Degenerative changes in sacroiliac joint in patients with its disfunction
Objective: to study the correlation of radiologic parameters of sacrum and pelvis in frontal plane, this can influence on the function of joint with degenerative changes in it.
Methods: we examined 50 patients (age 20–71 years old) with sacroiliac disfunction. Criteria of inclusion were: pain in the area of spinae iliaca superior, with irradiation to groin, gluteus region or hip, its duration more than 3 months; no effective conservative treatment; positive 4 of 6 provocative tests. On X-rays we measured angles of sacrum cranial plate tilt, pelvic tilt, sacrum rotation around axial plane, the width of joint space in the ventral, dorsal and medial parts. We assessed joint surfaces, subhondral sclerosis, osteophytes, ligaments ossification, bone spots. Obtained results were statistically calculated.
Results: in all patients we revealed degenerative changes. For the patients of the 1st claster — they all had the highest degree of asymmetry in ventral part, average — in medial and dorsal parts, large tilt of sacrum and pelvis, significant rotation of sacrum. In the 2nd claster — almost symmetric joint space in all three parts, tilt of pelvis and sacrum, large rotation of sacrum. In the 3rd claster — significant asymmetry of joint space in the medial part and small in dorsal, large tilt of pelvis and sacrum, significant rotation of sacrum. In the 4th claster — large asymmetry of joint space in the dorsal part and minimal in the ventral and medial parts, small tilt of sacrum and pelvis, small rotation of sacrum. Widespread combination of degenerative changes were infringement of articulation surface, subhondral sclerosis and osteophytes in articular space.
Conclusions: all patients with sacroiliac disfunction had degenerative changes. For diagnostics and forecasting of results we must take into consideration such factors which can lead to the disfunction of sacroiliac joint.
Full Text:PDF (Русский)
Vleeming, A., Albert, H. B, Ostgaard, H. C, Sturesson, B., & Stuge, B. (2008). European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal, 17, 794–819. doi:10.1007/s00586-008-0602-4/
Dijkstra, P. (2007). Basic problems in the visualization of the sacroiliac joint. Lumbopelvic Pain Integration of Research and Therapy. In A. Vleeming, V. Mooney, R. Stoeckart (Ed.). Chyrchill Livingstone, Edinburg.
Demir, M., Mavi, A., Gümüsburun, E., Bayram, M., Gürsoy, S., & Nishio, H. (2007). Anatomical Variations with Joint Space Measurements on CT. Kobe Journal of Medical Sciences, 53(5), 209–217.
Irvin, R. E. (2007). Why and how to optimize posture. In A. Vleeming, V. Mooney, R. Stoeckart (Ed.). Lumbopelvic pain integration of research and therapy (pp. 239-251). Chyrchill Livingstone, Edinburg.
Ravin, T. (2007). Visualization of pelvic biomechanical dysfunction. In A. Vleeming, V. Mooney, R. Stoeckartм (Ed.). Lumbopelvic Pain Integration of Research and Therapy. Chyrchill Livingstone, Edinburg.
Nakajuku, S., Matsumoto, Y., Morito, T., Yano, S., Tsuboi, A., Nishi, T., ... Murakami E. (2016). Radiological investigation of the lumbar spinal alignment in patients with sacroiliac joint disorders. Paper presented at 9th Interdisciplinary World Congress on Low Back & Pelvic Pain, Singapore, October 31–November 4 (pp. 444–445).
Cusi, M., van der Wall, H., Saunders, J., & Fogelman, I. (2013). SPECT/CT findings in large cohort with sacro-iliac joint incompetence (SIJI). Paper presented at 8th Interdisciplinary World Congress on Low Back & Pelvic Pain, Dubai, October 27–31 (pp. 83–90).
