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Search Results for : Sacroiliac Joint Dysfunction
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Cooled radiofrequency (RF) of L5 dorsal ramus for RF denervation of the sacroiliac joint: technical report.
Author(s): Kapural, L; Stojanovic, M; Bensitel, T; Zovkic, P
Journal: Pain Med 2010 Aug 13; Vol. 11, Issue 1; Page(s) 53-7
[Medline ID - 20030745]

BACKGROUND AND OBJECTIVES: The sacroiliac joint is a common source of chronic low back pain. We recently described the use of cooled radiofrequency (RF) electrodes for performing lateral branch neurotomy to treat sacroiliac joint pain. The procedure involves lesioning the lateral branches of the posterior primary rami at S1-S3, and the L5 dorsal ramus (L5DR). While the cooled RF electrode has been adopted as a means for lesioning the lateral branches, conventional RF electrodes are used to lesion the L5DR. The objective of this technical report is to evaluate the acute safety of denervating the L5DR using cooled RF electrode. METHODS: Electronic chart review was conducted on 100 consecutive RF procedures. Data collected included age, sex, years of pain, body mass index, post-procedural pain, numbness, weakness, and other complications. RESULTS: Of 100 procedures 82 were completed using cooled electrode for sacral lateral branches and L5DR. Of the 82 procedures completed using cooled RF to L5DR, 24 were reported to be of high difficulty and 19 with poor visualization (bowel gas). There were no major complications related to the procedure. Four patients reported increased pain: two from the conventional RF of L5DR group and two from the cooled RF group. All of the pains were transient and returned to the baseline within 6 weeks. There were two patients experiencing localized numbness over the upper medial quadrant of the buttock, both in cooled RF group. There was no reported weakness of the lower extremity. Two patients complained of increased lower back pain and two of prolonged itching. CONCLUSIONS: This review demonstrates the acute safety of using cooled RF for L5DR denervation with no report of significant or unusual patient complications. To establish frequency of complication associated with the treatment, a larger registry is required.

Impairment of static upright posture in subjects with undifferentiated arthritis in sacroiliac joint in conjunction with elevation of streptococcal serology.
Author(s): Chang, CC; Chu, HY; Chiang, SL; Li, TY; Chang, ST
Journal: J Back Musculoskelet Rehabil 2010 Mar 24; Vol. 22, Issue 1; Page(s) 33-41
[Medline ID - 20023362]

BACKGROUND AND OBJECTIVES: Our latest work has demonstrated a strong correlation between the anti-streptolysin O (ASO) titer and the sacroiliac (SI) joint scintigraphy in subjects with undifferentiated arthritis [Journal of Rheumatology 34 (2007), 1746-1752]. Of a significant percentage in those subjects with sacroiliac disorder reported suffering from postural abnormality. The purpose of this study was to determine whether there was an abnormality of upright postural sway in those subjects. METHODS: All subjects who have been examined for ASO titer levels and SI joint scintigraphy were divided into two groups according to the reference level of ASO titer in our central laboratory, and were subjected to ten sway tests to assess static postural sway when they were standing upright. The comparisons of the sway parameters were analyzed by using two sample t-test for continuous variables and repeated-measures analysis of variance (ANOVA) for the degree effect and interaction effect (sloped degree x group) in varying stressful conditions (eyes open vs closed, plantar flexion or dorsiflexion of feet). RESULTS: In a total of 84 subjects, mean age was 23 years (range 18.0-36.4). Compared with the low ASO (ASO titer < or=116 IU/mL) group, the two sample t-test showed that high ASO (ASO titer > 116 IU/mL) group had 2.76-, 4.46- and 4.59-fold in sway area, 1.32-, 1.50- and 1.61-fold in sway velocity, and 2.02-, 1.97- and 1.70-fold in sway intensity, over the study period at 0 degrees, 10 degrees, and 20 degrees in conditions of eyes open and plantar flexion. The values of sway velocity/intensity obtained with eyes open and plantarflexion/dorsiflexion had lower intensity values when compared with those obtained in closed eyes and plantar flexion/dorsiflexion in high ASO group, but not the same as in low ASO group. Repeated-measures ANOVA showed that the sloped degree only affected the sway area in condition of eyes closed and dorsiflexion (P = 0.016), and affected the velocity/intensity in all conditions tested (all P < 0.0001). In consideration of interaction effect, the sloped degree showed significant difference in sway area in conditions of eyes open and plantar flexion/dorsiflexion (P = 0.03 and P = 0.0113), in sway velocity in most conditions tested (P < 0.05), and in sway intensity in condition of eyes open and dorsiflexion only (P = 0.0004). CONCLUSION: Subjects with high level of streptococcal serology demonstrated increased sway on all postural control measures as compared to those with low serology. Proprioceptive deficits in the SI joint might contribute to the postural impairment measured in this study.

