups were not statistically significant (χ2=0.159, P>0.05). Results of Matta reduction criteria (Z=2.79, P<0.05), Majeed efficacy evaluation(Z=2.79, P<0.05), CT grading (Z=2.83, P<0.05) in CT group were better than those in C-arm group(P<0.05); the secondary surgical revision rate in the CT group was significantly lower than that in the C-arm group (χ2=5.641, P<0.05). CONCLUSION: Compared with traditional C-arm fluoroscopy, intraoperative slide rail CT combined with C-arm assisted percutaneous sacroiliac joint screw placement surgery has the characteristics of short operation time, high accuracy and safety, and significant decrease in postoperative secondary revision rate, and is one of the effective methods for re-establishing the stability of the posterior ring of pelvic fracture.

The effects of Core Stability Exercises and Mulligan's mobilization with movement techniques on sacroiliac joint dysfunction.

Purpose: Sacroiliac joint dysfunction (SIJD), while being the primary contributor to low back pain, is still disregarded and treated as low back pain. Mulligan's Mobilization with Movement (MWM) Techniques and Core Stability Exercises (CSE) are often used to treat low back pain. There is not much evidence that it is effective in SIJD. To evaluate the effectiveness of CSE coupled with MWM (CSE + MWM) in the treatment of SIJD. Methods: 39 patients with SIJD were recruited and randomly divided into distinct groups as follows: control group (n = 13), CSE group (n = 13) and CSE + MWM group (n = 13). The Numerical Pain Rating Scale (NPRS), the Roland Morris Disability Questionnaire (RMDQ), the Range of Motion (ROM), the Pressure Pain Threshold (PPT) and the pelvic tilt angle asymmetry ratio in the sagittal plane (PTAR) were used to gauge the intervention's success both before (M0) and after (M1) it. All experimental data were statistically analyzed. Results: The SIJ-related pain metric significantly decreased in both the CSE + MWM group and the CSE group between M0 and M1, as determined by the NPRS and RMDQ. Between M0 and M1, The CSE group's left axial rotation ROM and lumbar flexion ROM were significantly decreased. The CSE + MWM group's extension ROM and left lateral flexion ROM both significantly increased between M0 and M1. In the difference variable (M1-M0), the CSE + MWM group substantially outperformed control group in the left lateral flexion ROM and outperformed the CSE group in the left axial rotation ROM. Conclusion: In individuals with SIJD, CSE + MWM is beneficial in lowering pain, disability, and function. Treatment with CSE and MWM approaches for SIJ appears to boost this efficacy.

Anterior peri-sacroiliac joint osteotomy in the treatment of malunion and nonunion of complex pelvic ring fracture: techniques and preliminary results.

PURPOSE: To introduce anterior peri-sacroiliac joint osteotomy (APSJO) through the lateral-rectus approach (LRA) for treating pelvic fracture malunion and nonunion, and to evaluate the safety, feasibility, and potential effectiveness. METHODS: Data of 15 patients with pelvic fracture malunion and nonunion who underwent treatment by APSJO were selected and analyzed. The reduction quality was assessed using the Mears and Velyvis criteria, while the pre-operative and post-operative function was revealed by the Majeed scoring system. The British Medical Research Council (BMRC) grading system was recruited for the evaluation of lumbosacral plexus function. RESULTS: The average operative duration was 264.00 ± 86.75 min, while the intra-operative blood loss was 2000 (600, 3000) mL. Anatomical reduction was complete in three cases, satisfactory in ten cases, and unsatisfactory in two cases. Among the seven patients with lumbosacral plexus injury, the pre-operative Majeed grades were good in two cases, fair in two cases, and poor in three cases, while the post-operative Majeed grades were excellent in three cases, good in three cases, and fair in one case. Muscle strength recovered to M5 in two cases, M4 in three cases, and showed no recovery in two cases. The pre-operative Majeed grades were good in five cases, fair in two cases, and poor in one case of the series without lumbosacral plexus injury, while the post-operative Majeed grades were excellent in seven cases and good in one case. CONCLUSION: APSJO through LRA may be a feasible strategy for treating pelvic fracture malunion and nonunion with promising application.

Acupotomy combined with Korean medicine treatment in a patient with acute sacroiliac pain unresponsive to conventional therapy: A case report.

RATIONALE: Acute injury to the sacroiliac joint (SIJ) can result from high-energy external forces that cause a combination of axial loading and sudden rotational movements, resulting in severe pain that cannot be relieved by regular nonsteroidal anti-inflammatory drugs. The treatment includes injections of steroids and local anesthetics to reduce pain and promote healing. Here, we report the case of a patient with acute sacroiliac pain who did not respond to conventional injection therapy. PATIENT CONCERNS: A 58-year-old male patient who did not exercise regularly experienced pain in his left groin and difficulty walking while kicking on his right leg. He received two injections and manual therapy at a local orthopedic clinic; however, his symptoms did not improve despite taking painkillers. DIAGNOSES: Radiographic images showed no abnormalities. After confirming the cause of onset, pain pattern, physical examination, and tenderness, the patient was diagnosed with an acute SIJ sprain (static blood). INTERVENTIONS: At the first visit, a single acupotomy was performed on the seven treatment points identified during the physical examination, and immediate improvement in symptoms was confirmed. From then on, Korean medicine (KM) treatments, such as acupuncture, cupping, chuna, and bee venom pharmacopuncture, were performed. OUTCOMES: Immediately after acupotomy, groin pain improved by 80 %, gait immediately normalized, and the patient showed no symptoms at the 9th visit. LESSONS: For SIJ-type groin pain that does not respond to existing treatments, immediate relief is achieved after a single acupotomy at the exact treatment point. Therefore, in the future, the importance of identifying a precise treatment point for SIJ pain should be recognized, and the use of Korean medicine treatment techniques, including acupotomy, should be considered.

