1
|
Kaneuji A, Fukui M, Takahashi E, Sanji Y, Hirata H, Kawahara N. Hip-sacroiliac joint-spine syndrome in total hip arthroplasty patients. Sci Rep 2024; 14:3813. [PMID: 38361017 PMCID: PMC10869769 DOI: 10.1038/s41598-024-54472-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/13/2024] [Indexed: 02/17/2024] Open
Abstract
This study is designed to compare the extent of sacroiliac joint (SIJ) degeneration at total hip arthroplasty (THA) for two pathologies: osteoarthritis of the hip (OA) and osteonecrosis of the femoral head (ON). We also assessed the prevalence of SIJ degeneration in patients with lumbar spondylolisthesis or degenerative scoliosis. A total of 138 hips from 138 patients (69 OA and 69 ON) were assessed in this study, including 66 hips affected by OA secondary to developmental dysplasia of the hip. The degenerative changes in the SIJ and lumbar spine were evaluated prior to THA using radiographs and computed tomography (CT) scans, showing 9 instances of spondylolisthesis and 38 of degenerative scoliosis. The OA group exhibited longer duration from onset to surgery than the ON group. The OA group also included more cases with significant pelvic obliquity (3 degrees or more) and with significant increases in SIJ sclerosis and irregularities. Patients with lumbar spondylolisthesis or degenerative scoliosis were significantly more likely to have SIJ irregularities. The prevalence of SIJ degeneration was higher in cases of THA for OA than for ON. This study also suggests the possibility of Hip-SIJ-Spine syndrome in THA patients with OA.
Collapse
Affiliation(s)
- Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan.
| | - Makoto Fukui
- Department of Orthopaedic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Yusuke Sanji
- Department of Orthopaedic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Hiroaki Hirata
- Department of Orthopaedic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| |
Collapse
|
2
|
Karimi H, Rodrigues R, Patel S, Patel J, Kosarchuk J, Kryzanski J. A systematic review and update on diagnosis and treatment of new onset sacroiliac joint dysfunction after lumbar fusion. Acta Neurochir (Wien) 2024; 166:43. [PMID: 38280117 DOI: 10.1007/s00701-024-05918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/20/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Sacroiliac joint dysfunction (SIJD) after lumbar/lumbosacral fusion has become increasingly recognized as the utilization of lumbar fusion has grown. Despite the significant morbidity associated with this condition, uncertainty regarding its diagnosis and treatment remains. We aim to update the current knowledge of the etiology, diagnosis, and treatment of post-lumbar surgery SIJD. METHODS PRISMA guidelines were used to search the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, and OVID databases for literature published in the last 10 years. The ROBIS tool was utilized for risk of bias assessment. Statistical analyses were performed using the R foundation. A Fisher's exact test was performed to determine the risk of SIJD based on operative technique, gender, and symptom onset timeline. Odds ratios were reported with 95% confidence intervals. A p-value [Formula: see text] 0.05 was considered statistically significant. RESULTS Seventeen publications were included. The incidence of new onset SIJD was 7.0%. The mean age was 56 years, and the follow-up length was 30 months. SIJD was more common with fixed lumbar fusion vs floating fusion (OR = 1.48 [0.92, 2.37], p = 0.083), fusion of [Formula: see text] 3 segments (p < 0.05), and male gender increased incidence of SIJD (OR = 1.93 [1.27, 2.98], p = 0.001). Intra-articular injection decreased the Visual Analogue Scale (VAS) score by 75%, while radiofrequency ablation (RFA) reduced the score by 90%. An open approach resulted in a 13% reduction in VAS score versus 68 and 29% for SIJ fixation using the iFuse and DIANA approaches, respectively. CONCLUSIONS Lumbar fusion predisposes patients to SIJD, likely through manipulation of the SIJ's biomechanics. Definitive diagnosis of SIJD remains multifaceted and a newer modality such as SPECT/CT may find a future role. When conservative measures are ineffective, RFA and SIJ fixation using the iFuse System yield the greatest improvement VAS and ODI.
