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Wang Y, DU X, Tomaszewski R, Journeau P, Mayr J. Operative management of sacroiliac joint dislocation in children with unstable pelvic fractures - A STROBE-compliant investigation. J Orthop 2024; 52:6-11. [PMID: 38404697 PMCID: PMC10881409 DOI: 10.1016/j.jor.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Injuries involving severe spinal axial loading may be accompanied by sacroiliac joint dislocations. In children, these injuries are relatively rare, and there is little information on their optimal management in young patients. We conducted a multicentre study to investigate the outcome of surgical treatment of unstable pelvic fracture with sacroiliac joint dislocation in children. Patients & methods We assessed the quality of surgical reduction and functional outcome at follow-up in 7 patients (5 girls, 2 boys) with a median age of 6.4 years (range: 4.2-14.8 years). Patients with pelvic fractures and sacroiliac joint dislocations were treated at four international paediatric level 1 trauma centres between January 2008 and August 2023. We applied the Matta criteria to assess the quality of fracture reduction and graded the functional follow-up results using adjusted Majeed score. Results At follow-up, 3 patients showed excellent fracture reduction, with 2 patients showing good reduction and 2 patients exhibiting fair fracture reduction according to the Matta criteria. At follow-up visits at a median of 12 months (range: 3-84 months) after the injury, patients achieved a median adjusted Majeed score of 76 (range: 63 to 76). Conclusions Unstable pelvic injuries with sacroiliac joint dislocation without comminution can be stabilised with a single iliosacral screw in children. Comminuted pelvic fractures with unstable sacroiliac dislocation require stabilisation with lateral compression screws or plates. In case of residual pelvic instability after internal fixation, an additional external fixator or pelvic hammock should be applied to optimize the stability of fixation.
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Affiliation(s)
- Yanjiang Wang
- Department of Orthopedic Surgery, Tianjin Children's Hospital, Beichen Qu, Longyan dao 238 Hao, Tianjin, 30074, PR China
| | - Xiaojie DU
- Department of Orthopedic Surgery, Tianjin Children's Hospital, Beichen Qu, Longyan dao 238 Hao, Tianjin, 30074, PR China
| | - Ryszard Tomaszewski
- Department of Pediatric Orthopedics and Traumatology Department, Medical University of Silesia, ul. Medykow 16, 40-752, Katowice, Poland
| | - Pierre Journeau
- Hôpital Femme Mère Enfant, Service de Chirurgie Orthopédique et Traumatologique infantile, Hospices Civils de Lyon Groupement Hospitalier Est, 59 Boulevard Pinel, F-69677, BRON Cedex, France
| | - Johannes Mayr
- Department of Pediatric Surgery, University Children's Hospital Basel, University of Basel, Spitalstrasse 31, 4031, Basel, Switzerland
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Silva-Ortiz VM, Chapman KB, Chang Chien GC, Diwan S, Abd-Elsayed A. Sacroiliac Joint Denervation-A Novel Approach to Target Sacral Lateral Branches: A Practical Approach. Pain Ther 2024; 13:281-286. [PMID: 38407769 DOI: 10.1007/s40122-024-00585-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/12/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Sacroiliac joint (SIJ) pain is a relatively common cause of low back pain. Percutaneous radiofrequency (RF) techniques for SIJ are limited to ablation of the posterior SIJ innervation. Different techniques have been described for SIJ radiofrequency ablation, including conventional thermal, cooled RF, pulsed RF, bipolar RF, and specialized tip RF needle (i.e., multi-tined); however, additional costs may limit these applications. METHODS This new technique for SIJ denervation uses anatomical landmarks and a single RF cannula. Two spinal needles are placed lateral to the posterior S1 and S2 sacral foramina; then, with caudal tilt we get a coaxial view of the sacral bone, we advance an 18-G curved 15-mm active tip RF cannula just lateral to the aligned finder needles. Ablation is performed, and then the RF cannula is retracted 2 cm and ablation is repeated for a total of four lesions. RESULTS The two spinal needles placed lateral to the posterior sacral foramina S1 and S2 guide the final needle in the posterior aspect of the sacrum, lateral to the sacral foramina, where the lateral sacral branches are located. CONCLUSION We introduce a cost and time efficient technique to perform radiofrequency ablation of the sacral lateral branches using a single RF needle. This technique utilizes the sacrum's reliable anatomy and angulation and maximizes the surface area of the active tip lesioning. This technique creates a strip lesion lateral to the sacral foramina and reduces time and cost efficacy compared to several of the other techniques and/or commercially available special devices designed for sacroiliac denervation.
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Affiliation(s)
- Victor M Silva-Ortiz
- Department of Pain Management, Hospital Zambrano Hellion, Tec Salud, Batallon de San Patricio 112, Real San Agustín, San Pedro Garza Garcia, Nuevo León, México.
| | - Kenneth B Chapman
- Department of Anesthesiology, Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | | | | | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
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Shima K, Fujibayashi S, Otsuki B, Murata K, Shimizu T, Sono T, Matsuda S. S2 Alar Screw Insertion Accuracy and Factors Associated With Screw Loosening and Lumbosacral Nonunion. World Neurosurg 2024; 184:e129-e136. [PMID: 38253180 DOI: 10.1016/j.wneu.2024.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To investigate S2 alar screw (S2AS) accuracy and factors associated with S2AS loosening and lumbosacral nonunion. METHODS We retrospectively reviewed patients who underwent lumbosacral fusion surgery with S2AS addition under fluoroscopy. S2AS loosening and lumbosacral nonunion were analyzed using a 1-year postoperative computed tomography. S2AS insertion accuracy was originally classified as accurate, short, anterior perforation, lateral perforation, and sacroiliac joint (SIJ) deviation among lateral perforation. Clinical data including sex, age, body mass index, fused segments, fusion procedure, primary or revision surgery, Japanese Orthopedic Association scores and complications were collected. Factors associated with S2AS loosening and lumbosacral nonunion were analyzed. RESULTS A total of 37 patients (74 screws, age: 63.78 ± 13.57 years, female/male: 14/23 patients, body mass index: 23.11 ± 2.53, fused segments: 1-4 levels, revision: 38%) were included. S2AS loosening and lumbosacral nonunion were observed in 18 screws (13%) and 8 patients (22%) respectively. Only 35 screws (47%) were inserted accurately in our classification. Short, lateral perforation, and anterior perforation were observed in 14 screws (19%), 22 screws (30%), and 3 screws (4.1%). SIJ deviation was seen in 15 screws (20%) Factors associated with S2AS loosening were older age (P = 0.038), fusion levels (P = 0.011), and SIJ deviation (P < 0.001). S2AS loosening affects S1 pedicle screw (S1PS) loosening (P = 0.001). Furthermore, S2AS loosening is a risk factor for lumbosacral nonunion (P = 0.046). CONCLUSIONS S2AS insertion under fluoroscopy is inaccurate. S2AS loosening induces S1PS loosening and lumbosacral nonunion. Surgeons should avoid deviating to SIJ, especially in older patients and relatively longer fusion.
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Affiliation(s)
- Koichiro Shima
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | | | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Sono
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Agarwal R, Moreau JL, Mohanty K. Hydroxyapatite-Coated Screws Versus Titanium Triangular Dowels for Sacroiliac Joint Fusion: Results From a Nonrandomized Prospective Outcome Study. World Neurosurg 2024; 184:e367-e373. [PMID: 38307197 DOI: 10.1016/j.wneu.2024.01.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE This is a single-surgeon series that prospectively evaluates the results of sacroiliac joint (SIJ) fusion for patients with SIJ dysfunction using hydroxyapatite-coated screws (HACSs) compared with titanium triangular dowels (TTDs). METHODS A total of 113 patients underwent SIJ fusion surgery between 2013 and 2018 at the University Hospital Llandough to treat symptomatic SIJ dysfunction not responding to nonoperative measures. Of the 113 patients, 40 were treated with HACSs and 73 with TTDs. Patient-reported outcomes measures (PROMs) were collected preoperatively and at 12 months postoperatively, including the 36-item short-form health survey, Oswestry disability index, EuroQol-5D-5L, and Majeed pelvic score. Patients with ongoing symptoms were followed up beyond the study period. RESULTS Of the 113 patients, 33 completed follow-up in the HACS group compared with 61 in the TTD group. Both groups had comparable preoperative PROMs; however, the postoperative PROMs were significantly better in the TTD group. Additionally, 21 patients (63%) in the HACS group had radiological evidence of screw lysis compared with 5 patients (9%) in the TTD group. A subgroup analysis revealed less significant improvement in PROMs for patients with screw lysis compared with those without. Four patients were offered further revision surgery. CONCLUSIONS Minimally invasive SIJ fusion has been shown to have good clinical outcomes for select patients. However, our experience shows that HACSs are associated with a high rate of screw lysis and poorer patient outcomes compared with TTDs. Therefore, we recommend the use of TTDs instead of HACSs for SIJ fusion surgery.
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Affiliation(s)
- Rishi Agarwal
- Trauma and Orthopaedics Service, University Hospital Llandough, Llandough, United Kingdom
| | - Joshua Lee Moreau
- Department of Surgery, Morriston Hospital, Cwmrhydyceirw, United Kingdom.
| | - Khitish Mohanty
- Trauma and Orthopaedics Service, University Hospital Llandough, Llandough, United Kingdom
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De Salvatore S, Russo F, Vadalà G, Pascarella G, Papalia GF, Ambrosio L, Ruggiero A, Migliorelli S, Carassiti M, Papalia R, Denaro V. Interventional treatments for low back pain due to sacroiliac joint dysfunction: a systematic review of the literature. Eur Spine J 2024; 33:1407-1423. [PMID: 38329572 DOI: 10.1007/s00586-024-08130-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE This systematic review aimed to report the current evidence in the literature about the efficacy of interventional treatments in the management of low back pain (LBP) due to sacroiliac joint dysfunction. METHODS A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Medline, EMBASE, Scopus, CINAHL, Cochrane Library, and CENTRAL bibliographic databases were searched. The search was performed from October to December 2021, and articles from the inception of the database to December 2021 were searched. RESULTS Fourteen studies were included for qualitative synthesis. Five studies used the traditional radiofrequency approach (tRF), five studies used cooled radiofrequency approach (cRF), one study used botulinum toxin (BT), two studies used steroid injection, triamcinolone (TA) and local anesthetics injections, and one study used pulsed radiofrequency (PRF) denervation. Two studies used sham as a comparator. CONCLUSIONS Cooled radiofrequency seems to be the most effective treatment in improving pain and functionality, while intra-articular injections are helpful only as diagnostic tools. However, due to the lack of high-quality studies, it was not possible to draw significant conclusions.
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Affiliation(s)
- Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Department of Orthopedics, Children's Hospital Bambino Gesù, 00165, Palidoro, Rome, Italy
| | - Fabrizio Russo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Gianluca Vadalà
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giuseppe Pascarella
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio Medico University and Teaching Hospital University and Teaching Hospital, Rome, Italy
| | - Giuseppe Francesco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Luca Ambrosio
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Alessandro Ruggiero
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio Medico University and Teaching Hospital University and Teaching Hospital, Rome, Italy
| | - Sabrina Migliorelli
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio Medico University and Teaching Hospital University and Teaching Hospital, Rome, Italy
| | - Massiliano Carassiti
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio Medico University and Teaching Hospital University and Teaching Hospital, Rome, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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Li X, Lin Y, Xie Z, Lu Z, Song L, Ye Q, Wang M, Fang X, He Y, Chen H, Zhao Y. Automatic segmentation of fat metaplasia on sacroiliac joint MRI using deep learning. Insights Imaging 2024; 15:93. [PMID: 38530554 DOI: 10.1186/s13244-024-01659-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE To develop a deep learning (DL) model for segmenting fat metaplasia (FM) on sacroiliac joint (SIJ) MRI and further develop a DL model for classifying axial spondyloarthritis (axSpA) and non-axSpA. MATERIALS AND METHODS This study retrospectively collected 706 patients with FM who underwent SIJ MRI from center 1 (462 axSpA and 186 non-axSpA) and center 2 (37 axSpA and 21 non-axSpA). Patients from center 1 were divided into the training, validation, and internal test sets (n = 455, 64, and 129). Patients from center 2 were used as the external test set. We developed a UNet-based model to segment FM. Based on segmentation results, a classification model was built to distinguish axSpA and non-axSpA. Dice Similarity Coefficients (DSC) and area under the curve (AUC) were used for model evaluation. Radiologists' performance without and with model assistance was compared to assess the clinical utility of the models. RESULTS Our segmentation model achieved satisfactory DSC of 81.86% ± 1.55% and 85.44% ± 6.09% on the internal cross-validation and external test sets. The classification model yielded AUCs of 0.876 (95% CI: 0.811-0.942) and 0.799 (95% CI: 0.696-0.902) on the internal and external test sets, respectively. With model assistance, segmentation performance was improved for the radiological resident (DSC, 75.70% vs. 82.87%, p < 0.05) and expert radiologist (DSC, 85.03% vs. 85.74%, p > 0.05). CONCLUSIONS DL is a novel method for automatic and accurate segmentation of FM on SIJ MRI and can effectively increase radiologist's performance, which might assist in improving diagnosis and progression of axSpA. CRITICAL RELEVANCE STATEMENT DL models allowed automatic and accurate segmentation of FM on sacroiliac joint MRI, which might facilitate quantitative analysis of FM and have the potential to improve diagnosis and prognosis of axSpA. KEY POINTS • Deep learning was used for automatic segmentation of fat metaplasia on MRI. • UNet-based models achieved automatic and accurate segmentation of fat metaplasia. • Automatic segmentation facilitates quantitative analysis of fat metaplasia to improve diagnosis and prognosis of axial spondyloarthritis.
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Affiliation(s)
- Xin Li
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Yi Lin
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, 999077, China
| | - Zhuoyao Xie
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Zixiao Lu
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Liwen Song
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Qiang Ye
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Menghong Wang
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China
| | - Xiao Fang
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, 999077, China
| | - Yi He
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, China
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, 999077, China
| | - Yinghua Zhao
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, 510630, Guangdong, China.