Lower limb involvement in spinal function and low back pain.
Author(s): McGregor, AH; Hukins, DW
Journal: J Back Musculoskelet Rehabil 2010 Mar 24; Vol. 22, Issue 4; Page(s) 219-22
[Medline ID - 20023353]

AIM: To evaluate evidence for involvement of the lower limb in spinal function and low back pain (LBP). DESIGN: A hypothesis based on a critical review of the relevant biomechanical and clinical literature. RESULTS: The spine resembles an inverted pendulum that supports the weight of the upper body; its stability requires a moving base that is provided by the joints of the lower limb, especially the hip. However, the sacroiliac joints are unlikely to be important for spinal function. The changing pattern of gait and development of lumbar lordosis, in early child hood, provide evidence for the inter-dependence of spinal curvature and lower limb action. Clinical signs associated with LBP may be associated with an inability to rotate the trunk about the hips. These include disorientation of the pelvis and weakness or tightness of muscles around the hip. The "sway back" posture seen in LBP involves flexion of the hip, knee and ankle to compensate for abdominal and back muscle weakness. CONCLUSIONS: In order to understand the varied clinical presentation of LBP patients, the function of the spine should be considered in the context of the whole body, especially the lower limb.

[Miliary tuberculosis presented as a sacroiliitis: a case report]
Author(s): Utkan, A; G; ülbahçe, K; Ciliz, A; T; ümöz, MA
Journal: Eklem Hastalik Cerrahisi 2010 Mar 6; Vol. 20, Issue 3; Page(s) 161-4
[Medline ID - 19958273]

Miliary tuberculosis is a clinical picture due to hematogenous dissemination of a very large amount of bacilli. We present a case with miliary tuberculosis in which the diagnosis and treatment was delayed due to focusing on complaints about the sacroiliac joint. The 28-year-old male patient was admitted with a five-month history of pain in his left sacroiliac joint which was not traumatic. As a definitive diagnosis could not be reached by means of laboratory tests performed, an open biopsy was planned. In the chest X-ray obtained for routine preoperative evaluation, diffuse, bilateral opacities with a 1-2 mm radius were detected and the case was diagnosed with miliary tuberculosis. Miliary tuberculosis is a disease involving multiple organs and systems and treatment can be started empirically as microbiologic verification is difficult. Sacroiliac joint infections are rare and diagnosis is often delayed. The diagnosis of bone and joint tuberculosis is hard because of relative rarity of the disorder, the wide variety in clinical presentation, low suspicion of the examining physician, and rare diagnostic findings on radiographs. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection.

The effects of manual pelvic compression on trunk motor control during an active straight leg raise in chronic pelvic girdle pain subjects.
Author(s): Beales, DJ; O'Sullivan, PB; Briffa, NK
Journal: Man Ther 2010 May 18; Vol. 15, Issue 2; Page(s) 190-9
[Medline ID - 19945907]

A sub-group of pelvic girdle pain (PGP) patients with a positive active straight leg raise (ASLR) responds positively to the application of external pelvic compression during the test. This study investigated the effect of this phenomenon on electromyographic (EMG) activity of the trunk muscles and intra-abdominal and intra-thoracic pressures in subjects with a unilateral sacroiliac joint (SIJ) pain disorder (n=12). All subjects reported reduced difficulty ratings during an ASLR with pelvic compression (paired t-test: p < 0.001), yet no statistically significant changes in the muscle activation or pressure variables were found. However, visual inspection of the data revealed two divergent motor control strategies with the addition of compression. Seven subjects displayed characteristics of a decreased EMG profile, while in the other five subjects the EMG profile appeared to increase. As such this study provides preliminary evidence of two disparate patterns of motor control in response to the addition of pelvic compression to an ASLR. The findings may reflect different mechanisms, not only in the response to pelvic compression, but also of the underlying PGP disorder.