Collapse
Affiliation(s)
- Helen Karimi
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA.
| | - Rahul Rodrigues
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA
| | - Shrey Patel
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA
| | - Jainith Patel
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA
| | - Jacob Kosarchuk
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA
| |
Collapse
|
3
|
Splitt T, Pflugmacher R, Soliman O, Abd Allah HM, Hering R, Kasapovic A, Rössler P, Koch EMW, Bornemann R. Surgical Treatment of Patients with Sacroiliac Joint Syndrome: Comparative Study of Two Implants. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37992733 DOI: 10.1055/a-2188-3398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The treatment of patients with ISJ dysfunction is difficult due to the multifactorial causes of pain and various problems in clarification. Treatment includes physical therapy, corticosteroids, prolotherapy, radiofrequency denervation and sacroiliac joint fusion. A new option for the surgical treatment of ISG dysfunction is the Torpedo implant system. For a safe fusion, only 2 implants are needed, which are available in lengths of 30-50 mm. The new implant system has been tested in pilot studies for efficacy and biocompatibility with good results. For further documentation for the Torpedo implant system, a comparative study against the iFuse system was carried out.Two different implants were used: Group 1: Deltacor Torpedo, Group 2: iFuse implants (Si-Bone). The data generated during admission and subsequent check-ups (VAS, ODI, opioid use) were entered into an evaluation file set up for this purpose. Follow-up appointments were set at 1 month, 3, 6 and 12 months postoperatively.The data of 65 patients were evaluated comparatively. In all comparisons, only very small effect sizes were found with regard to the differences in the decrease in pain intensities, so that equivalent effectiveness of the two methods could initially be postulated from a clinical point of view. Most patients in both groups reported taking opioids to treat pain before surgery. According to the decrease in pain intensity, opioid treatment could be discontinued in some patients after the operation. After 12 months, the number of patients treated with opioids decreases to 23% in group 1 and to 17% in group 2. The success of the fusions with the two methods can also be proven by image documentation, from which the position of the implants can also be clearly recognised. In no case was there any loosening.Overall, the evaluation of this study allows the conclusion that both implant systems can be successfully used for the treatment of patients with ISJ syndrome. The present results should be confirmed in further comparative studies with the proposed evaluation methods.
Collapse
Affiliation(s)
- Theresa Splitt
- Klinik für Wirbelsäulenchirurgie, Krankenhaus Mechernich, Mechernich, Deutschland
| | - Robert Pflugmacher
- Klinik für Wirbelsäulenchirurgie, Krankenhaus Mechernich, Mechernich, Deutschland
| | - Osama Soliman
- Klinik für Wirbelsäulenchirurgie, Krankenhaus Mechernich, Mechernich, Deutschland
| | | | - Rudolf Hering
- Klinik für Anästhesie, Kreiskrankenhaus Mechernich GmbH, Mechernich, Deutschland
| | - Adnan Kasapovic
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Philip Rössler
- Orthopädie, Gelenkzentrum Mittelrhein, Koblenz, Deutschland
| | - Ernst M W Koch
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
- mdm, Alsbach, Deutschland
| | - Rahel Bornemann
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| |
Collapse
|
4
|
Lazennec JY, Pour AE. Patient perception of leg length after total hip arthroplasty does not correlate with sagittal lumbar spine stiffness, history of spinal pathology or fusion. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05810-0. [PMID: 37071149 DOI: 10.1007/s00264-023-05810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/09/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Although spinal pathology or fusion can change patients' posture and pelvic orientation, their correlation with perception of limb length discrepancy (LLD) after total hip arthroplasty (THA) is not well understood. We hypothesised that LLD perception after THA would not correlate with a history of spinal pathology, fusion or sagittal lumbar spine stiffness among patients who underwent THA. METHODS Four hundred consecutive patients who underwent THA and had a complete set of anteroposterior and lateral EOS® imaging in standing and sitting positions were included in this retrospective case-control study. All patients underwent THA between 2011 and 2020. Sagittal lumbar spine stiffness was measured by changes in lumbar lordosis and sacral slope from the standing to the sitting position (lumbar spine stiffness: standing sacral slope-sitting sacral slope < 10°). Anatomical and functional lower extremity length, change in the centre of hip rotation, coronal and sagittal knee alignment, and hindfoot height were measured. Multiple logistic regression was used to investigate the correlation between patient perceptions of LLD, and the variables found to be significant in the univariate analysis. RESULTS There was a substantial difference between the patients with and without LLD perceptions regarding axial pelvic rotation (p = 0.001), knee flexum-recurvatum (p = 0.007) and hindfoot height (p = 0.004). There was no significant difference between patients with and without LLD perceptions regarding differences in femoral length (p = 0.06), history of spine pathology or fusion (p = 0.128) and lumbar spine stiffness (p = 0.955). CONCLUSIONS Our study found no significant correlation between perceptions of LLD after THA and spinal fusion or lumbar spine stiffness. Changes in the position of the centre of hip rotation can affect the functional leg length. Surgeons should consult patients regarding other factors, such as knee alignment or hind-/midfoot pathologies, as well as compensatory mechanisms, such as axial pelvic rotation, that could affect perceptions of LLD.