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Toyohara R, Ohashi T. A literature review of biomechanical studies on physiological and pathological sacroiliac joints: Articular surface structure, joint motion, dysfunction and treatments. Clin Biomech (Bristol, Avon) 2024; 114:106233. [PMID: 38531152 DOI: 10.1016/j.clinbiomech.2024.106233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Sacroiliac joints are affected by mechanical environments; the joints are formed under mechanical stimulation, receive impact of walking between the upper and lower parts of the bodies and can be a cause of pain due to non-physiological loads. However, there are so far very few studies that reviewed biomechanics of physiological and pathological sacroiliac joints. This review article aims to describe the current sacroiliac joint biomechanics. METHODS Previous original papers have been summarized based on three categories: articular surface structure, sacroiliac joint motion and sacroiliac joint dysfunction and treatments. FINDINGS Although the articular surface morphologies vary greatly from individual to individual, many researchers have tried to classify the joints into several types. It has been suggested that the surface morphologies may not change regardless of joint dysfunction, however, the relationship between the joint structure and pain are still unclear. The range of sacroiliac joint motion is demonstrated to be less than 1 mm and there is no difference between physiological and pathological joints. The sacroiliac joint absorbs shock within the pelvis by the joint structures of pelvic morphology, ligaments and fat tissues. The morphology and motion of the sacroiliac joints may be optimized for upright bipedal walking. INTERPRETATION There is no doubt that pelvic mechanical environments affect pain induction and treatment; however, no one has yet provided a concrete explanation. Future research could help develop treatments based on sacroiliac joint biomechanics to support joint function.
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Affiliation(s)
- Ryota Toyohara
- Faculty of Engineering, Hokkaido University, Japan; Creative Research Institution, Hokkaido University, Japan.
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Vereecke E, Diekhoff T, Eshed I, Herregods N, Morbée L, Jaremko JL, Jans L. ESR Essentials: Imaging of sacroiliitis-practice recommendations by ESSR. Eur Radiol 2024:10.1007/s00330-024-10653-3. [PMID: 38459347 DOI: 10.1007/s00330-024-10653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024]
Abstract
Sacroiliitis is commonly seen in patients with axial spondyloarthritis, in whom timely diagnosis and treatment are crucial to prevent irreversible structural damage. Imaging has a prominent place in the diagnostic process and several new imaging techniques have been examined for this purpose. We present a summary of updated evidence-based practice recommendations for imaging of sacroiliitis. MRI remains the imaging modality of choice for patients with suspected sacroiliitis, using at least four sequences: coronal oblique T1-weighted and fluid-sensitive sequences, a perpendicular axial oblique sequence, and a sequence for optimal evaluation of the bone-cartilage interface. Both active inflammatory and structural lesions should be described in the report, indicating location and extent. Radiography and CT, especially low-dose CT, are reasonable alternatives when MRI is unavailable, as patients are often young. This is particularly true to evaluate structural lesions, at which CT excels. Dual-energy CT with virtual non-calcium images can be used to depict bone marrow edema. Knowledge of normal imaging features in children (e.g., flaring, blurring, or irregular appearance of the articular surface) is essential for interpreting sacroiliac joint MRI in children because these normal processes can simulate disease. CLINICAL RELEVANCE STATEMENT: Sacroiliitis is a potentially debilitating disease if not diagnosed and treated promptly, before structural damage to the sacroiliac joints occurs. Imaging has a prominent place in the diagnostic process. We present a summary of practice recommendations for imaging of sacroiliitis, including several new imaging techniques. KEY POINTS: • MRI is the modality of choice for suspected inflammatory sacroiliitis, including a joint-line-specific sequence for optimal evaluation of the bone-cartilage interface to improve detection of erosions. • Radiography and CT (especially low-dose CT) are reasonable alternatives when MRI is unavailable. • Knowledge of normal imaging features in children is mandatory for interpretation of MRI of pediatric sacroiliac joints.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität Zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, 5262000, Ramat Gan, Israel
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, AB, T6G 2B7, Canada
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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Lehman VT, Tiegs-Heiden CA, Broski SM. Beyond Anatomy: Fat-Suppressed MR and Molecular Imaging of Spinal Pain Generators. Radiol Clin North Am 2024; 62:247-261. [PMID: 38272618 DOI: 10.1016/j.rcl.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Spine pain is highly prevalent and costly, but evaluation with clinical features and anatomic imaging remain limited. Fat-suppressed MR imaging and molecular imaging (MI) may help identify inflammatory, lesional, and malignant causes. Numerous MI agents are available, each with advantages and disadvantages. Herein, FDG PET, prostate-specific membrane antigen (PSMA), bone radiotracers, and others are highlighted. No specific pain MI agents have been identified, but mechanisms of key agents are shown in video format, and the mechanism of PSMA as a theranostic agent is displayed. A multidisciplinary approach is needed to master this topic.
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Affiliation(s)
- Vance T Lehman
- Department of Radiology, Mayo Clinic, 200 1st Street SouthWest, Rochester, MN 55905, USA.
| | | | - Stephen M Broski
- Department of Radiology, Mayo Clinic, 200 1st Street SouthWest, Rochester, MN 55905, USA
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Fan W, Yang S, Chen J, Guo LX, Zhang M. A Biomechanical Comparison of 2 Different Topping-off Devices and Their Influence on the Sacroiliac Joint Following Lumbosacral Fusion Surgery. Neurospine 2024; 21:244-252. [PMID: 38317555 PMCID: PMC10992661 DOI: 10.14245/ns.2347108.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Interspinous spacer (ISS)-based and pedicle screw-rod dynamic fixator (PDF)-based topping-off devices have been applied in lumbar/lumbosacral fusion surgeries for preventing the development of proximal adjacent segment degeneration. However, little attention has been paid to sacroiliac joint (SIJ), which belongs to the adjacent joints. Accordingly, the objective of this study was to compare how these 2 topping-off devices affect the SIJ biomechanics. METHODS A validated, normal finite-element lumbopelvic model (L3-pelvis) was initially adjusted to simulate interbody fusion with rigid fixation at the L5-S1 level, and then the DIAM or BioFlex system was instrumented at the L4-5 level to establish the ISS-based or PDF-based topping-off model, respectively. All the developed models were loaded with moments of 4 physiological motions using hybrid loading protocol. RESULTS Compared with the rigid fusion model (without topping-off devices), range of motion and von-Mises stress at the SIJs were increased by 23.1%-64.1% and 23.6%-62.8%, respectively, for the ISS-based model and by 51.2%-126.7% and 50.4%-108.7%, respectively, for the PDF-based model. CONCLUSION The obtained results suggest that the PDF-based topping-off device leads to higher increments in SIJ motion and stress than ISS-based topping-off device following lumbosacral fusion, implying topping-off technique could be linked to an increased risk of SIJ degeneration, especially when using PDF-based device.
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Affiliation(s)
- Wei Fan
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Song Yang
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Jie Chen
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong, China
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11
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Maksymowych WP, Herregods N, Varma N, Meyers AB, Stimec J, Doria AS, Tzaribachev N, Otobo TM, van Rossum MA, Paschke J, Wichuk S, Lambert RG. Systematic calibration reduces sources of variability for the preliminary OMERACT juvenile idiopathic arthritis MRI- sacroiliac joint score (OMERACT JAMRIS-SIJ). Semin Arthritis Rheum 2024; 64:152299. [PMID: 38039747 DOI: 10.1016/j.semarthrit.2023.152299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To determine whether systematic calibration enhances scoring proficiency of the OMERACT juvenile idiopathic arthritis MRI-Sacroiliac Joint score (JAMRIS-SIJ) and whether contrast-enhancement enhances its performance. METHODS MRI SIJ scans of 50 cases with juvenile spondyloarthritis were scored by 7 raters after calibration with 3 different knowledge transfer tools. RESULTS Calibrated readers achieved greater reliability for scoring certain inflammatory and structural lesions. Sensitivity and reliability for scoring inflammatory lesions was greater on fluid-sensitive compared to contrast-enhanced sequences. CONCLUSION Systematic calibration should be implemented prior to the use of JAMRIS-SIJ for clinical trials. It is unlikely that contrast-enhanced MRI will improve the performance of this method.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Canada; CARE Arthritis, Edmonton, Alberta, Canada.
| | - Nele Herregods
- Division of Pediatric Radiology, Universitair Ziekenhuis Ghent, Ghent, Belgium
| | - Nisha Varma
- Department of Paediatric Radiology, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Medical Imaging Department, Western Health, Melbourne, Victoria, Australia
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada; Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Nikolay Tzaribachev
- Department of Pediatric Rheumatology, Medical Center Bad Bramstedt, Bramstedt, Germany
| | - Tarimobo M Otobo
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Marion A van Rossum
- Amsterdam Rheumatology and Immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
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12
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Zhao X, Pan A, Hai Y. Greater pelvic obliquity in adolescent idiopathic scoliosis combined with hip dysplasia. Eur Spine J 2024; 33:680-686. [PMID: 38097782 DOI: 10.1007/s00586-023-08055-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 03/03/2024]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a spinal deformity that affects adolescents and poses a challenging public health problem. Compared to the general population, adolescents with AIS have a higher prevalence of hip dysplasia. However, the mechanisms underlying the impact of hip dysplasia on the coronal balance of the spine remain poorly understood. We hypothesized that the combination of AIS with hip dysplasia would exacerbate coronal imbalance. METHODS We retrospectively analyzed the medical records and radiographs of adolescents diagnosed with AIS between 2015 and 2020. Participants were divided into two groups: those with hip dysplasia and those without. We recorded parameters related to the coronal deformity of the spine, sacral and pelvic obliquity, and center edge angle (CEA). We investigated differences in these parameters in those with and without hip dysplasia and analyzed their relationships in those with combined AIS and hip dysplasia. RESULTS A total of 103 adolescents were included, 36 with hip dysplasia and 67 without. Those with hip dysplasia had significantly higher sacroiliac discrepancy (SID) compared to those without (t = - 2.438, P = 0.017). In adolescents with hip dysplasia, only iliac obliquity angle (IOA) was significantly correlated with SID (r = - 0.803, P < 0.001), with a linear relationship between them (r2 = 0.645, P < 0.001). CONCLUSIONS The incidence of hip dysplasia is higher in the AIS population. In adolescents with combined AIS and hip dysplasia, pelvic obliquity is greater, potentially contributing to the increased prevalence of low back pain.
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Affiliation(s)
- Xiaoxiong Zhao
- Department Orthopedics, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Aixing Pan
- Department Orthopedics, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department Orthopedics, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, 8 Gongti South Road, Chaoyang District, Beijing, 100020, China.
- Academic Department of Orthopedic Surgery, Capital Medical University, Beijing, China.
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Interligator S, Le Bozec A, Cluzel G, Devilder M, Ghaouche J, Guenoun D, Fleury A, Petit Lemaire F, Carlier RY, Valente C, Creze M. Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation. Skeletal Radiol 2023:10.1007/s00256-023-04535-w. [PMID: 38110777 DOI: 10.1007/s00256-023-04535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE To describe the frequency of MR and CT features of infectious sacroiliitis (ISI) and assess its extent and complications MATERIALS AND METHODS: This retrospective study included patients with ISI who were evaluated between 2008 and 2021 in a single center. Two radiologists reviewed MRI and CT images to determine the anatomical distribution (unilateral/bilateral, iliac/sacral bone, proximal/middle/distal), severity (bone marrow edema [BME]/periostitis/erosions), concurrent infection (vertebral/nonvertebral), and complications (abscess/probable adjacent osteomyelitis/cavitation/devitalized areas/sequestrum/pelvic venous thrombosis) of ISI. Interobserver reproducibility was assessed. Correlation analysis evaluated the effect of the causative microorganism on severity. Two human bodies were dissected to outline possible ways that ISI can spread. RESULTS Forty patients with ISI (40 years ± 22; 26 women) were evaluated. Ten patients had bilateral ISI. Concurrent vertebral infection was associated in 15% of cases. Reproducibility of sacral BME, periostitis, and reactive locoregional abnormalities was perfect (κ = 1). Reproducibility was low for erosion count (κ = 0.52[0.52-0.82]) and periarticular osteopenia (κ = 0.50[0.18-0.82]). Inflammatory changes were BME (42/42 joints), muscle edema (38/42), and severe periostitis along the ilium (33/37). Destructive structural changes occurred with confluent erosions (iliac, 20/48; sacral, 13/48), sequestrum (20/48), and cavitation (12/48). Complications occurred in 75% of cases, including periarticular abscesses (n = 30/47), probable adjacent osteomyelitis (n = 16/37), and pelvic thrombophlebitis (n = 3). Tuberculous ISI (6/40) correlated with sclerosis (rs = 0.45[0.16; 0.67]; p < 10-2) and bone devitalization (rs = 0.38[0.16; 0.67]; p = .02). The anatomical study highlighted the shared venous vascularization of sacroiliac joints, pelvic organs, and mobile spine. CONCLUSION Complications of ISI are frequent, including abscesses, adjacent osteomyelitis, and periostitis. ISI had bilateral involvement nonrarely and is commonly associated with another spinal infection.
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Affiliation(s)
- Sarah Interligator
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Antoine Le Bozec
- Department of Pharmacy, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Guillaume Cluzel
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Matthieu Devilder
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Jessica Ghaouche
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Daphne Guenoun
- Department of Radiology, Hôpital Sainte-Marguerite, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Albane Fleury
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Florian Petit Lemaire
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Robert-Yves Carlier
- Department of Radiology, Hôpital Raymond Poincaré, Assistance-Publique des Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, 92380 Garches, Paris, France
| | - Catarina Valente
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - Maud Creze
- Department of Radiology, Hôpital Bicêtre, Assistance-Publique des Hôpitaux de Paris, 78 rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France.
- Laboratoire d'Imagerie Biomedicale Multimodale Paris-Saclay, BioMaps, Paris-Saclay University, 4 place du Général Leclerc, 91401 Orsay, Paris, France.