Staude, V., Radzishevska, Y., & Zlatnyk, R. (2017). Radiometric parameters of the sacrum and pelvis in patients with dysfunctions of the sacroiliac joint, affecting the spinae-pelvic balance in the frontal plane. Orthopaedics, traumatology and prosthetics, 3, 54–62. doi:http://dx.doi.org/10.15674/0030-59872017354-62
Korzh, M., Staude, V., Kondratyev, A., & Karpinsky, M. (2016). Stress-strain state of the system "lumbar spine-sacrum-pelvis" in the conditions of front pelvis. Orthopaedics, traumatology and prosthetics, 1, 54–61. doi:http://dx.doi.org/10.15674/0030-59872016154-61
Korzh, M., Staude, V., Kondratyev, A., & Karpinsky, M. (2015). Stress-strain state of the kinematic chain «lumbar spine – sacrum – pelvis» in cases of asymmetry of articular gaps of the sacroiliac joint. Orthopaedics, traumatology and prosthetics, 3, 5-13. doi:http://dx.doi.org/10.15674/0030-5987201535-13
Hammer, N., Steinke, H., Lingslebe, U., Bechmann, I., Josten, C., Slowik, V., & Böhme, J. (2013). Ligamentous influence in pelvic load distribution. The Spine Journal, 13(10), 1321-1330. doi:10.1016/j.spinee.2013.03.050
Laslett, M., Young, S. B., Aprill, C. N., & McDonald, B. (2003). Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. Australian Journal of Physiotherapy, 49(2), 89-97. doi:10.1016/s0004-9514(14)60125-2
Perlman, R., Golan, J., & Lugo M. (2016). Diagnosis of sacroiliac joint syndrome in low back/pelvic pain: reliability of 3 key clinical signs. Paper presented at 9th Interdisciplinary World Congress on Low Back & Pelvic Pain, Singapore, October 31–November 4 (pp. 408–409).
Orel, А. М. (2007). Spine X-ray examination for manual therapeutist. Moscow: Vidar.
Palesy, P. D. (1997). Tendon and ligament insertions—a possible source of musculoskeletal pain. CRANIO®, 15(3), 194-202. doi:10.1080/08869634.1997.11746012
Benjamin, M. D., Toumi, H., Ralphs, J. R., Bydder, G., Best, T. M., & Milz, S. (2006). Where tendons and ligaments meet bone: attachment sites ('entheses') in relation to exercise and/or mechanical load. Journal of Anatomy, 208(4), 471-490. doi:10.1111/j.1469-7580.2006.00540.x
Mc Kay, M. J. (2016). Unique mechanism for lumbar musculoskeletal pain defined from primary care research into periosteal enthesis response to biomechanical stress and formation of small fibre polyneuropathy. Paper presented at 9th Interdisciplinary World Congress on Low Back & Pelvic Pain, Singapore October 31–November 4.
Kirkaldy-Willis, W. H., & Farfan, H. F. (1982). Instability of the lumbar spine. Clinical Orthopaedics and Related Research, 165, 110–123.
Panjabi, M. M. (1992). The stabilizing system of the spine. Part 1. Function,dysfunction, adaptation and enhancement (discussion 97). Journal of Spinal Disorders, 5, 383–389.
Panjabi, M. M. (1992). The stabilizing system of the spine. Part 2. Neutral zone and instability hypothesis. Journal of Spinal Disorders, 5(4), 390–396.
Panjabi, M. M. (2005). A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. European Spine Journal, 15(5), 668-676. doi:10.1007/s00586-005-0925-3
Tanaka, N. M., An, H. S., Lim, T., Fujiwara, A., Jeon, C., & Haughton, V. M. (2001). The relationship between disc degeneration and flexibility of the lumbar spine. The Spine Journal, 1(1), 47-56. doi:10.1016/s1529-9430(01)00006-7
Fujiwara, A., Lim, T., An, H. S., Tanaka, N., Jeon, C., Andersson, G. B., & Haughton, V. M. (2000). The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine, 25(23), 3036-3044. doi:10.1097/00007632-200012010-00011
Al-Rawahi, M., Luo, J., Pollintine, P., Dolan, P., & Adams, M. A. (2011). Mechanical function of vertebral body osteophytes, as revealed by experiments on cadaveric spines. Spine, 36(10), 770-777. doi:10.1097/brs.0b013e3181df1a70
Copyright (c) 2018 Volodymyr Staude, Yevgenya Radzishevska, Ruslan Zlatnyk
This work is licensed under a Creative Commons Attribution 4.0 International License.