Collapse
Affiliation(s)
- Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière Hospital Assistance Publique-Hopitaux de Paris, Sorbonne Medecine Universite, Paris, France
| | - Aidin Eslam Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, 06510, USA.
| |
Collapse
|
5
|
Li J, Li Y, Ping R, Zhang Q, Chen HY, Lin D, Qi J. Biomechanical analysis of sacroiliac joint motion following oblique-pulling manipulation with or without pubic symphysis injury. Front Bioeng Biotechnol 2022; 10:960090. [PMID: 36204470 PMCID: PMC9530983 DOI: 10.3389/fbioe.2022.960090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Oblique-pulling manipulation has been widely applied in treating sacroiliac joint (SIJ) dysfunction. However, little is known about the biomechanical mechanism of the manipulation. This study aims to analyze the SIJ motion under oblique-pulling manipulation, in comparison with compression and traction loads. Methods/Study Design: A total of six specimens of embalmed human pelvis cadavers were dissected to expose the SIJ and surrounding ligaments. Through a servo-hydraulic testing system, biomechanical tests were performed on the stable pelvis and the unstable pelvis with pubic symphysis injury (PSI). A three-dimensional (3D) photogrammetry system was employed to determine the separation and nutation in three tests: axial compression (test A), axial traction (test B), and oblique-pulling manipulation (test C). Results: After applying the testing loads, the range of nutation was no more than 0.3° (without PSI) and 0.5°(with PSI), separately. Except for test B, a greater nutation was found with PSI (p < 0.05). Under both conditions, nutation following test A was significantly greater than that of other tests (p < 0.05). SIJ narrowed in test A and separated in tests B and C, where the range of motion did not exceed 0.1 mm (without PSI) or 0.3 mm (with PSI) separately. Under both conditions, the separation of SIJ in test C was not as apparent as the narrowness of SIJ in test A (p < 0.05). Compared to SIJ, a more significant increasing displacement was found at the site of the iliolumbar ligament (p < 0.05). Nevertheless, when the force was withdrawn in all tests, the range of nutation and separation of SIJ nearly decreased to the origin. Conclusion: Pubic symphysis is essential to restrict SIJ motion, and the oblique-pulling manipulation could cause a weak nutation and separation of SIJ. However, the resulting SIJ motion might be neutralized by regular standing and weight-bearing load. Also, the effect on SIJ seems to disappear at the end of manipulation. Therefore, the stretching and loosening of surrounding ligaments need to be paid more attention to.