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Zheng M, Zhu G, Chen D, Xiao Q, Lei T, Ye C, Pan C, Miao S, Ye L. T1-weighted images-based radiomics for structural lesions evaluation in patients with suspected axial spondyloarthritis. Radiol Med 2023; 128:1398-1406. [PMID: 37731149 DOI: 10.1007/s11547-023-01717-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE The aim of this study was to investigate the feasibility of radiomics based on T1-weighted images (T1WI) for assessing sacroiliac joint (SIJ) structural lesions in patients with suspected axial spondyloarthritis (axSpA). MATERIALS AND METHODS A total of 266 patients with clinical suspicion of axSpA between December 2016 and January 2022 were enrolled. Structural lesions were assessed on low-dose CT (ldCT) and MRI, respectively. Radiomic features, extracted from SIJ T1WI, were included to generate the radiomics model. The performance of the radiomics model was evaluated using receiver operating characteristic (ROC) curve. Furthermore, point-biserial correlation analysis was used to interpret the associations between the radiomic feature and structural lesions. RESULTS Using ldCT as the reference standard, the radiomics model showed favorable performance for detecting positive global structural lesions in the training cohort (AUC, 0.82 [95% CI: 0.76, 0.88]) and validation cohort (AUC, 0.82 [95% CI: 0.72, 0.91]. Experienced MRI raters yielded predictive AUCs of 0.73 (95% CI: 0.67, 0.79), and 0.74 (95% CI: 0.66, 0.83) in the training and validation cohort, respectively. The seven radiomic features included in the radiomics model showed significant correlation with different kinds of structural lesions (P all < 0.05). Among them, Wavelet.LHL_firstorder_90Percentile showed the strongest association with fat lesion (r = 0.48, P < 0.05). CONCLUSION The radiomics analysis with T1WI could effectively detect SIJ structural lesions and achieved expert-level performance. Each radiomic feature was correlated with different structural lesions significantly, which might inform radiomic-based applications for axSpA intelligent diagnosis.
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Affiliation(s)
- Mo Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China
| | - Guanxia Zhu
- Department of Radiology, Longgang People's Hospital, Wenzhou, 325802, Zhejiang, China
| | - Dan Chen
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China
| | - Qinqin Xiao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China
| | - Tao Lei
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Chenhao Ye
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Chenqiang Pan
- Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Shouliang Miao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China.
| | - Lusi Ye
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325015, Zhejiang, China.
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Frémondière P, Thollon L, Marchal F, Desseauve D. The impact of femoral rotation on sacroiliac articulation during pregnancy. Is there evidence to support Farabeuf's hypothesis by finite element modelization? Eur J Obstet Gynecol Reprod Biol 2023; 290:78-84. [PMID: 37738891 DOI: 10.1016/j.ejogrb.2023.08.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Counter-nutation movement is deemed crucial during the management of the birth process. It is a combination of lateral ilia expansion and backward displacement of the promontory resulting from the external rotations of the femurs producing an enlargement of the pelvic inlet. However, since its description by Farabeuf, this mechanism has never been challenged and analyzed in a dynamic finite element study. METHODS Based on a female pelvic mesh and sacroiliac ligaments, we simulated external rotations of both femurs with imposed rotation of the two acetabulum centers. We hypothesize that lateral ilia expansion generates a sacrum movement resulting in a backward displacement of the promontory and a pelvic inlet enlargement. RESULTS Finite element simulation confirms our hypothesis and reveals that ilio-sacro-transverse and axile ligaments play an essential role in this mechanism. Indeed, the increase in stiffness (ranging from 500 MPa to 750 MPa) of these ligaments accentuates the counter-nutation movement and the opening of the inlet. Instead of the anatomic congruence between the ilium and the sacrum, the sacroiliac ligaments may explain the counter-nutation. After a 6° of femur rotation, the inlet area increases to 11 cm2 (141 cm2 vs. 130 cm2). This enlargement could be noteworthy in case of obstructed labor or shoulder dystocia. Moreover, the association between external rotation and flexion of the femurs could be more efficient for opening the pelvic inlet. CONCLUSIONS Our result did not support the original assumption of Farabeuf. By revealing how postural adjustment increases the bony birth canal, this study provides essential information for the clinical management of the delivery.
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Affiliation(s)
- Pierre Frémondière
- Aix Marseille Univ, CNRS, EFS, ADES, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France; Aix Marseille Univ, School of Midwifery, Faculty of Medical and Paramedical Sciences, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France.
| | - Lionel Thollon
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - François Marchal
- Aix Marseille Univ, CNRS, EFS, ADES, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - David Desseauve
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Gynecology and Obstetrics Unit, Hôpital de la Croix-Rousse 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
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Van Den Berghe T, Babin D, Chen M, Callens M, Brack D, Maes H, Lievens J, Lammens M, Van Sumere M, Morbée L, Hautekeete S, Schatteman S, Jacobs T, Thooft WJ, Herregods N, Huysse W, Jaremko JL, Lambert R, Maksymowych W, Laloo F, Baraliakos X, De Craemer AS, Carron P, Van den Bosch F, Elewaut D, Jans L. Neural network algorithm for detection of erosions and ankylosis on CT of the sacroiliac joints: multicentre development and validation of diagnostic accuracy. Eur Radiol 2023; 33:8310-8323. [PMID: 37219619 DOI: 10.1007/s00330-023-09704-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 03/25/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the feasibility and diagnostic accuracy of a deep learning network for detection of structural lesions of sacroiliitis on multicentre pelvic CT scans. METHODS Pelvic CT scans of 145 patients (81 female, 121 Ghent University/24 Alberta University, 18-87 years old, mean 40 ± 13 years, 2005-2021) with a clinical suspicion of sacroiliitis were retrospectively included. After manual sacroiliac joint (SIJ) segmentation and structural lesion annotation, a U-Net for SIJ segmentation and two separate convolutional neural networks (CNN) for erosion and ankylosis detection were trained. In-training validation and tenfold validation testing (U-Net-n = 10 × 58; CNN-n = 10 × 29) on a test dataset were performed to assess performance on a slice-by-slice and patient level (dice coefficient/accuracy/sensitivity/specificity/positive and negative predictive value/ROC AUC). Patient-level optimisation was applied to increase the performance regarding predefined statistical metrics. Gradient-weighted class activation mapping (Grad-CAM++) heatmap explainability analysis highlighted image parts with statistically important regions for algorithmic decisions. RESULTS Regarding SIJ segmentation, a dice coefficient of 0.75 was obtained in the test dataset. For slice-by-slice structural lesion detection, a sensitivity/specificity/ROC AUC of 95%/89%/0.92 and 93%/91%/0.91 were obtained in the test dataset for erosion and ankylosis detection, respectively. For patient-level lesion detection after pipeline optimisation for predefined statistical metrics, a sensitivity/specificity of 95%/85% and 82%/97% were obtained for erosion and ankylosis detection, respectively. Grad-CAM++ explainability analysis highlighted cortical edges as focus for pipeline decisions. CONCLUSIONS An optimised deep learning pipeline, including an explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical performance on a slice-by-slice and patient level. CLINICAL RELEVANCE STATEMENT An optimised deep learning pipeline, including a robust explainability analysis, detects structural lesions of sacroiliitis on pelvic CT scans with excellent statistical metrics on a slice-by-slice and patient level. KEY POINTS • Structural lesions of sacroiliitis can be detected automatically in pelvic CT scans. • Both automatic segmentation and disease detection yield excellent statistical outcome metrics. • The algorithm takes decisions based on cortical edges, rendering an explainable solution.
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Affiliation(s)
- Thomas Van Den Berghe
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Danilo Babin
- Department of Telecommunication and Information Processing - Image Processing and Interpretation (TELIN-IPI), Faculty of Engineering and Architecture, Ghent University - IMEC, Sint-Pietersnieuwstraat 41, 9000, Ghent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Martijn Callens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Denim Brack
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Helena Maes
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jan Lievens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Marie Lammens
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Maxime Van Sumere
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Simon Hautekeete
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Stijn Schatteman
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Tom Jacobs
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Willem-Jan Thooft
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Wouter Huysse
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Robert Lambert
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Walter Maksymowych
- Department of Radiology and Diagnostic Imaging and Rheumatology, University of Alberta, 8440 122 Street NW, Edmonton, Alberta, T6G 2B7, Canada
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstraße 45, 44649, Herne, Germany
| | - Ann-Sophie De Craemer
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Philippe Carron
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Vlaams Instituut voor Biotechnologie (VIB) Centre for Inflammation Research (IRC), Ghent University, Technologiepark 927, 9052, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Chatain GP, Oldham A, Uribe J, Duhon B, Gardner MJ, Witt JP, Yerby S, Kelly BP. Biomechanics of sacroiliac joint fixation using lag screws: a cadaveric study. J Orthop Surg Res 2023; 18:807. [PMID: 37898818 PMCID: PMC10613391 DOI: 10.1186/s13018-023-04311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Iliosacral screw placement is ubiquitous and now part of the surgeon's pelvic trauma armamentarium. More recent evidence supports sacroiliac arthrodesis for treating sacroiliac joint (SIJ) dysfunction in select patients. Regardless of the surgical indication, there are currently no studies examining lag screw compression biomechanics across the SIJ. The objective of this biomechanical investigation was to quantify iliosacral implant compressive loads and to examine the insertion torque and compressive load profile over time. METHODS Eight human cadaveric pelvic specimens underwent SIJ fixation at S1 and S2 using 11.5 and 10.0 mm iFuse-TORQ Lag implants, respectively, and standard 7.3 mm trauma lag screws. Load decay analysis was performed, and insertion and removal torques were measured. RESULTS For both implants at S1 and S2 levels, the load relaxed 50% in approximately 67 min. Compressive load decay was approximately 70% on average occurring approximately 15 h post-insertion. Average insertion torque for the 11.5 mm TORQ implant at S1 was significantly greater than the trauma lag screw. Similarly, at S2, insertion torque of the 10.0 mm TORQ implant was greater than the trauma lag screw. At S1, removal torque for the 11.5 mm TORQ implant was higher than the trauma lag screw; there was no significant difference in the removal torque at S2. CONCLUSIONS In this study, we found that a novel posterior pelvic implant with a larger diameter, roughened surface, and dual pitch threads achieved improved insertion and removal torques compared to a standard screw. Load relaxation characteristics were similar between all implants.
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Affiliation(s)
- Grégoire P Chatain
- Department of Neurosurgery, University of Colorado School of Medicine, 12605 E 16Th Ave, Aurora, CO, 80045, USA.
| | - Alton Oldham
- Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Juan Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Bradley Duhon
- Department of Neurosurgery, University of Colorado School of Medicine, 12605 E 16Th Ave, Aurora, CO, 80045, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
| | - Jens-Peter Witt
- Department of Neurosurgery, University of Colorado School of Medicine, 12605 E 16Th Ave, Aurora, CO, 80045, USA
| | | | - Brian P Kelly
- Spinal Biomechanics Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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He Z, Tung NTC, Yahara Y, Makino H, Yasuda T, Seki S, Suzuki K, Futakawa H, Kamei K, Kawaguchi Y. Association between serum interleukin-17 levels and ectopic bone formation in OPLL patients with DISH. Rheumatology (Oxford) 2023:kead555. [PMID: 37889295 DOI: 10.1093/rheumatology/kead555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE To investigate the relationship between the severity and morphology of heterotopic ossification in the spinal ligaments including sacroiliac (SI) joints, and serum interleukin-17 (IL-17) levels in patients with ossification of the posterior longitudinal ligament (OPLL) with or without diffuse idiopathic skeletal hyperostosis (DISH), as well as a non-OPLL group. METHODS A total of 103 patients with OPLL (DISH (-), n = 50; DISH (+), n = 53) and 53 age- and gender-matched controls were included. The serum levels of IL-17 were analyzed, and the severity of ectopic ossification and the morphology of ectopic bone formation were evaluated. The SI joint morphological variations were categorized into four types. RESULTS No significant differences were found in serum IL-17 levels between the OPLL and control groups. However, the DISH (+) group showed higher IL-17 levels than the DISH (-) group, especially in female patients (p = 0.003). Additionally, IL-17 levels were positively correlated with the number of Flat vertebral units, meaning one of the characteristics of DISH ossification type (R2 = 0.199, p = 0.012). IL-17 levels in type 4 were significantly higher in the DISH (+) group than in the DISH (-) group. CONCLUSIONS The morphological characteristics of paravertebral bone formation in the entire spine, including the SI joint, are likely associated with serum IL-17 levels in OPLL. These findings provide pathological and serological evidence of local inflammation contributing to paravertebral ossification of OPLL patients.
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Affiliation(s)
- Zhongyuan He
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, 930-0194, Japan
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Nguyen Tran Canh Tung
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, 930-0194, Japan
- Department of Trauma and Orthopaedic Surgery, Vietnam Military Medical University, Hanoi, 100000, Vietnam
| | - Yasuhito Yahara
- WPI-Immunology Frontier Research Center, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, 930-0194, Japan
| | - Taketoshi Yasuda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, 930-0194, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, 930-0194, Japan
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, 930-0194, Japan
| | - Hayato Futakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, 930-0194, Japan
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, 930-0194, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, 930-0194, Japan
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19
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Hermann KGA, Diekhoff T. [Computed tomography versus magnetic resonance imaging : Pros and cons in axial spondyloarthritis]. Z Rheumatol 2023; 82:638-645. [PMID: 37815608 DOI: 10.1007/s00393-023-01415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 10/11/2023]
Abstract
The diagnosis of axial spondyloarthritis depends on direct visualization of the sacroiliitis in addition to clinical assessment and determination of the histocompatibility antigen HLA-B27. While the value of conventional radiographic images has meanwhile been described in many studies as insufficient to diagnose the disease at an early stage, magnetic resonance imaging and also computed tomography now offer the possibility to visualize findings, such as bone marrow edema, erosion, fat metaplasia, backfill and ankylosis. Thus, it is necessary to decide which procedure should be used and when. Furthermore, both cross-sectional imaging techniques are currently undergoing major changes, and technical advancements are making great strides every year. This article provides an overview of which future technologies will be included in the rheumatological diagnostics of the sacroiliac joints. This overview also illustrates which standard methods are established in the diagnostics of axial spondyloarthritis and how they are used.