Minimally invasive sacroiliac joint fusion secondary to lumbosacral fusion: Clinical and functional results at 2years of follow-up.

INTRODUCTION: Degenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion. MATERIALS AND METHODS: We carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2years' follow-up. The primary outcome was the improvement in lumbar and radicular pain on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59years (27-88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1-7) before the SI fusion. RESULTS: The lumbar and radicular NRS were 8.4 (7-10) and 5.1 (2-10) preoperatively and 5.2 (0-8) and 3.0 (0-8) at 2years postoperatively, which was a reduction of 37% and 42% (p<0.001), respectively. The Oswestry score went from 69.4 (52-86) preoperatively to 45.6 (29-70) at 2years, which was a 33% improvement (p<0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery. DISCUSSION: After minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included. CONCLUSION: Minimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally. LEVEL OF EVIDENCE: IV, retrospective study.

Intraoperative fat embolism syndrome associated with implantation of titanium sacroiliac joint fusion implants: a report of two cases.

Background: For patients undergoing long-construct fusion surgeries, simultaneous sacroiliac joint (SIJ) fusion is a growing trend in spine surgery. Some options for posterior SIJ fusion include 3D-printed triangular titanium implants or self-harvesting SIJ screws. Both implants require fixation within the sacrum and ileum. Fat embolism syndrome is a rare but known complication of lumbar pedicle instrumentation but has never been reported in association with SIJ fusion, regardless of implant type. We report the first two known cases of fat embolism associated with placement of SIJ fusion devices during long construct posterior spine fusion. Case Description: Case 1-a 50-year-old female with multiple previous spine surgeries complicated by osteomyelitis/diskitis that was successfully eradicated, underwent T10-pelvis posterior spinal fusion (PSF), L4 pedicle-subtracting-osteotomy, and bilateral SIJ fusion. During implantation of each SIJ fusion device, the patient's hemodynamic status deteriorated necessitating vasopressor support, intravenous fluid bolus, and hyperventilation, but quickly resolved. The case was completed without further issue, and she had an uneventful post-operative course. Case 2-a 71-year-old female with a past medical history of ankylosing spondylitis, previous L2-L5 PSF, rheumatoid arthritis on chronic steroids, underwent a T9-pelvis PSF, bilateral SIJ fusion, L4 pedicle subtraction osteotomy, T10-L1 Smith Peterson osteotomies. After implantation of the second SIJ fusion device, she became hypotensive and tachycardic, pulses were absent, and cardiopulmonary resuscitation was initiated. Pulses returned quickly, the index surgery was terminated, and she was transferred to the intensive care unit (ICU). In the ICU she was quickly weaned off the ventilator on post-operative day 1. On post-operative day 4, the patient returned to the operating room for completion of the surgery and had an extended, but uneventful, recovery afterwards. Conclusions: We report on the first two known cases of fat embolism syndrome occurring immediately after implantation of SIJ fusion devices. Spine surgeons should be aware of this rare, but potentially fatal, complication. Collaboration with the anesthesia team and optimization of the patient's hemodynamic status prior to implantation may help prevent catastrophic complications.

A Case Report of Sjögren's Syndrome and Rheumatoid Arthritis: The Role of Physiotherapy in Enhancing Quality of Life.

Rheumatoid arthritis (RA) is a systemic autoimmune disease with profound effects on joints and extra-articular organs. This case report explores the complex treatment approach for a 54-year-old female patient who is dealing with the dual diagnosis of RA and Sjogren's syndrome (SS). RA primarily involves joint inflammation and morning stiffness leading to significant disability, while SS, another autoimmune condition, manifests with autoantibodies and lymphocytic infiltration affecting exocrine glands. The patient presented with joint and low back pain, alongside reduced mobility, portraying a complex clinical picture. Physiotherapy played a crucial role in addressing the diverse symptoms exhibited by the patient. Treatment involved Mulligan mobilization targeting sacroiliac joint dysfunction, laser therapy for pain relief, and tailored exercises focusing on joint mobility and muscle strength. Progress was monitored using the Rheumatoid Arthritis Disease Activity Index (RADAI-5) and overall quality of life assessments. Significant improvements were observed post-rehabilitation including reduced pain levels, increased joint range of motion, increased muscle strength, and enhanced sacroiliac mobility. These positive outcomes highlight the efficacy of physiotherapy in managing autoimmune rheumatic disorders. Collaboration between healthcare professionals particularly rheumatologists and physiotherapists is essential for comprehensive patient care. This case emphasizes the importance of adopting a holistic approach to managing autoimmune disorders. Physiotherapy emerges as a pivotal component in alleviating symptoms and enhancing physical function underscoring its integration into the multidisciplinary care framework for individuals facing the challenges of autoimmune rheumatic disorders.