Collapse
Affiliation(s)
- Jing Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Ruiyue Ping
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Qing Zhang
- Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Hai-Yun Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Hai-Yun Chen, ; Dingkun Lin, ; Ji Qi,
| | - Dingkun Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Hai-Yun Chen, ; Dingkun Lin, ; Ji Qi,
| | - Ji Qi
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Postdoctoral Research Station, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Hai-Yun Chen, ; Dingkun Lin, ; Ji Qi,
| |
Collapse
|
6
|
Wang TY, Bergin SM, Murphy KR, Abd-El-Barr MM, Grossi P, Shaffrey CI, Crutcher C, Than KD. Sacroiliac Joint Fusion Using Robotic Navigation: Technical Note and Case Series. Oper Neurosurg (Hagerstown) 2022; 23:1-7. [PMID: 35726923 DOI: 10.1227/ons.0000000000000179] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients undergoing sacroiliac (SI) fusion can oftentimes experience significant improvements in pain and quality of life. OBJECTIVE To describe a novel application of robotic navigation to assist with minimally invasive SI joint fusion. METHODS Patients undergoing stand-alone SI joint fusion with ExcelsiusGPS robotic navigation from July 2020 through June 2021 were retrospectively enrolled. Baseline demographic and perioperative variables including radiation exposure, postoperative pain scores, and narcotic requirements in the postanesthesia care unit (PACU) were recorded. Length of stay and any postoperative complications were also noted. RESULTS A total of 10 patients (64.4 ± 8.2 years, body mass index 28.7 ± 4.8 kg/m2) met inclusion criteria. Seven patients (70.0%) were female, and there was a 6:4 split between left-sided and right-sided SI joint fusion. The total operative time was 54 ± 9 minutes, and the estimated blood loss was 21.0 ± 16.7 mL. The intraoperative radiation exposure was 13.7 ± 6.2 mGy, and there were no complications. The average pain score in PACU was 5.2 ± 1.0, and the average opioid administration in PACU was 27.6 ± 10.3 morphine equivalents. Length of stay was 0.4 ± 0.7 days, with 7 of 10 patients discharged on the same day as surgery. There were no readmissions. The average length of follow-up was 4.3 ± 2.5 months. At the last follow-up, patients reported an average of 73.1% ± 30.1% improvement in their preoperative pain. CONCLUSION Robot-navigated SI joint fusion is a feasible and reproducible method for addressing refractory SI joint disease. Further investigation on clinical outcomes and long-term fusion rates is needed, as are studies comparing robot-navigated SI joint fusion with more traditional techniques.
Collapse
Affiliation(s)
- Timothy Y Wang
- Department of Neurological Surgery, Division of Spine, Duke University, Durham, North Carolina, USA
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Aranke M, McCrudy G, Rooney K, Patel K, Lee CA, Hasoon J, Kaye AD. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia) 2022; 14:34098. [PMID: 35769646 PMCID: PMC9235436 DOI: 10.52965/001c.34098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/06/2021] [Indexed: 04/05/2024] Open
Abstract
Sacroiliac joint (SIJ) pain is responsible for approximately 15-25% of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.
Collapse
Affiliation(s)
- Mayank Aranke
- Department of Anesthesiology, University of Texas Health Science Center
| | - Grace McCrudy
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kelsey Rooney
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kunaal Patel
- LSU Health Sciences Center Shreveport School of Medicine
| | - Christopher A Lee
- Department of Internal Medicine, Creighton University School of Medicine-Phoenix Regional Campus
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport
| |
Collapse
|
8
|
Aranke M, McCrudy G, Rooney K, Patel K, Lee CA, Hasoon J, Urits I, Viswanath O, Kaye AD. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia) 2022; 14:31915. [DOI: 10.52965/001c.31915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Grace McCrudy
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kelsey Rooney
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kunaal Patel
- LSU Health Sciences Center Shreveport School of Medicine
| | | | | | | | | | | |
Collapse
|
9
|
Morimoto K, Harrington A, Nelson C, Loveless B. Osteopathic approach to sacroiliac joint pain in pregnant patients. J Osteopath Med 2022; 122:235-242. [PMID: 35176817 DOI: 10.1515/jom-2021-0231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/06/2022] [Indexed: 01/25/2023]
Abstract
This paper aims to provide a comprehensive review of the management of sacroiliac (SI) joint pain in pregnant patients. Although SI joint pain is highly prevalent among pregnant patients, the unique anatomy of the joint is rarely discussed in a clinical setting. This paper provides comprehensive review of the epidemiology, anatomy, alarm findings, standard treatment, osteopathic assessment, and osteopathic manipulative treatment (OMT) of the SI joint, and it provides a general and in-depth understanding of the SI joint pain in pregnant patients and its management.