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Affiliation(s)
- Kay Geert A Hermann
- Klinik für Radiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Torsten Diekhoff
- Klinik für Radiologie, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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20
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Fan S, Chen S, Mai Q, Li T, Chen Y, Zhu Z, Wang H, Yang C, Liao J, Zhang R, Zhang Y. Treatment of Anterior Dislocation of the Sacroiliac Joint via the Lateral-rectus Approach: Surgical Techniques and Preliminary Outcomes. Orthop Surg 2023; 15:2300-2308. [PMID: 37430470 PMCID: PMC10475662 DOI: 10.1111/os.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/23/2023] [Accepted: 04/29/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE Anterior dislocation of the sacroiliac joint (ADSIJ) is caused by strong violence, and because of its low morbidity, there are no standardized diagnostic and therapeutical guidelines at this moment. This study aims to explore the surgical techniques and preliminary outcomes of the lateral-rectus approach (LRA) for treating ADSIJ. METHODS A retrospective study was conducted of 15 patients with ADSIJ from January 2016 to January 2021. The patients' age ranged from 1.8 years old to 57 years old (37 ± 18 years old). All patients underwent open reduction and internal fixation (ORIF) through the LRA. Eight patients were combined with lumbosacral plexus injury and underwent neurolysis during operation. Patients' fracture type, mechanism of injury, associated injuries, operation time and intraoperative bleeding volume were accessed by reviewing medical history. Quality of fracture reduction was evaluated with the Matta score. At 1-year follow-up, the functional rehabilitation was evaluated by the Majeed rehabilitation criteria. For those with lumbosacral plexus injury, the neuromotor function was evaluated using muscle strength grading proposed by the British Medical Research Council (BMRC) and recovery was recorded. RESULTS All 15 patients underwent the operation successfully. The surgical time ranged from 70 to 220 min (126 ± 42 min), and the intraoperative blood loss ranged from 180 to 2000 mL (816 ± 560 mL). Eighty percent of the cohort (12/15) were rated as excellent and good in the Matta score for fracture reduction quality after operation without surgical incision-related complications. At 1-year follow-up, the overall excellent and good rate was 73.3% (11/15) according to the Majeed criteria, the neuromotor function recovered completely in six cases and partially in two cases according to the BMRC muscle strength grading, and the recovery of sensory function was evaluated as excellent in six cases, good in one case and poor in one case, with an overall excellent and good rate of 87.5%. CONCLUSION The LRA can well expose the surrounding structures of the sacroiliac joint from the front, which helps surgeons reduce and fix the anterior dislocation of the sacroiliac joint under direct vision and effectively decompress the entrapment of the lumbosacral plexus to achieve better clinical efficacy.
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Affiliation(s)
- Shicai Fan
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThird Affiliated Hospital of Southern Medical UniversityGuangzhouChina
- Trauma Emergency CenterThird Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Sheqiang Chen
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThird Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Qiguang Mai
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThird Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Tao Li
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThird Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Yuhui Chen
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThird Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Zhenhua Zhu
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThird Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Hua Wang
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThird Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Cheng Yang
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThird Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Jianwen Liao
- Department of Traumatic Surgery, Center for Orthopaedic SurgeryThird Affiliated Hospital of Southern Medical UniversityGuangzhouChina
| | - Ruipeng Zhang
- Trauma Emergency CenterThird Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yingze Zhang
- Trauma Emergency CenterThird Hospital of Hebei Medical UniversityShijiazhuangChina
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21
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Fan W, Zhang C, Wang QD, Guo LX, Zhang M. The effects of topping-off instrumentation on biomechanics of sacroiliac joint after lumbosacral fusion. Comput Biol Med 2023; 164:107357. [PMID: 37586205 DOI: 10.1016/j.compbiomed.2023.107357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/02/2023] [Accepted: 08/12/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Lumbar/lumbosacral fusion supplemented with topping-off devices has been proposed with the aim of avoiding adjacent segment degeneration proximal to the fusion construct. However, it remains unclear how the biomechanics of the sacroiliac joint (SIJ) are altered after topping-off surgery. The objective of this study was to investigate the biomechanical effects of topping-off instrumentation on SIJ after lumbosacral fusion. METHODS The validated finite element model of an intact lumbar spine-pelvis segment was modified to simulate L5-S1 interbody fusion fixed with a pedicle screw system. An interspinous spacer, Device for Intervertebral Assisted Motion (DIAM), was used as a topping-off device and placed between interspinous processes of the L4 and L5 segments. Range of motion (ROM), von-Mises stress distribution, and ligament strain at SIJ were compared between fusion (without DIAM) and topping-off (fusion with DIAM) models under moments of four physiological motions. RESULTS ROM at the left and right SIJs in the topping-off model was higher by 26.9% and 27.5% in flexion, 16.8% and 16.1% in extension, 18.8% and 15.8% in lateral bending, and 3.7% and 7.4% in axial rotation, respectively, compared to those in the fusion model. The predicted stress and strain data showed that under all physiological loads, the topping-off model exhibited higher stress and ligament strain at the SIJs than the fusion model. CONCLUSIONS Motion, stress, and ligament strain at SIJ increase when supplementing lumbosacral fusion with topping-off devices, suggesting that topping-off surgery may be associated with higher risks of SIJ degeneration and pain than fusion alone.
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Affiliation(s)
- Wei Fan
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China.
| | - Chi Zhang
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Qing-Dong Wang
- Department of Mechanical Engineering, Tsinghua University, Beijing, China
| | - Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong, China
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22
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Abu-Leil S, Weisman A, Peled N, Kasem H, Dar G, Masharawi Y. Lumbosacral zone features in individuals with nonspecific chronic low back pain are unique compared to controls and correlate with pain and dysfunction. Eur Radiol 2023; 33:6392-6401. [PMID: 37060447 DOI: 10.1007/s00330-023-09626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES To compare the lumbosacral nerve distances (LNDs) and sacroiliac joint (SIJ) morphology in individuals with nonspecific chronic low back pain (NSCLBP) and control and examine their correlations with pain and dysfunction in the former. MATERIALS AND METHODS The sample includes 200 adult patients (ranging from 20 to 50 years old) referred for computerized abdominal tomography (CT): 100 individuals with NSCLBP (50 males and 50 females) and 100 individuals without NSCLBP (50 males and 50 females). CT scans were assessed for LNDs, degenerative sacroiliac changes, and joint bridging. Those factors were correlated to the outcomes of three self-reported questionnaires about pain and function (Oswestry, Fear-Avoidance, and Numerical Pain Rating Scale) in the NSCLBP group. RESULTS Individuals with NSCLBP tend to have reduced LNDs from the sacral part of the SIJ compared to controls (males: right Δ = 5.8 mm, left Δ = 6.03 mm; females: right Δ = 7.9 mm, left Δ = 7.73 mm, two-way ANOVA, p < 0.01), with moderate significant negative correlations with all three questionnaires (-0.38 < Pearson's r < - 0.57, p < 0.02, i.e., reduced LNDs with greater disability and pain). The NSCLBP group had more significant SIJ degeneration severity that moderately correlated with two questionnaires (0.39 < Pearson's r < 0.66, p < 0.04, i.e., greater SIJ degeneration with greater disability and pain). In males, the existence of SIJ bridging strongly correlated with all three questionnaires (0.38 < Pearson's r < 0.78, p < 0.03), and in females, only the Fear-Avoidance Questionnaire and Numerical Pain Scale (0.29 < Pearson's r < 0.41, p < 0.04). CONCLUSION Compared to controls, individuals with NSCLBP have reduced LNDs and worse SIJ degenerative changes that correlate with function and pain. KEY POINTS • Individuals with nonspecific low back pain tend to have reduced lumbosacral nerve distances than healthy controls. This may be due to entrapments or inflammation of the nerves or surrounding tissues. • Individuals with nonspecific low back pain tend to have more severe degeneration of their sacroiliac joint than healthy controls. • The above findings significantly correlated with the scores of three self-reported questionnaires about pain and function, implicating that they may be of clinical significance.
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Affiliation(s)
- Saher Abu-Leil
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Klatchkin 35, Tel-Aviv, Israel
- Department of Physical Therapy, Zefat Academic College, Zefat, Israel
| | - Asaf Weisman
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Klatchkin 35, Tel-Aviv, Israel
| | - Natan Peled
- Department of Radiology, Carmel Medical Center, Haifa, Israel
| | - Haytam Kasem
- Department of Mechanical Engineering, Azrieli College of Engineering, Jerusalem, Israel
| | - Gali Dar
- Department of Physical Therapy, The University of Haifa, Haifa, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Klatchkin 35, Tel-Aviv, Israel.
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Herregods N, Anisau A, Schiettecatte E, Vereecke E, Morbée L, Laloo F, Jaremko JL, Jans L. MRI in pediatric sacroiliitis, what radiologists should know. Pediatr Radiol 2023; 53:1576-1586. [PMID: 36856758 DOI: 10.1007/s00247-023-05602-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 03/02/2023]
Abstract
MRI is used for early detection of inflammation of sacroiliac joints as it shows active lesions of sacroiliitis long before radiographs show damage to the sacroiliac joints. Early diagnosis of arthritis allows early treatment of inflammation and can help delay disease progression and prevent irreversible damage. Also, early identification of axial involvement in juvenile spondyloarthropathy is crucial, as treatment options are different than for peripheral juvenile spondyloarthropathy. In general, standard sequences used in adults are also applied to children. However, interpreting MR images of pediatric sacroiliac joints is more challenging than in adults, because of normal physiological changes during skeletal maturation, which can simulate disease on MR images. Furthermore, classical definitions of sacroiliitis used in adults, for both active inflammatory and structural lesions, can be difficult to extrapolate to children. The development of reliable pediatric-specific definitions for sacroiliitis is still in active study. Understanding both normal and pathological signal changes in children is important to distinguish physiologic findings from disease and to make a correct diagnosis. In this review, the main imaging characteristics of sacroiliitis on MRI in children and its frequent pitfalls will be illustrated, while also citing some discussion points regarding the scan protocol.
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Affiliation(s)
- Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Aliaksandr Anisau
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Eva Schiettecatte
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Elke Vereecke
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, 8440-112 Street, EdmontonAlberta, T6G 2B7, Canada
- Medical Imaging Consultants, Edmonton, AB, Canada
| | - Lennart Jans
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
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Tanaka A, Shimizu T, Kawai T, Fujibayashi S, Murata K, Matsuda S, Otsuki B. Risk of further surgery after decompression in patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segments: focus on the number of residual lumbar/lumbosacral and sacroiliac mobile segments. Eur Spine J 2023; 32:2336-2343. [PMID: 37219710 DOI: 10.1007/s00586-023-07773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/19/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Patients with diffuse idiopathic skeletal hyperostosis (DISH) that extends to the lumbar segments (L-DISH) have a high risk of further surgery after lumbar decompression. However, few studies have focused on the ankylosis status of the residual caudal segments, including the sacroiliac joint (SIJ). We hypothesized that patients with more ankylosed segments beside the operated level, including the SIJ, would be at a higher risk of further surgery. METHODS A total of 79 patients with L-DISH who underwent decompression surgery for lumbar stenosis at a single academic institution between 2007 and 2021 were enrolled. The baseline demographics and radiological findings by CT imaging focusing on the ankylosing condition of the residual lumbar segments and SIJ were collected. Cox proportional hazard analysis was conducted to investigate the risk factors for further surgery after lumbar decompression. RESULTS The rate of further surgery was 37.9% during an average of 48.8 months of follow-up. Cox proportional hazard analysis demonstrated that the presence of fewer than three segments of non-operated mobile caudal segments was an independent predictor for further surgery (including both the same and adjacent levels) after lumbar decompression (adjusted hazard ratio 2.53, 95%CI [1.12-5.70]). CONCLUSIONS L-DISH patients with fewer than three mobile caudal segments besides index decompression levels are at a high risk of further surgery. Ankylosis status of the residual lumbar segments and SIJ should be thoroughly evaluated using CT during preoperative planning.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
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25
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Chan OM, Lai BMH, Leung ASY, Leung TF, Ho ACH. High prevalence of sacroiliitis and early structural changes in the sacroiliac joint in children with enthesitis-related arthritis: findings from a tertiary centre in Hong Kong. Pediatr Rheumatol Online J 2023; 21:45. [PMID: 37138335 PMCID: PMC10158136 DOI: 10.1186/s12969-023-00825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/30/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Epidemiological studies have demonstrated a wide, unexplained disparity in the prevalence of juvenile idiopathic arthritis (JIA) subtypes depending on geographical location, ethnicity and other factors. Enthesitis-related arthritis (ERA) is more prevalent in Southeast Asia. Axial involvement in ERA patients is increasingly recognised to occur early in the disease course. Inflammation in the sacroiliac joint (SIJ) observed on MRI seems highly predictive of subsequent structural radiographic progression. The resulting structural damage can have significant impacts on both functional status and spinal mobility. This study aimed to evaluate the clinical characteristics of ERA in a tertiary centre in Hong Kong. The primary objective of the study was to provide a comprehensive description of the clinical course and radiological findings of the SIJ among ERA patients. METHOD Paediatric patients diagnosed with JIA attending the paediatric rheumatology clinic from January 1990 to December 2020 were recruited from our registry based at the Prince of Wales Hospital. RESULTS In our cohort, 101 children were included. The median age of diagnosis was 11 years, interquartile range (IQR) 8-15 years. The median follow-up duration was 7 years (IQR 2-11.5 years). ERA was the most prevalent subtype (40%), followed by oligoarticular JIA (17%). Axial involvement was frequently reported in our cohort of ERA patients. 78% demonstrated radiological evidence of sacroiliitis. Among those, 81% had bilateral involvement. The median duration from disease onset to confirmation of radiological sacroiliitis was 17 months (IQR 4-62 months). Among the ERA patients, 73% had structural changes of the SIJ. Alarmingly, 70% of these patients had already developed radiological structural changes when sacroiliitis was first detected on imaging (IQR 0-12 months). Erosion was the most common finding (73%), followed by sclerosis (63%), joint space narrowing (23%), ankylosis (7%) and fatty change (3%). The duration from symptom onset to diagnosis was significantly longer in ERA patients with SIJ structural changes (9 vs 2 months, p = 0.009), comparing with those without. CONCLUSION We found that a high proportion of ERA patients had sacroiliitis and a significant number of them had radiological structural changes during early disease. Our findings illustrate the importance of prompt diagnosis and early treatment in these children.