Septic shock in pregnancy due to pyogenic sacroiliitis: a case report.
Author(s): Moros, ML; Rodrigo, C; Villacampa, A; Ruiz, J; Lapresta, C
Journal: J Med Case Reports 2009 Oct 16; Vol. 3; Page(s) 6505
[Medline ID - 19830110]

INTRODUCTION: Lower back pain due to sacroiliac joint dysfunction is a common symptom during pregnancy. However, infection of the sacroiliac joint is rare, even more so if no predisposing factors are present. CASE PRESENTATION: After the onset of unspecific acute pain in the left buttock region, a 31-year-old pregnant woman developed septic shock due to pyogenic sacroiliitis. The medical and obstetric management, treatment applied and patient's experience are described. CONCLUSION: The correct diagnosis and treatment of pyogenic sacroiliitis during pregnancy may avoid joint and bone destruction in addition to maternal and fetal complications.

Diffuse idiopathic skeletal hyperostosis: differentiation from ankylosing spondylitis.
Author(s): Olivieri, I; D'Angelo, S; Palazzi, C; Padula, A; Mader, R; Khan, MA
Journal: Curr Rheumatol Rep 2009 Dec 23; Vol. 11, Issue 5; Page(s) 321-8
[Medline ID - 19772826]

Diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) share involvement of the axial skeleton and peripheral entheses. Both diseases produce bone proliferations in the later phases of their course. Although the aspect of these bone proliferations is dissimilar, confusion of radiologic differential diagnosis between the two diseases exists mostly as a consequence of a lack of awareness of their characteristic clinical and radiographic features. The confusion may extend to the clinical field because both advanced DISH and advanced AS may cause the same limitations of spinal mobility and postural abnormalities. However, the radiologic spinal findings are so different that changes due to each disease can be recognized even in patients in whom both diseases occur. This article reviews the clinical and radiologic characteristics that should help clinicians differentiate between the two diseases without much difficulty.

The role of tumor necrosis factor (TNF)-alpha and TNF receptor polymorphisms in susceptibility to ankylosing spondylitis.
Author(s): Chatzikyriakidou, A; Georgiou, I; Voulgari, PV; Drosos, AA
Journal: Clin Exp Rheumatol 2009 Nov 13; Vol. 27, Issue 4; Page(s) 645-8
[Medline ID - 19772798]

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joint and vertebral column. Tumor necrosis factor alpha (TNF-alpha), a cytokine that acts via two tumor necrosis factor receptors (TNFR1 and TNFR2), may be implicated in the pathogenesis of AS. The aim of the present study was to examine the role of the polymorphisms 36A > G (TNFR1), 676T > G (TNFR2), -857C > T (TNF-alpha), -308G > A (TNF-alpha), and -238G > A (TNF-alpha) in AS susceptibility. METHODS: Forty-nine AS patients and 68 randomly chosen healthy volunteers were enrolled in the study. Polymerase chain reaction coupled with a restriction fragment length polymorphism assay was performed in the genotype analysis of each variant. RESULTS: The polymorphisms 36A > G (TNFR1) and -238G > A (TNF-alpha were not found to be in Hardy-Weinberg equilibrium in the patient group and therefore were excluded from the statistical analysis. A marginally statistically significant difference was observed in the distribution of 676T > G (TNFR2) genotypes between AS patients and controls (p=0.054) and was revealed to be more significant in the 676T > G allele distribution between the two groups (p=0.031). The complex genotype TNFR2 676TG/ TNF-alpha -857CC (p=0.041) was also differently distri-buted between AS patients and controls. CONCLUSIONS: The TNFR2 676T allele is reported here for first time to be differently distributed between AS patients and controls. The higher frequency of the wild type TNFR2 676T allele in AS patients suggests the functional ability of TNFR2 to support increased TNF-alpha mediated immunoactivity.