Collapse
Affiliation(s)
- Kaori Morimoto
- Western University of Health Sciences COMP-Northwest, Lebanon, OR, USA
| | - Alisha Harrington
- Western University of Health Sciences COMP-Northwest, Lebanon, OR, USA
| | - Claudia Nelson
- Western University of Health Sciences COMP-Northwest, Lebanon, OR, USA
| | - Brian Loveless
- Western University of Health Sciences COMP, Pomona, CA, USA
| |
Collapse
|
10
|
Mank VM, Barranco-Trabi J, Mank JK, Roberts J, Newman DP. A Case Study of Chronic Iliopsoas Tendinopathy and Sacroiliac Joint Dysfunction Masquerading As Pelvic Girdle Pain. Cureus 2021; 13:e15719. [PMID: 34290919 PMCID: PMC8288589 DOI: 10.7759/cureus.15719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/30/2022] Open
Abstract
Pain related to pregnancy can occur anytime between conception to the postpartum period. Pregnancy and the following months after birth are a time of physical change to the woman’s body, with significant hormonal effects. We present a case of a young female with chronic pain several years after her second pregnancy that presented a diagnostic challenge. She was initially diagnosed with persistent pelvic girdle pain (PGP) type 2, responded somewhat to appropriately targeted pelvic floor therapy, with a plateau in her progress. The diagnosis was revised to PGP type 4, with some improvement in pain with customized therapy. Her treatment again changed with a focus on sacroiliac joint (SIJ) dysfunction and iliopsoas tendinopathy with excellent and complete resolution of her pain. The overlapping nature of these diagnoses caused a significant challenge in creating a tailored physical therapy approach to her pain that eventually led to her final diagnosis being one of exclusion. Treatment was focused on optimization of joint mobility and tissue lengthening, with the resolution of her pain.
Collapse
Affiliation(s)
- Victoria M Mank
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, USA
| | | | - Jeffrey K Mank
- Department of Biology, University of New England, Biddeford, USA
| | - Jefferson Roberts
- Department of Rheumatology, Tripler Army Medical Center, Honolulu, USA
| | - David P Newman
- Pain Management-Physiotherapy, Interdisciplinary Pain Management Clinic, Tripler Army Medical Center, Honolulu, USA
| |
Collapse
|
11
|
Himstead AS, Brown NJ, Shahrestani S, Tran K, Davies JL, Oh M. Trends in Diagnosis and Treatment of Sacroiliac Joint Pathology Over the Past 10 Years: Review of Scientific Evidence for New Devices for Sacroiliac Joint Fusion. Cureus 2021; 13:e15415. [PMID: 34249562 PMCID: PMC8253473 DOI: 10.7759/cureus.15415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Sacroiliac (SI) joint pathology is a newly appreciated contributor to lower back pain. Sacroiliac joint fusion (SIJF) has grown rapidly in popularity in association with the advent of minimally-invasive surgical techniques. This has led to an explosion of new medical devices used for SIJF. The objective of this article is to outline clinical trends, summarize the current data, and categorize novel devices for SIJF. Trends in SI joint pathology and fusion were obtained via the Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) database and Web of Science. To review literature on devices for SIJF, PubMed was searched using the Boolean phrase “sacroiliac joint AND (fusion OR arthrodesis)” since 2010. To establish a list of SIJF devices not represented in the literature, searches were performed on the FDA 510(k), premarket approval, and de novo databases, as well as Google and LinkedIn. Literature review yielded 11 FDA-approved devices for minimally invasive SIJF. Database query yielded an additional 22 devices for a total of 33 devices. Twenty-one devices used the lateral transiliac approach, six posterior allograft approach, three posterolateral approach, and three combined the lateral transiliac and posterolateral approaches. The evidence for the lateral transiliac approach is the most robust. Many novel devices have been developed for minimally invasive SIJF over the past 10 years. Further randomized comparative trials are warranted to evaluate different surgical approaches and novel devices at this time.