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Affiliation(s)
- Oi Man Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Billy Ming-Hei Lai
- Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR
| | - Agnes Sze-Yin Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ting Fan Leung
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Assunta Chi-Hang Ho
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong, Hong Kong SAR.
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Maalouly J, Rao PJ. Cooled radiofrequency ablation of the sacroiliac joint a retrospective case series. BMC Musculoskelet Disord 2023; 24:261. [PMID: 37016334 PMCID: PMC10071620 DOI: 10.1186/s12891-023-06344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Sacroiliac (SI) joint dysfunction is a common source of back pain. Recent evidence from different parts of the world suggest that cooled radiofrequency ablation of sacral nerves supplying the SI joints has superior pain alleviating properties than currently available treatment options for SI joint dysfunction. PATIENTS AND METHODS After obtaining institutional review board approval, the medical records of 81 patients who underwent cooled radiofrequency ablation in a single institution and by a single surgeon were analyzed retrospectively. The recurrence of pain, progression to fusion and functional outcomes were noted. The patients were operated on between June 2020 and December 2021, they include 59 females and 22 males, the average age was 55.4 ± 17.3. Follow up was at least 6 months postoperative. RESULTS 22 of the patients had previously underwent lumbar fusions. Follow up period ranged from 6 to 18 months. After radiofrequency ablation, 7 patients progressed to fusions, and 6 patients had to have the procedure done again to relieve their pain. Student t-test was used to compare between preoperative and postoperative values of NPRS (numerical pain rating score) and ODI (Oswestry disability index). It showed significance with P-value < 0.001 in both. CONCLUSIONS Sacroiliac joint radiofrequency ablation is a good option in the treatment of SI joint pain showing good results in the short term follow up period. It is a simple procedure that can be done in less than 30 min and is capable of providing significant pain relief for patients with sacroiliac joint dysfunction.
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Affiliation(s)
- Joseph Maalouly
- Brain and spine surgery, Norwest Private Hospital, Suite G16/9 Norbrik Dr, Bella Vista, NSW, 2153, Australia.
| | - Prashanth J Rao
- Brain and spine surgery, Norwest Private Hospital, Suite G16/9 Norbrik Dr, Bella Vista, NSW, 2153, Australia
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Bordner A, Aouad T, Medina CL, Yang S, Molto A, Talbot H, Dougados M, Feydy A. A deep learning model for the diagnosis of sacroiliitis according to Assessment of SpondyloArthritis International Society classification criteria with magnetic resonance imaging. Diagn Interv Imaging 2023:S2211-5684(23)00056-6. [PMID: 37012131 DOI: 10.1016/j.diii.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE The purpose of this study was to develop and evaluate a deep learning model to detect bone marrow edema (BME) in sacroiliac joints and predict the MRI Assessment of SpondyloArthritis International Society (ASAS) definition of active sacroiliitis in patients with chronic inflammatory back pain. MATERIALS AND METHODS MRI examinations of patients from the French prospective multicenter DESIR cohort (DEvenir des Spondyloarthropathies Indifférenciées Récentes) were used for training, validation and testing. Patients with inflammatory back pain lasting three months to three years were recruited. Test datasets were from MRI follow-ups at five years and ten years. The model was evaluated using an external test dataset from the ASAS cohort. A neuronal network classifier (mask-RCNN) was trained and evaluated for sacroiliac joints detection and BME classification. Diagnostic capabilities of the model to predict ASAS MRI active sacroiliitis (BME in at least two half-slices) were assessed using Matthews correlation coefficient (MCC), sensitivity, specificity, accuracy and AUC. The gold standard was experts' majority decision. RESULTS A total of 256 patients with 362 MRI examinations from the DESIR cohort were included, with 27% meeting the ASAS definition for experts. A total of 178 MRI examinations were used for the training set, 25 for the validation set and 159 for the evaluation set. MCCs for DESIR baseline, 5-years, and 10-years follow-up were 0.90 (n = 53), 0.64 (n = 70), and 0.61 (n = 36), respectively. AUCs for predicting ASAS MRI were 0.98 (95% CI: 0.93-1), 0.90 (95% CI: 0.79-1), and 0.80 (95% CI: 0.62-1), respectively. The ASAS external validation cohort included 47 patients (mean age 36 ± 10 [SD] years; women, 51%) with 19% meeting the ASAS definition. MCC was 0.62, sensitivity 56% (95% CI: 42-70), specificity 100% (95% CI: 100-100) and AUC 0.76 (95% CI: 0.57-0.95). CONCLUSION The deep learning model achieves performance close to those of experts for BME detection in sacroiliac joints and determination of active sacroiliitis according to the ASAS definition.
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Affiliation(s)
- Adrien Bordner
- Sorbonne Médecine Université, 75013 Paris, France; Department of Radiology, Hôpital Cochin, APHP, 75014 Paris, France.
| | - Théodore Aouad
- CentraleSupélec, Université Paris-Saclay, Inria, 91190 Gif-sur-Yvette, France
| | - Clementina Lopez Medina
- Department of Rheumatology, Reina Sofia University Hospital, IMIBIC, University of Cordoba, 14004 Cordoba, Spain
| | - Sisi Yang
- Department of Radiology, Hôpital Cochin, APHP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Anna Molto
- Department of Rheumatology, Hôpital Cochin, APHP, 75014 Paris, France; INSERM U1153, Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, 75004 Paris, France
| | - Hugues Talbot
- CentraleSupélec, Université Paris-Saclay, Inria, 91190 Gif-sur-Yvette, France
| | - Maxime Dougados
- Université Paris Cité, 75006 Paris, France; Department of Rheumatology, Hôpital Cochin, APHP, 75014 Paris, France; INSERM U1153, Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, 75004 Paris, France
| | - Antoine Feydy
- Department of Radiology, Hôpital Cochin, APHP, 75014 Paris, France; Université Paris Cité, 75006 Paris, France; INSERM U1153, Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, 75004 Paris, France
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Zhao Z, Zheng G, Chu X, Wang S. Application of the pedicle axis view in percutaneous screw placement for type III fracture dislocation of the sacroiliac joint. BMC Musculoskelet Disord 2023; 24:248. [PMID: 37004039 PMCID: PMC10064750 DOI: 10.1186/s12891-023-06333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
AIM To investigate the clinical application of axial view projection of the pedicle in percutaneous screw placement for type III fracture dislocation of the sacroiliac joint. METHODS Percutaneous sacroiliac screw fixation was performed in 29 patients with type III sacroiliac joint fractures under X-ray fluoroscopy (C-arm) using axial view projection of the pedicle after preoperative traction reduction and preoperative preparation. The study included 19 males and 10 females, aged 20 to 75 years old, with a mean age of 42.1 ± 3.4 years. RESULTS The total operative time ranged between 44 and 135 min, with a mean of 95.5 ± 9.4 min. The intraoperative fluoroscopy time ranged between 15 and 42 s, with a mean of 25 ± 4.7 s. The intraoperative blood loss ranged between 5 and 10 ml, with a mean of 7.1 ± 1.3 ml. According to the Matta scoring system, excellent outcomes were achieved in 25 cases, whereas good outcomes were achieved in 4 cases. Based on the definition by Neo et al., pedicle screw positions were categorized into four grades: grade 0 (33 screws), grade I (2 screws), grade II (2 screws), and grade III (0 screws). Excellent outcomes were achieved in 94.6% of Grade 0 and I screws. According to Majeed's functional score, 21 cases achieved excellent outcomes, whereas 8 cases achieved good outcomes. The 29 patients were followed between 3 and 18 months, with a mean of 7.1 ± 1.2 months. All patients achieved anatomical reduction with accurate screw placement and successful healing of their fractures, with no cases of bone penetration or neurovascular injury. CONCLUSION Axial view imaging of the pedicle using fluoroscopy is a convenient and rapid fluoroscopy method for percutaneous screw placement for type III fracture dislocation of the sacroiliac joint, with a high rate of success, good safety, and short fluoroscopy time.
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Affiliation(s)
- Zhongzhen Zhao
- Hangzhou Normal University, Hangzhou, Zhejiang, China
- The First People's Hospital of Linping District, Hangzhou, Zhejiang, China
| | - Guofu Zheng
- The First People's Hospital of Linping District, Hangzhou, Zhejiang, China.
| | - Xiaodong Chu
- The First People's Hospital of Linping District, Hangzhou, Zhejiang, China
| | - Shuofan Wang
- The First People's Hospital of Linping District, Hangzhou, Zhejiang, China
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Martín-Noguerol T, Casado-Verdugo OL, Beltrán LS, Aguilar G, Luna A. Role of advanced MRI techniques for sacroiliitis assessment and quantification. Eur J Radiol 2023; 163:110793. [PMID: 37018900 DOI: 10.1016/j.ejrad.2023.110793] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/07/2023]
Abstract
The introduction of MRI was supposed to be a qualitative leap for the evaluation of Sacroiliac Joint (SIJ) in patients with Axial Spondyloarthropathies (AS). In fact, MRI findings such as bone marrow edema around the SIJ has been incorporated into the Assessment in SpondyloArthritis International Society (ASAS criteria). However, in the era of functional imaging, a qualitative approach to SIJ by means of conventional MRI seems insufficient. Advanced MRI sequences, which have successfully been applied in other anatomical areas, are demonstrating their potential utility for a more precise assessment of SIJ. Dixon sequences, T2-mapping, Diffusion Weighted Imaging or DCE-MRI can be properly acquired in the SIJ with promising and robust results. The main advantage of these sequences resides in their capability to provide quantifiable parameters that can be used for diagnosis of AS, surveillance or treatment follow-up. Further studies are needed to determine if these parameters can also be integrated into ASAS criteria for reaching a more precise classification of AS based not only on visual assessment of SIJ but also on measurable data.
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Affiliation(s)
| | - Oscar L Casado-Verdugo
- Osatek Alta Tecnología Sanitaria S.A., Department of Magnetic Resonance Imaging, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Luis S Beltrán
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Antonio Luna
- MRI Unit, Radiology Department, HT Medica, Jaén, Spain
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Cardwell MC, Martin JM, Meinerz C, Beck CJ, Wang M, Schmeling GJ. A cadaveric biomechanical evaluation of anterior posterior compression II injuries. Injury 2023; 54:834-840. [PMID: 36623999 DOI: 10.1016/j.injury.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Pelvic fractures are associated with high morbidity and often require surgical intervention. An Anterior Posterior Compression (APC) II injury consists of disruption at the pubic symphysis and anterior sacroiliac joint. Studies investigating specific ligamentous contributions would aid in development of novel fixation techniques. The objective of this study is to determine the level of pelvic destabilization from progressive soft tissue disruptions associated with APC II injuries. METHODS Six fresh-frozen cadaveric pelvises were dissected of soft tissues, preserving joint capsules and ligaments. Each pelvis was secured in a double-leg stance and joint motion was tracked with the specimens cyclically loaded to 60% body weight. Each specimen was measured in the intact state and again following stepwise destabilization to an APC II injury model (PS: sectioned pubic symphysis, IPS JOINT: PS + ipsilateral anterior sacroiliac, sacrotuberous, sacrospinous ligaments sectioned, IPS LIGS: IPS JOINT + ipsilateral interosseous ligaments sectioned, IPS JOINT+CONT ASI: IPS LIGS + contralateral anterior sacroiliac ligament disruption). RESULTS Compared to the intact state, there was a statistically significant increase in movement in the IPS JOINT (ipsilateral 177%, p<0.001; contralateral 46%, p<0.005) and IPS JOINT+CONT ASI (ipsilateral 184%, p<0.002; and contralateral 62%, p<0.002) states bilaterally. No significant change was demonstrated in the PS or IPS LIGS state. CONCLUSION Disruption of ipsilateral ligamentous structures destabilized both sacroiliac joints. The interosseous and posterior sacroiliac ligaments provide the majority of stability of the sacroiliac joint and will likely benefit most from surgical stabilization. LEVEL OF EVIDENCE mechanism-based reasoning.
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Affiliation(s)
- Maxwell C Cardwell
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States.
| | - Jill M Martin
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States
| | - Carolyn Meinerz
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States
| | - Chad J Beck
- Floyd Medical Center Orthoapedic Trauma Surgery, United States
| | - Mei Wang
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States
| | - Gregory J Schmeling
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States
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Kim JH, Jin ZW, Hayashi S, Murakami G, Abe H, Rodríguez-Vázquez JF. Development and growth of the human fetal sacroiliac joint revisited: a comparison with the temporomandibular joint. Anat Cell Biol 2023:acb.22.189. [PMID: 36788115 DOI: 10.5115/acb.22.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 02/16/2023] Open
Abstract
The human fetal sacroiliac joint (SIJ) is characterized by unequal development of the paired bones and delayed cavitation. Thus, during the long in utero period, the bony ilium becomes adjacent to the cartilaginous sacrum. This mor-phology may be analogous to that of the temporomandibular joint (TMJ). We examined horizontal histological sections of 24 fetuses at 10-30 weeks and compared the timing and sequences of joint cartilage development, cavitation, and ossification of the ilium. We also examined histological sections of the TMJ and humeroradial joint, because these also contain a disk or disk-like structure. In the ilium, endochondral ossification started in the anterior side of the SIJ, extended posteriorly and reached the joint at 12 weeks GA, and then extended over the joint at 15 weeks GA. Likewise, the joint cartilage appeared at the anterior end of the future SIJ at 12 weeks GA, and extended along the bony ilium posteriorly to cover the entire SIJ at 26 weeks GA. The cavitation started at 15 weeks GA. Therefore, joint cartilage development seemed to follow the ossification of the ilium by extending along the SIJ, and cavitation then occurred. This sequence "ossification, followed by joint cartilage formation, and then cavitation" did not occur in the TMJ or humeroradial joint. The TMJ had a periosteum-like membrane that covered the joint surface, but the humeroradial joint did not. After muscle contraction starts, it is likely that the mechanical stress from the bony ilium induces development of joint cartilage.