Receptor activator of nuclear factor kappa B ligand-mediated osteoclastogenesis is elevated in ankylosing spondylitis.
Author(s): Im, CH; Kang, EH; Ki, JY; Shin, DW; Choi, HJ; Chang, EJ; Lee, EY; Lee, YJ; Lee, EB; Kim, HH; Song, YW
Journal: Clin Exp Rheumatol 2009 Nov 13; Vol. 27, Issue 4; Page(s) 620-5
[Medline ID - 19772794]

OBJECTIVE: Ankylosing spondylitis (AS) is an inflammatory arthritis involving the axial skeleton. Decreased bone mineral density has also been reported in AS patients. This study sought to determine whether osteoclastogenesis and osteoclast activity are increased in AS. METHODS: Twenty patients with AS were evaluated using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and other clinical parameters. Mononuclear cells were separated out from peripheral blood samples taken from AS patients and normal healthy controls and cultured with monocyte colony stimulating factor and receptor activator of the nuclear factor kappa B ligand (RANKL). Multi-nucleated, tartrate-resistant acid phosphatase stain-positive osteoclasts were counted after 9 days, and the areas of calcium absorption on calcium-coated plates were determined. RESULTS: Osteoclastogenesis was significantly greater in AS patients than in normal controls (number of osteoclasts/1106 mononuclear cells, median, 518.0 vs. 362.5, p=0.036). No differences were observed between AS patients and controls in terms of calcium absorption areas or the serum concentrations of tumor necrosis factor and RANKL. Osteoclastogenesis was greater in AS patients with sacroiliac joint ankylosis than in those without. Osteoclastogenesis and the calcium absorption area were not found to be correlated with BASDAI nor with other clinical parameters including age, erythrocyte sedimentation rate, and C-reactive protein levels. CONCLUSION: Osteoclastogenesis is elevated in AS patients, especially in those with sacroiliac joint ankylosis. Increased osteoclastogenesis may be related to osteopenia in AS patients.

[Assessing the treatment for sacroiliac joint dysfunction, piriformis syndrome and tarsal tunnel syndrome associated with lumbar degenerative disease]
Author(s): Morimoto, D; Isu, T; Shimoda, Y; Hamauchi, S; Sasamori, T; Sugawara, A; Kim, K; Matsumoto, R; Isobe, M
Journal: No Shinkei Geka 2009 Dec 16; Vol. 37, Issue 9; Page(s) 873-9
[Medline ID - 19764421]

OBJECTIVE: Sacroiliac joint (SIJ) dysfunction, piriformis syndrome (PFS) and tarsal tunnel syndrome (TTS) produce symptoms similar to lumbar degenerative disease (LDD). Patients who have these diseases plus LDD sometimes experience residual symptoms after surgery for LDD. We therefore assessed the results of treatment of SIJ dysfunction, PFS and TTS associated with LDD. PATIENTS AND METHODS: We assessed 25 patients who underwent surgery for LDD and were affected with SIJ dysfunction (12 patients), PFS (7 patients) or TTS (6 patients). SIJ dysfunction was treated with rest, drugs, pelvic band and sacroiliac joint block. PFS was treated with rest, drugs, physical exercise, injection of local anesthetic into the piriformis muscle, and surgical resection of the piriformis muscle. TTS was treated with drugs and tarsal tunnel opening. We analyzed the improvement score and recovery rate (JOA score) for both LDD surgery and the treatment of SIJ dysfunction, PFS and TTS. RESULTS: Symptom improvement was observed in all patients with SIJ dysfunction and PFS and in 4 patients with TTS. The improvement score and recovery rate of treatments for SIJ dysfunction, PFS and TTS were lower than those of surgery for LDD. CONCLUSION: The improvement score and recovery rate of tr eatment for SIJ dysfunction, PFS and TTS were not as high as those for LDD. To enhance patient satisfaction, it is important to consider these complicating diseases when designing treatments for LDD.
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