Collapse
Affiliation(s)
- Alexander S Himstead
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Nolan J Brown
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Shane Shahrestani
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Katelynn Tran
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Jordan L Davies
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Michael Oh
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| |
Collapse
|
12
|
Le Huec JC, Bourret S, Thompson W, Daulouede C, Cloché T. A painful unknown: sacroiliac joint diagnosis and treatment. EFORT Open Rev 2020; 5:691-698. [PMID: 33204512 PMCID: PMC7608515 DOI: 10.1302/2058-5241.5.190081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The sacroiliac joint (SIJ) is a complex anatomical structure located near the centre of gravity of the body. Micro-traumatic SIJ disorders are very difficult to diagnose and require a complete clinical and radiological examination. To diagnose micro-trauma SIJ pain it is recommended to have at least three positive provocative specific manoeuvres and then a radiologically controlled infiltration test. Conservative treatment combining physiotherapy and steroid injections is the most common therapy but has a low level of efficiency. SIJ thermolysis is the most efficient non-invasive therapy. SIJ fusion using a percutaneous technique is a solution that has yet to be confirmed on a large cohort of patients resistant to other therapies.
Cite this article: EFORT Open Rev 2020;5:691-698. DOI: 10.1302/2058-5241.5.190081
Collapse
Affiliation(s)
| | - Stephane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux Univ, 33 300 Bordeaux, France
| | - Wendy Thompson
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux Univ, 33 300 Bordeaux, France
| | - Christian Daulouede
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux Univ, 33 300 Bordeaux, France
| | - Thibault Cloché
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux Univ, 33 300 Bordeaux, France
| |
Collapse
|
13
|
Wendling D. Reply to Aktaş et al. "Local sacroiliac injections in the treatment of spondyloarthritis. What is the evidence?" Joint Bone Spine 2020. DOI:10.1016/j.jbspin.2020.105083. Joint Bone Spine 2020; 88:105094. [PMID: 33157232 DOI: 10.1016/j.jbspin.2020.105094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Wendling
- Department of Rheumatology, University Teaching Hospital, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA4266, EPILAB, université Bourgogne-Franche-Comté, 25030 Besançon, France.
| |
Collapse
|
14
|
Casaroli G, Bassani T, Brayda-Bruno M, Luca A, Galbusera F. What do we know about the biomechanics of the sacroiliac joint and of sacropelvic fixation? A literature review. Med Eng Phys 2019; 76:1-12. [PMID: 31866118 DOI: 10.1016/j.medengphy.2019.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 10/15/2019] [Accepted: 10/20/2019] [Indexed: 01/25/2023]
Abstract
The purpose of this review is to summarize the general knowledge about the biomechanics of the sacroiliac joint and sacropelvic fixation techniques. Additionally, this study aims to support biomechanical investigations in defining experimental protocols as well as numerical modeling of the sacropelvic structures. The sacroiliac joint is characterized by a large variability of shape and ranges of motion among individuals. Although the ligament network and the anatomical features strongly limit the joint movements, sacroiliac displacements and rotations are not negligible. Currently available treatments for sacroiliac joint dysfunction include physical therapy, steroid injections, Radio-frequency ablation of specific neural structures, and open or minimally invasive SIJ fusion. In long posterior construct, the most common solutions are the iliac screws and the S2 alar - iliac screws, whereas for the joint fixation alone, mini - invasive alternative system can be used. Several studies reported the clinical outcomes of the different techniques and investigated the biomechanical stability of the relative construct, but the effect of sacropelvic fixation techniques on the joint flexibility and on the stress generated into the bone is still unknown. In our opinion, more biomechanical analyses on the behavior of the sacroiliac joint may be performed in order to better predict the risk of failure or instability of the joint.
Collapse
Affiliation(s)
- Gloria Casaroli
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tito Bassani
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Marco Brayda-Bruno
- III Spine Surgery - Scoliosis Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Andrea Luca
- III Spine Surgery - Scoliosis Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Fabio Galbusera
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| |
Collapse
|