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Affiliation(s)
- Ji Hyun Kim
- Department of Anatomy, Jeonbuk National University Medical School, Jeonju, Korea
| | - Zhe-Wu Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Shogo Hayashi
- Department of Anatomy, Tokai University School of Medicine, Isehara, Japan
| | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
| | - Hiroshi Abe
- Emeritus professor of Akita University School of Medicine, Akita, Japan
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Vereecke E, Morbée L, Laloo F, Chen M, Jaremko JL, Herregods N, Jans L. Anatomical variation of the sacroiliac joints: an MRI study with synthetic CT images. Insights Imaging 2023; 14:30. [PMID: 36750489 PMCID: PMC9905396 DOI: 10.1186/s13244-023-01373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Synthetic computed tomography (sCT) images are magnetic resonance imaging (MRI)-based images, generated using artificial intelligence. This study aimed to determine the prevalence of anatomical variants of sacroiliac joints (SIJ) on sCT images and the correlation with age, sex and body weight. METHODS MRI of the SIJ including sCT images of 215 patients clinically suspected for sacroiliitis were retrospectively analyzed. The presence of anatomical variants of the SIJ was assessed. Age, sex and body mass index at the time of the MRI were recorded. RESULTS SIJ variants were found in 82.8% (356/430) of the evaluated joints. The most frequent variants were iliosacral complex (27.7%), bipartite iliac bony plate (27.2%) and crescent iliac bony plate (27%). One new variant was identified, consisting of an accessory facet of the SIJ on the superior side. Overall, SIJ variants were slightly more frequent in women (85.8% vs. 77.8%), but iliosacral complex was significantly more frequent in men. Isolated synostosis was more prevalent with advancing age, in contrast to semicircular defect and unfused ossification center. The occurrence of iliosacral complex was associated with higher BMI, while crescent iliac bony plate occurred more in patients with lower BMI. CONCLUSION Over 80% of patients in this study, who were all suspected of sacroiliitis, had at least one SIJ variant. These variants may actually represent subtypes of the normal SIJ. sCT enables detection of very small or subtle findings including SIJ variants.
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Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Lieve Morbée
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Frederiek Laloo
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Min Chen
- grid.440601.70000 0004 1798 0578Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036 China
| | - Jacob L. Jaremko
- grid.241114.30000 0004 0459 7625Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB T6G 2B7 Canada
| | - Nele Herregods
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Lennart Jans
- grid.410566.00000 0004 0626 3303Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Cho W, Wang W, Lim HJ, Bucklen BS. An In Vitro Biomechanical Analysis of Contralateral Sacroiliac Joint Motion Following Unilateral Sacroiliac Stabilization with and without Lumbosacral Fixation. Asian Spine J 2023; 17:185-193. [PMID: 36849242 PMCID: PMC9977980 DOI: 10.31616/asj.2021.0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/02/2022] [Indexed: 03/01/2023] Open
Abstract
STUDY DESIGN Cadaveric biomechanics study. PURPOSE This study investigated the effects of unilateral sacroiliac joint (SIJ) fixation for fusion with/without L5-S1 fixation on contralateral SIJ range of motion (ROM). OVERVIEW OF LITERATURE SIJ fusion raises concerns that unilateral SIJ stabilization for fusion may increase contralateral SIJ mobility, leading to accelerated SIJ degeneration. Also, prior lumbosacral fixation may lead to accelerated SIJ degeneration, due to adjacent level effects. SIJ fixation biomechanics have been evaluated, showing a reduced-ROM, but SIJ fixation effects on contralateral nonfixated SIJ remain unknown. METHODS Seven human lumbopelvic spines were used, each affixed to six-degrees-of-freedom testing apparatus; 8.5-Nm pure unconstrained bending moments applied in flexion-extension, lateral bending, and axial rotation. The ROM of left and right SIJ was measured using a motion analysis system. Each specimen tested as (1) intact, (2) injury (left), (3) L5-S1 fixation, (4) unilateral stabilization (left), (5) unilateral stabilization+L5-S1 fixation, (6) bilateral stabilization, and (7) bilateral stabilization+L5-S1 fixation. Both left-sided iliosacral and posterior ligaments were cut for injury condition to model SIJ instability before surgery. RESULTS There were no statistical differences between fixated and contralateral nonfixated SIJ ROM following unilateral stabilization with/without L5-S1 fixation for all loading directions (p>0.930). Injured condition and L5-S1 fixation provided the largest motion increases across both joints; no significant differences were recorded between SIJs in any loading direction (p>0.850). Unilateral and bilateral stabilization with/without L5-S1 fixation reduced ROM compared with the injured condition for both SIJs, with bilateral stabilization providing maximum stability. CONCLUSIONS In the cadaveric model, unilateral SIJ stabilization with/without lumbosacral fixation did not lead to significant contralateral SIJ hypermobility; long-term changes and in vivo response may differ.
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Affiliation(s)
- Woojin Cho
- Albert Einstein College of Medicine, New York, NY, USA,Department of Orthopaedic Surgery, Montefiore Medical Center, New York, NY, USA
| | - Wenhai Wang
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical Inc., Audubon, PA, USA,Corresponding author: Wenhai Wang Globus Medical Inc., 2560 General Armistead Avenue, Audubon, PA 19403, USA Tel: +1-610-930-1800 (ext. 1660), Fax: +1-610-930-2042, E-mail:
| | - Hyun Jin Lim
- Hanyang University College of Medicine, Seoul, Korea
| | - Brandon S. Bucklen
- Musculoskeletal Education and Research Center (MERC), A Division of Globus Medical Inc., Audubon, PA, USA
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Xu Z, Huang Z, Zhang Z, Feng Z, Yan Y, Zhu Q, Li Y. Effects of manipulations of oblique pulling on the biomechanics of the sacroiliac joint: a cadaveric study. BMC Musculoskelet Disord 2023; 24:55. [PMID: 36683034 PMCID: PMC9869564 DOI: 10.1186/s12891-023-06175-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There are many reports on the treatment of sacroiliac joint dysfunction by manipulation of oblique pulling (MOP). However, the specific mechanism of MOP on the sacroiliac joint remains unclear. This study aimed to investigate the effect of MOP on the biomechanics of the sacroiliac joint and the effect of the anterior sacroiliac ligament on the stability of the sacroiliac joint. METHODS First, MOP-F1 (F: force) and MOP-F2 were applied to nine cadaveric pelvises. Then, segmental resection of the anterior sacroiliac ligament was performed. The range of motion of the sacroiliac joint was observed in all procedures. RESULTS Under MOP-F1 and F2, the average total angles were 0.84° ± 0.59° and 1.52° ± 0.83°, and the displacements were 0.61 ± 0.21 mm and 0.98 ± 0.39 mm, respectively. Compared with MOP-F1, MOP-F2 caused greater rotation angles and displacements of the sacroiliac joint (p = 0.00 and p = 0.01, respectively). In addition, the rotation angles and displacements of the sacroiliac joint significantly increased after complete resection of the anterior sacroiliac ligament (p = 0.01 and p = 0.02, respectively). The increase was mainly due to the transection of the upper part of the anterior sacroiliac ligament. CONCLUSIONS MOP-F2 caused greater rotation angles and displacements of the sacroiliac joint and was a more effective manipulation. The anterior sacroiliac ligament played an important role in maintaining the stability of the sacroiliac joint; the upper part of the anterior sacroiliac ligament contributed more to the stability of the joint than the lower part.
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Affiliation(s)
- Zhun Xu
- grid.412017.10000 0001 0266 8918Department of Spine Surgery, The First Affiliated Hospital,Hengyang Medical School, University of South China, Hengyang, Hunan Province China ,grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangdong Province, Guangzhou, China
| | - Zhiping Huang
- grid.284723.80000 0000 8877 7471Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangdong Province, Guangzhou, China
| | - Zhaocong Zhang
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangdong Province, Guangzhou, China
| | - Ziyu Feng
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangdong Province, Guangzhou, China
| | - Yiguo Yan
- grid.412017.10000 0001 0266 8918Department of Spine Surgery, The First Affiliated Hospital,Hengyang Medical School, University of South China, Hengyang, Hunan Province China
| | - Qingan Zhu
- grid.284723.80000 0000 8877 7471Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangdong Province, Guangzhou, China
| | - Yikai Li
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangdong Province, Guangzhou, China
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Trentadue TP, Anderson TL, Wenger DE, McKenzie GA. Prevalence of accessory sacroiliac joint anatomy and associated clinical features. Skeletal Radiol 2023; 52:1359-1368. [PMID: 36642769 DOI: 10.1007/s00256-023-04281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The accessory sacroiliac joint (ASIJ) is the most common sacroiliac joint anatomical variant; however, its literature-reported prevalence is inconsistent. Previous CT-based studies of the ASIJ have used thick axial slices, which may not adequately detail ASIJ anatomy. The aims of this study are to (1) evaluate ASIJ prevalence and radiographic features in a large age- and sex-balanced cohort using thin-section CT and (2) determine associations between ASIJ anatomy, patient features, and treatment strategies. MATERIALS AND METHODS Thin-section CTs (0.75 to 2.00 mm) of the pelvis from 800 patients were reviewed by two musculoskeletal radiologists. Degree of degenerative change and ankylosis at ASIJs were detailed. The EMR was used to capture demographics, lower back or sacroiliac joint symptoms, and treatments. RESULTS The ASIJ was present in 25.8% of patients and bilateral in 53.3% of those with any ASIJ. ASIJs were more common at the S2 than S1 neural foramen level (75.7% and 27.2%). There was a statistically significant difference between age and presence of any ASIJ anatomy (mean (SD) 69.0 (19.8) with ASIJ versus 55.9 (22.1) years without ASIJ). Degenerative changes and ankylosis were found in 93.5% and 20.3% of ASIJs, respectively. There was a higher odds ratio of having received a sacroiliac joint corticosteroid injection in those with ASIJ anatomy. CONCLUSION Radiologists should be familiar with the ASIJ and consider its age-related association, propensity to show ASIJ degenerative change, and ability to serve as a potential pain generator. Steroid injections may be considered for diagnostic and therapeutic purposes.
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Affiliation(s)
- Taylor P Trentadue
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN, USA
| | | | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Kurosawa D, Murakami E, Aizawa T, Watanabe T. Clinical Features Requiring Sacroiliac Joint Arthrodesis in Patients with Sacroiliac Joint Pain. J Med Invest 2023; 70:123-128. [PMID: 37164707 DOI: 10.2152/jmi.70.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE This study aimed to reveal the clinical features requiring sacroiliac joint (SIJ) arthrodesis, which was performed for patients who complain of severe SIJ pain. METHODS The differences in clinical features between a surgical treatment group (n=20) and a conservative treatment group (n=66) were investigated. All patients were definitively diagnosed with SIJ pain by the use of SIJ injections. RESULTS Six significant features were identified in the surgical treatment group, namely, sitting tolerance (<15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and any accident that induced SIJ pain (P<0.01). Univariate logistic regression analysis revealed that sitting tolerance <15 minutes (odds ratio : 31.73), pain in the supine position (13.07), and pain while lying on the painful side (18.30) showed a high odds ratio. CONCLUSIONS Sitting tolerance (<15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and a history of any accident that induced SIJ pain may be considered as indicators for surgery after >?6 months of continued substantial conservative treatment. J. Med. Invest. 70 : 123-128, February, 2023.
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Affiliation(s)
- Daisuke Kurosawa
- Department of Orthopaedic Surgery / Japan Sacroiliac Joint and Low Back pain Center, JCHO Sendai Hospital, Sendai, Japan
| | - Eiichi Murakami
- Department of Orthopaedic Surgery / Japan Sacroiliac Joint and Low Back pain Center, JCHO Sendai Hospital, Sendai, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Takashi Watanabe
- Department of Hospital Medicine, JCHO Sendai Hospital, Sendai, Japan
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Li Y, Xiong Y, Hou B, Liu C, Wang J, Morelli JN, Hu S, Zhang Y, Sun D, Li X. Detection of erosions and fat metaplasia of the sacroiliac joints in patients with suspected sacroiliitis using a chemical shift-encoded sequence (IDEAL-IQ). Eur J Radiol 2023; 158:110641. [PMID: 36495683 DOI: 10.1016/j.ejrad.2022.110641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/08/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the performance of a chemical shift-encoded sequence called IDEAL-IQ for detecting sacroiliac joint (SIJ) erosions and fat metaplasia compared to T1-weighted fast spin echo (T1 FSE) using qualitative and quantitative analysis. METHOD Thirty-four patients with suspicion of sacroiliitis who underwent both MRI and CT were included. Each SIJ was divided into four quadrants for analysis. For qualitative analysis, the diagnostic performance of IDEAL-IQ and T1 FSE for erosions were compared by the McNemar test, using CT as the gold standard. Cochran's Q and McNemar tests were used to determine differences in structural changes detected by different imaging methods. For quantitative analysis, two-sample t test and receiver operating characteristic (ROC) analysis were used for the analysis of histogram parameters of proton density fat fraction (PDFF). RESULTS Diagnostic sensitivity and accuracy of IDEAL-IQ were greater than T1 FSE for erosions (all P < 0.05). IDEAL-IQ and CT detected more erosions than T1 FSE (all P < 0.05). IDEAL-IQ did not statistically significantly differ from T1 FSE for the detection of fat metaplasia (P = 0.678). All histogram parameters were different between groups with and without fat metaplasia (all P < 0.05) and could distinguish the two groups (all P < 0.05). PDFF75th was the most effective histogram parameter. CONCLUSION IDEAL-IQ detects SIJ erosions with better accuracy than T1 FSE and is similar to T1 FSE for detection of fat metaplasia, enabling further quantitative analysis of the latter via histogram analysis.
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Hangai M, Kaneoka K, Dohi M, Niitsu M, Onishi T, Nakajima K, Okuwaki T. Magnetic resonance imaging findings related to sacroiliac joint pain in high-performance athletes. J Back Musculoskelet Rehabil 2023; 36:1325-1333. [PMID: 37458015 DOI: 10.3233/bmr-220323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sacroiliac joint (SIJ) dysfunction in athletes affects competitiveness. However, the pathology and imaging features have not been clarified. OBJECTIVE To clarify the association between SIJ pain and MRI findings in high-performance athletes. METHODS Fifty-two Japanese high-performance athletes with or without SIJ pain were recruited. MRI short tau inversion recovery (STIR) semi-coronal and semi-axial images of their SIJs were taken. The relationships between high-signal changes in MRI-STIR and SIJ pain and pain duration were investigated. Six athletes with continuous SIJ pain were prospectively followed. RESULTS The proportion of athletes with high-signal changes in the SIJ was significantly higher among athletes with SIJ pain for one month or more (76.9%, 10/13) than among athletes with SIJ pain for less than one month (18.2%, 2/11) and among athletes without SIJ pain (28.6%, 8/28). High-signal changes on painful SIJs were most often present in the sacrum. In three of the six athletes who were prospectively followed, the high-signal area and intensity on MRI both diminished as their symptoms improved. CONCLUSIONS High-signal changes of the SIJ on MRI-STIR images in high-performance athletes may reflect their SIJ pain.
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Affiliation(s)
- Mika Hangai
- Department of Sport Medicine and Research, Japan Institute of Sports Sciences, Kita City, Tokyo, Japan
| | - Koji Kaneoka
- Faculty of Sport Sciences, Waseda University, Shinjuku City, Tokyo, Japan
| | - Michiko Dohi
- Department of Sport Medicine and Research, Japan Institute of Sports Sciences, Kita City, Tokyo, Japan
| | - Mamoru Niitsu
- Department of Radiology, Saitama Medical University, Iruma District, Saitama, Japan
| | - Takahiro Onishi
- Department of Sport Medicine and Research, Japan Institute of Sports Sciences, Kita City, Tokyo, Japan
| | - Kohei Nakajima
- Department of Sport Medicine and Research, Japan Institute of Sports Sciences, Kita City, Tokyo, Japan
| | - Toru Okuwaki
- Department of Sport Medicine and Research, Japan Institute of Sports Sciences, Kita City, Tokyo, Japan
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Morbée L, Vereecke E, Laloo F, Chen M, Herregods N, Jans LBO. Common incidental findings on sacroiliac joint MRI: Added value of MRI-based synthetic CT. Eur J Radiol 2023; 158:110651. [PMID: 36535080 DOI: 10.1016/j.ejrad.2022.110651] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/01/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the prevalence of incidental findings on sacroiliac joint MRI and to determine the added value of MRI-based synthetic CT in the detection and evaluation of these incidental findings. METHOD In this retrospective study 210 patients clinically suspected of spondyloarthritis who underwent MRI of the sacroiliac joint with synthetic CT sequence were included. The images were reviewed by two radiologists in consensus for the prevalence of sacroiliitis, incidental findings, and the ability of synthetic CT and the conventional MRI to detect and diagnose these findings. RESULTS In 44.7% of patients sacroiliitis was present. In 89.0% of patients MRI showed at least one incidental finding other than sacroiliitis. Degeneration of the sacroiliac joint was the most prevalent finding (140 patients, 66.6%). The most frequent incidental findings outside the sacroiliac joint were facet joint degeneration (29.0%), disc degeneration (25.2%), enostosis (19.5%) and lumbosacral transitional vertebrae (14.3%). A total of 788 lesions was recorded and synthetic CT was found to be problem solving or necessary for diagnosis in 543 (68.9%) of these lesions. 42.1% of lesions were not visible on conventional MRI (T1 TSE and STIR), most often degenerative osteophytes in the sacroiliac joint or lower lumbar spine. CONCLUSION Incidental findings are seen more frequently on sacroiliac joint MRI than sacroiliitis, which is relevant as some will have clinical significance or require treatment. Nearly half of these incidental lesions were only visible on synthetic CT, which additionally has been shown to be problem solving for diagnosis in many other cases.
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Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Elke Vereecke
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Min Chen
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Lennart B O Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Tani T, Takao M, Soufi M, Otake Y, Fukuda N, Hamada H, Uemura K, Sato Y, Sugano N. Rotational-motion measurement of the sacroiliac joint using upright MRI scanning and intensity-based registration: is there a sex difference? Int J Comput Assist Radiol Surg 2023; 18:79-84. [PMID: 36565369 PMCID: PMC9883344 DOI: 10.1007/s11548-022-02806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/30/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE The sacroiliac joint (SIJ) has attracted increasing attention as a source of low back and groin pain, but the kinematics of SIJ against standing load and its sex difference remain unclear due to the difficulty of in vivo load study. An upright magnetic resonance imaging (MRI) system can provide in vivo imaging both in the supine and standing positions. The reliability of the mobility of SIJ against the standing load was evaluated and its sex difference was examined in healthy young volunteers using an upright MRI. METHOD Static (reliability) and kinematic studies were performed. In the static study, a dry bone of pelvic ring embedded in gel form and frozen in the plastic box was used. In the kinematic study, 19 volunteers (10 males, 9 females) with a mean age of 23.9 years were included. The ilium positions for the sacrum in supine and standing positions were measured against the pelvic coordinates to evaluate the mobility of the SIJ. RESULTS In the static study, the residual error of the rotation of the SIJ study was < 0.2°. In the kinematic study, the mean values of SIJ sagittal rotation from supine to standing position in males and females were - 0.9° ± 0.7° (mean ± standard deviation) and - 1.7° ± 0.8°, respectively. The sex difference was statistically significant (p = 0.04). The sagittal rotation of the SIJ showed a significant correlation with the sacral slope. CONCLUSION The residual error for measuring the SIJ rotation using the upright MRI was < 0.2°. The young healthy participants showed sex differences in the sagittal rotation of the SIJ against the standing load and the females showed a larger posterior rotation of the ilium against the sacrum from the supine to standing position than the males. Therefore, upright MRI is useful to investigate SIJ motion.
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Affiliation(s)
- Tetsuro Tani
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka Japan ,Department of Orthopaedic Surgery, Osaka Police Hospital, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2–2 Yamadaoka, Suita, Osaka Japan
| | - Mazen Soufi
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara Japan
| | - Yoshito Otake
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara Japan
| | - Norio Fukuda
- Center for Information and Neural Networks (CiNet), Advanced ICT Research Institute, National Institute of Information and Communications Technology (NICT), Suita, Osaka Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka Japan
| | - Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka Japan
| | - Yoshinobu Sato
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka Japan
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Hermans SMM, Paulussen EMB, Notermans RAJ, Krijntjes BDM, Schotanus MGM, Most J, van Santbrink H, van Hemert WLW, Curfs I. Motion analysis in patients with postpartum sacroiliac joint dysfunction: A cross-sectional case-control study. Clin Biomech (Bristol, Avon) 2022; 100:105773. [PMID: 36191512 DOI: 10.1016/j.clinbiomech.2022.105773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with sacroiliac joint dysfunction are limited in daily life activities such as gait, climbing stairs and rising from a chair. It is well known that individuals with chronic low back pain have impaired balance compared to healthy individuals. This cross-sectional case-control study aims to investigate spatiotemporal parameters, center of pressure and mass, pelvic angles and other joint angles in patients with sacroiliac joint dysfunction in comparison with healthy controls. METHODS Motion analysis existed of three tasks: (1) normal gait, (2) single-leg-stance, and (3) sit-to-stance. Spatiotemporal parameters, center of pressure, pelvic angles and other joint angles were measured using a twelve-camera, three-dimensional motion capture system and ground reaction force platforms. FINDINGS Thirty subjects were recruited for this study; ten patients, ten matched controls and ten healthy student controls. For gait, patients had a lower cadence, longer double support phase, shorter step length and slower walking speed than controls. For single-leg-stance, patients had a smaller hip angle of the risen leg than controls. Also, variability in center of pressure was larger in patients. For sit-to-stance, the total time to perform the task was almost doubled for patients compared to controls. INTERPRETATION This study demonstrates that patients with sacroiliac joint dysfunction have an impaired gait, more balance problems during standing and standing up compared to healthy controls. This novel information assists to further comprehend the pathology and disease burden of sacroiliac joint dysfunction, in addition, it may allow us to evaluate the effect of current therapies.
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Affiliation(s)
- Sem M M Hermans
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands; Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, The Netherlands.
| | - Evy M B Paulussen
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Remi A J Notermans
- Department of Biometrics, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Bas D M Krijntjes
- Department of Biometrics, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Martijn G M Schotanus
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands; Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, The Netherlands
| | - Jasper Most
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands; Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, The Netherlands
| | - Henk van Santbrink
- Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, The Netherlands; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurosurgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Wouter L W van Hemert
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Inez Curfs
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
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Lee K, Kim H, Kim YI, Park B, Shim WH, Oh JS, Hong S, Kim YG, Ryu JS. Preliminary Study for Quantitative Assessment of Sacroiliitis Activity Using Bone SPECT/CT: Comparison of Diagnostic Performance of Quantitative Parameters. Nucl Med Mol Imaging 2022; 56:282-290. [PMID: 36425275 PMCID: PMC9679044 DOI: 10.1007/s13139-022-00766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/23/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose We compared the feasibility of quantitative analysis methods using bone SPECT/CT with those using planar bone scans to assess active sacroiliitis. Methods We retrospectively reviewed whole-body bone scans and pelvic bone SPECT/CTs of 8 patients who had clinically confirmed sacroiliitis and enrolled 24 patients without sacroiliitis as references. The volume of interest of each sacroiliac joint, including both the ilium and sacrum, was drawn. Active arthritis zone (AAZ) was defined as the zone of voxels with higher SUV than sacral mean SUV within the VOI of SI joint. Then, the following SPECT/CT quantitative parameters, SUVmax (maximum SUV), SUV50% (mean SUV in highest 50% of SUV), and SUV-AAZ, and the ratio of those values to sacral mean SUV (SUVmax/S, SUV50%/S, SUV-AAZ/S) were calculated. For the planar bone scan, the mean count ratio of SI joint/sacrum (SI/S) was conventionally measured. Results Most of the SPECT/CT parameters of the sacroiliitis group were significantly higher than the normal group, whereas SI/S of the planar bone scan was not significantly different between the two groups. In receiver operating characteristic curve analysis, SUV-AAZ/S showed the highest AUC of 0.992, followed by SUV50%/S and SUVmax/S. All ratio parameters of the SPECT/CT showed higher AUC values than the SUV parameters of SI joint or SI/S of the planar scan. Conclusions The quantitative analyses of bone SPECT/CT showed better performance in assessing active sacroiliitis than the planar bone scan. SPECT/CT parameters using the ratio of the SI joint to sacrum showed more favorable results than SUV parameters such as SUVmax, SUV50%, and SUV-AAZ.
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Affiliation(s)
- Koeun Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyunji Kim
- Department of Nuclear Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Yong-il Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bumwoo Park
- Health Innovation Big Data Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Woo Hyun Shim
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Jungsu S. Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Rodríguez-Pastor JA, Caro-Puértolas B, Caña-Pino A, Sánchez-Preciado AM, Garrido-Ardila EM, Apolo-Arenas MD. Effect of osteopathic manipulation of the sacroiliac joint vs electrotherapy on pain and functional disability in patients with low back pain: A pilot study. J Back Musculoskelet Rehabil 2022; 35:1219-1226. [PMID: 35599463 DOI: 10.3233/bmr-210120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND One of the main problems faced by physiotherapists in primary care is low back pain with or without radiation to lower limbs. There are many different treatment approaches for the management of low back pain. Despite the large amount of published studies, the evidence remains contradictory. OBJECTIVE To evaluate the influence of the osteopathic manipulation of the sacroiliac joint on low back pain with or without radiation to lower limbs. METHOD Single-blind randomized clinical controlled trial. Participants with low back pain with or without lower limb radiation were randomized to osteopathic manipulation of the sacroiliac joint group (intervention, 6 sessions) or to an electrotherapy group (control, 15 sessions) for 3 weeks. Measures were taken at baseline (week 0) and post-intervention (week 4). The primary outcome measures were pain (Visual Analogue Scale), functional disability (Oswestry disability index and Roland Morris questionnaire). The secondary outcome measure was pain threshold at muscular tender points in the quadratus lumborum, pyramidal, mayor gluteus, and hamstrings. RESULTS In all, 37 participants completed the study. The results of the intragroup comparisons showed statistically significant improvements in both groups in the visual analogue scale (Osteopathic manipulation group, P= 0.000; Electrotherapy group, P= 0.005) and Oswestry disability index (Osteopathic manipulation group, P= 0.000; Electrotherapy group- P= 0.026) but not in the Roland Morris questionnaire (P= 0.121), which only improved in the intervention group (P= 0.01). The osteopathic manipulation was much more effective than electrotherapy improving to pain and functional disability. CONCLUSION Osteopathic manipulation of the sacroiliac joint improves pain and disability in patients with sacroiliac dysfunction after three weeks of treatment.
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Affiliation(s)
- José Antonio Rodríguez-Pastor
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | - Berta Caro-Puértolas
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | - Alejandro Caña-Pino
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | | | - Elisa María Garrido-Ardila
- ADOLOR Research group, Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | - Ma Dolores Apolo-Arenas
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
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Steinke H, Saito T, Kuehner J, Reibetanz U, Heyde CE, Itoh M, Voelker A. Sacroiliac innervation. Eur Spine J 2022; 31:2831-2843. [PMID: 36029360 DOI: 10.1007/s00586-022-07353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To investigate the innervation pattern of the sacroiliac region, especially with regard to the sacroiliac joint (SIJ). Dorsal SIJ innervation was analyzed and described. Our main hypothesis was that nerves reach the SIJ dorsally, passing ligamental compartments, as this would explain dorsal SIJ pain. METHODS To examine sacroiliac innervation, we followed the nerves in over 50 specimens over several years. Plastinated slices were evaluated, nerves in the region were stained histologically, and the data were summarized as 3D models. RESULTS The Rami communicans and posterior branches of the spinal nerves and their branches that form a dorsal sacral plexus and communicating branches, together with corresponding vessels, were observed to form neurovascular bundles embedded by tiny fatty connectives in gaps and tunnels. Branches of L5-S1 pass the inner sacroiliac ligaments (the interosseous sacroiliac ligament and axial interosseous ligament). The outer sacroiliac ligaments (posterior sacroiliac ligaments, long posterior sacroiliac ligament, sacrotuberal ligament, thoracolumbar fascia) are passed by the S1-S4 branches. However, although the paths of these nerves are in the direction of the SIJ, they do not reach it. It is possible that impingement of the neurovascular bundles may result in pain. Moreover, the gaps and tunnels connect to the open dorsal SIJ. CONCLUSION Our findings suggest that Bogduk's term "sacroiliac pain" correlates to "sacroiliac innervation", which consists of "inner-" and "outer sacroiliac ligament innervation", and to ventral "SIJ pain". The watery gaps and tunnels observed could play a significant role in innervation and thus in the origins of SIJ pain. LEVEL OF EVIDENCE Individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Hanno Steinke
- Department of Anatomy, University Leipzig, Liebigstr. 13, 04103, Leipzig, Germany.
| | - Toshiyuki Saito
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Janne Kuehner
- Department of Anatomy, University Leipzig, Liebigstr. 13, 04103, Leipzig, Germany
| | - Uta Reibetanz
- Department of Biophysics, University Leipzig, Härtelstr. 16-18, 04107, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopeadics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Anna Voelker
- Department of Orthopeadics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Salah R, Bouya A, Bennis A, Zaddoug O, Benchakroun M, Zine A, Tanane M, Bouabid S. Gluteus maximus abscess revealing a tuberculous arthritis: A case report and review of the literature. Indian J Tuberc 2022; 69:710-714. [PMID: 36460414 DOI: 10.1016/j.ijtb.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/01/2021] [Indexed: 06/17/2023]
Abstract
Although tuberculosis is a widespread disease in Morocco, musculoskeletal form is relatively rare and even rarer when affects the sacroiliac joint. Tuberculous sacroiliitis remains a challenge for orthopedists owing to its insidious onset and non-specific clinical presentation. Herein, we report the case of a 23-year-old male with a growing mass in his left gluteal area, diagnosed with tuberculous sacroiliitis, based on bacteriological and histological findings. The aim of our work is to draw attention to the importance of continued awareness for early detection and adequate treatment of this very rare entity.
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Affiliation(s)
- Rhita Salah
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco.
| | - Ayoub Bouya
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Azzelarab Bennis
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Omar Zaddoug
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Mohamed Benchakroun
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Ali Zine
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Mansour Tanane
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
| | - Salim Bouabid
- Orthopedic Surgery and Traumatology, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Morocco
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Mitsuzawa S, Kusakabe K, Matsuda S. Minimally invasive transiliac anatomical locking plate for posterior pelvic ring injury: A technical trick of the gull wing plate. J Clin Orthop Trauma 2022; 33:101991. [PMID: 36061970 PMCID: PMC9436802 DOI: 10.1016/j.jcot.2022.101991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022] Open
Abstract
Posterior pelvic ring injuries commonly involve sacral fractures, which are difficult to reduce and stabilize. Because conservative treatment requires long-term bedrest and leads to unsatisfactory outcomes, surgical intervention is a beneficial option to protect neurological structures and provide sufficient stability for early mobilization. Several studies have investigated a variety of internal fixation techniques, such as iliosacral screws, transiliac bars, spinal instruments, and transiliac plates. The gull wing plate (GWP) is a pre-contoured anatomical locking plate with two cancellous screws (φ6.5 mm) and four locking screws (φ5.0 mm), the design of which is unique among posterior tension-band plates. The GWP provides reliable stability of the posterior construct of the pelvic ring and accelerates rehabilitation. Compared to alternative surgical techniques for posterior fixation, the simple surgical procedure of the GWP is minimally invasive and highly reproducible, which leads to fewer complications and less radiation exposure.
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Affiliation(s)
- Sadaki Mitsuzawa
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Kusakabe
- Department of Orthopaedic Trauma, Senshu Trauma and Critical Care Center, Rinku General Medical Center, Osaka, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Carneiro BC, Rizzetto TA, Silva FD, da Cruz IAN, Guimarães JB, Ormond Filho AG, Nico MAC. Sacroiliac joint beyond sacroiliitis-further insights and old concepts on magnetic resonance imaging. Skeletal Radiol 2022; 51:1923-35. [PMID: 35556157 DOI: 10.1007/s00256-022-04067-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 02/02/2023]
Abstract
The sacroiliac joint (SIJ) is an amphiarthrosis composed of a posterior syndesmosis and an anterior cartilaginous portion, with limited yet present mobility. Its main function is to transmit the load from the axial skeleton to the lower limbs and vice-versa; it is susceptible to early mechanical and degenerative changes which are much more common than inflammatory sacroiliitis. Magnetic resonance imaging (MRI) has increasingly been used to evaluate these changes, and while subchondral bone marrow edema (BME) is a common finding related to both, care must be taken when applying the ASAS research MRI definition for sacroiliitis without considering lesion BME topography, size and depth, concomitant structural damage and, of course, the clinical picture. In this review, we will discuss the anatomy and biomechanics of the SIJ, the noninflammatory causes of SIJ subchondral BME, and how these concepts combined can be used to increase our diagnostic confidence.
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Pastrak M, Vladicic N, Sam J, Vrooman B, Ma F, Mahmoud A, Khan JS, Abd-Elsayed A, Khandwalla F, McGilvray S, Visnjevac O. Review of Opioid Sparing Interventional Pain Management Options and Techniques for Radiofrequency Ablations for Sacroiliac Joint Pain. Curr Pain Headache Rep 2022; 26:855-862. [PMID: 36178572 DOI: 10.1007/s11916-022-01088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The goal of this clinical review was to provide an update about the existing treatment options and associated evidence for various radiofrequency ablation techniques for sacroiliac joint pain. An electronic literature search on radiofrequency for the treatment of sacroiliac joint pain was conducted using PubMed, NCBI and Google Scholar. The following search keywords were used: radiofrequency ablation (cooled, pulsed, conventional, bipolar, intra-articular), sacroiliac joint and sacroiliac pain. The search was limited to human subjects, English language and articles with available full text. The bibliographic sections of all manuscripts were further searched for additional relevant citations. The full text of the relevant articles was reviewed by all the authors. RECENT FINDINGS Our study showed that radiofrequency ablation is a safe and effective treatment option that can be utilized to manage sacroiliac joint pain. It offers accessibility to the primary care physician, reduces office visits with "pain" as the primary complaint and provides the added benefit of acting as a non-opioid sparing means of analgesia.
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Affiliation(s)
| | - Nikola Vladicic
- St. George's University School of Medicine, St. George's, Grenada
| | - Jordan Sam
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Bruce Vrooman
- Dartmouth Hitchcock Medical Centre, Lebanon, NH, USA
| | | | | | | | - Alaa Abd-Elsayed
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
| | | | | | - Ognjen Visnjevac
- McMaster University, Hamilton, ON, Canada
- Bloor Pain Specialists, Toronto, ON, Canada
- Cleveland Clinic Canada, Toronto, ON, Canada
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Mitsuzawa S, Kusakabe K, Nakao S, Matsuoka T, Yasuda T, Matsuda S. Minimally invasive transiliac anatomical locking plate for posterior pelvic ring injury: a retrospective analysis of clinical outcomes and radiographic parameters for the gull wing plate. BMC Musculoskelet Disord 2022; 23:880. [PMID: 36138399 PMCID: PMC9494767 DOI: 10.1186/s12891-022-05829-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
Background Posterior pelvic ring injuries are challenging for surgeons to treat adequately due to difficulties with reduction and stabilization. Surgical intervention is a beneficial option to protect neurological structures and provide sufficient stability for early mobilization. The gull wing plate (GWP) is a pre-contoured anatomical locking plate with six screws, and its design is unique among posterior transiliac tension-band plates. The purpose of this study was to investigate clinical results of the GWP. Methods Patients who had an unstable posterior pelvic ring injury and underwent internal fixation with GWP were retrospectively analyzed at a trauma center. Demographic data, fracture type, perioperative data, and radiological evaluation with computed tomography (CT) were collected. Clinical outcomes were graded using the functional independence measure (FIM) and Majeed outcome score. Results Twenty-six patients were enrolled (mean age, 54 years), and the mean follow-up period was 23 months. The mean Injury Severity Score was 24 points, and internal fixation was performed 6.6 days post-trauma. CT evaluation showed the lateral surface angle of the uninjured ilium was approximately 68°. The GWP pre-contoured anatomical design closely matched this angle. The mean FIM and Majeed score were 119 and 76 points, respectively, which were graded as excellent (n = 14), good (n = 9), or fair (n = 3). Conclusions With the retrospective single-center data available, the GWP seems to be a minimally-invasive alternative, provides reliable stability of the posterior pelvic ring and allows for rehabilitation within normal ranges.
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Affiliation(s)
- Sadaki Mitsuzawa
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Kenji Kusakabe
- Department of Orthopaedic Trauma, Senshu Trauma and Critical Care Center, Rinku General Medical Center, Osaka, Japan
| | - Shota Nakao
- Department of Orthopaedic Trauma, Senshu Trauma and Critical Care Center, Rinku General Medical Center, Osaka, Japan
| | - Tetsuya Matsuoka
- Department of Orthopaedic Trauma, Senshu Trauma and Critical Care Center, Rinku General Medical Center, Osaka, Japan
| | - Tadashi Yasuda
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Gladman DD, Mease PJ, Bird P, Soriano ER, Chakravarty SD, Shawi M, Xu S, Quinn ST, Gong C, Leibowitz E, Poddubnyy D, Tam LS, Helliwell PS, Kavanaugh A, Deodhar A, Østergaard M, Baraliakos X. Efficacy and safety of guselkumab in biologic-naïve patients with active axial psoriatic arthritis: study protocol for STAR, a phase 4, randomized, double-blinded, placebo-controlled trial. Trials 2022; 23:743. [PMID: 36064592 PMCID: PMC9444112 DOI: 10.1186/s13063-022-06589-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
Background Axial involvement constitutes a specific domain of psoriatic arthritis (PsA). Interleukin (IL)-23 inhibitors have demonstrated improvement in axial PsA (axPsA) symptoms, but have not shown efficacy in treating ankylosing spondylitis (AS), suggesting differences in axPsA processes and treatments. In a post hoc, pooled analysis of patients with investigator- and imaging-confirmed sacroiliitis in two phase 3, randomized, placebo-controlled studies (DISCOVER-1 and DISCOVER-2), patients treated with guselkumab, an IL-23p19 inhibitor, had greater axial symptom improvements compared with placebo. Confirmatory imaging at baseline was restricted to the sacroiliac (SI) joints, occurred prior to/at screening, and was locally read. Methods The STAR study will prospectively assess efficacy outcomes in PsA patients with magnetic resonance imaging (MRI)-confirmed axial inflammation. Eligible, biologic-naïve patients with PsA (N = 405) for ≥ 6 months and active disease (≥ 3 swollen and ≥ 3 tender joints, C-reactive protein [CRP] ≥ 0.3 mg/dL) despite prior non-biologic disease-modifying antirheumatic drugs, apremilast, and/or nonsteroidal anti-inflammatory drugs will be randomized (1:1:1) to guselkumab every 4 weeks (Q4W); guselkumab at week (W) 0, W4, then every 8 weeks (Q8W); or placebo with crossover to guselkumab at W24, W28, then Q8W. Patients will have Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥ 4, spinal pain component score (0–10 visual analog scale) ≥ 4, and screening MRI-confirmed axial involvement (positive spine and/or SI joints according to centrally read Spondyloarthritis Research Consortium of Canada [SPARCC] score ≥ 3 in ≥ 1 region). The primary endpoint is mean change from baseline in BASDAI at W24; multiplicity controlled secondary endpoints at W24 include AS Disease Activity Score employing CRP (ASDAS), Disease Activity Index for PsA (DAPSA), Health Assessment Questionnaire – Disability Index (HAQ-DI), Investigator’s Global Assessment of skin disease (IGA), and mean changes from baseline in MRI SI joint SPARCC scores. Centrally read MRIs of spine and SI joints (scored using SPARCC) will be obtained at W0, W24, and W52, with readers blinded to treatment group and timepoint. Treatment group comparisons will be performed using a Cochran-Mantel-Haenszel or chi-square test for binary endpoints and analysis of covariance, mixed model for repeated measures, or constrained longitudinal data analysis for continuous endpoints. Discussion This study will evaluate the ability of guselkumab to reduce both axial symptoms and inflammation in patients with active PsA. Trial registration This trial was registered at ClinicalTrials.gov, NCT04929210, on 18 June 2021. Protocol version: Version 1.0 dated 14 April 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06589-y.
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Affiliation(s)
- Dafna D Gladman
- Centre for Prognosis Studies in The Rheumatic Diseases, Toronto Western Hospital, Toronto, ON, Canada.
| | - Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Rheumatology Research, Seattle, WA, USA
| | - Paul Bird
- University of New South Wales, Randwick, NSW, Australia
| | | | - Soumya D Chakravarty
- Janssen Scientific Affairs, LLC, Horsham, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - May Shawi
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, PA, USA
| | - Stephen Xu
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Sean T Quinn
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Cinty Gong
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | | | | | - Lai-Shan Tam
- The Chinese University of Hong Kong, Hong Kong, China
| | | | | | - Atul Deodhar
- Oregon Health & Science University, Portland, OR, USA
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