scholarly journals Four Clinical Tests of Sacroiliac Joint Dysfunction: The Association of Test Results With Innominate Torsion Among Patients With and Without Low Back Pain

1999 ◽  
Vol 79 (11) ◽  
pp. 1043-1057 ◽  
Author(s):  
Pamela K Levangie
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sacroiliac Joint ◽  
Low Back ◽  
Test Results ◽  
Leg Length ◽  
Old Patients ◽  
Predictive Values ◽  
Forward Flexion ◽  
Combined Test

Abstract Background and Purpose. The purpose of this study was to assess the association between innominate torsion (asymmetric anteroposterior positioning of the pelvic innominates) and the Gillet, standing forward flexion, sitting forward flexion, and supine-to-sit tests. Subjects. A sample of 21- to 50-year-old patients with low back pain (n=150) and a comparison group of patients with upper-extremity impairments (n=138) were recruited from outpatient physical therapy facilities. Methods. The association of single and combined test results with innominate torsion (calculated from pelvic landmark data) and with presence or absence of low back pain were estimated via odds ratios, sensitivities, specificities, and predictive values. Results. Individual test sensitivities were low (8%-44%), as were negative predictive values (28%-38%), for identifying the presence of innominate torsion. Combining tests and controlling for sex, age group, leg-length difference, or iliac crest level did not improve performance characteristics. The associations of test results with low back pain were weak, with the exception of the Gillet test (odds ratio=4.57). Conclusion and Discussion. The data do not support the value of these tests in identifying innominate torsion, although the use of these tests for identifying other phenomena (eg, sacroiliac joint hypomobility) cannot be ruled out. Further exploration of the association of Gillet test results with low back pain is warranted.

scholarly journals POS0982 DIAGNOSTIC VALUE OF SPECT/CT IN AXIAL SPONDYLOARTHRITIS AND OTHER LOW BACK PAIN

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 758.2-758
Author(s):  
J. S. Kim ◽  
K. Hyun-Sook ◽  
L. Kyung-Ann
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Sacroiliac Joint ◽  
Axial Spondyloarthritis ◽  
Tracer Uptake ◽  
Low Back ◽  
Clinical Markers ◽  
Predictive Values ◽  
Pain Site ◽  
Bone Spect

Background:Spondyloarthropathies (SpA) including ankylosing spondylitis are characterized by inflammatory arthritis involving the spine and peripheral joints. Bone SPECT/CT is in the spotlight as it can reflect the current level of inflammation.Objectives:We aimed to investigate the diagnostic performance of bone SPECT/CT for axial SpA (axSpA) at the level of sacroiliac joints.Methods:Patients with low back pain who had undergone SPECT/CT of the SI joints were selected for inclusion in this study through a retrospective review of medical records from August 2016 and July 2018. We used semi-quantitative scoring methods for SPECT/CT. For visual scoring, a score of 0 was assigned when tracer uptake in the sacroiliac joint was less than that in the sacrum; a score of 1, when equal to that in the sacrum; and a score of 2, when greater than that in the sacrum. A score of 2 was considered positive for the diagnosis of sacroiliitis on SPECT/CT (Figure 1). The diagnosis of axSpA was retained when patients fulfilled the Assessment of SpA International Society criteria.Results:A total of 164 patients were enrolled (34 patients with axSpA). The remaining 130 patients had non-axSpA rheumatic inflammatory disease (n=24), vertebral disk herniation (n=13), avascular necrosis (n=11), and others such as bursitis, and fracture (n=85). The mean age of aSpA (37.8±15.6 years) was lower than controls (49.8±16.4 years) (p<0.001), and axSpA (64.5 %) had more male than others (42.1 %) (p=0.024). The sensitivity, specificity, positive and negative predictive values of bone SPECT/CT for axSpA were 83.9%, 63.2%, 34.7%, and 94.4%, respectively. The bone SPECT/CT maximal score and BASDAI score has positive correlation (r=0.481, p=0.007). The bone SPECT/CT compared with MRI is marginal correlation (k=0.369, p<0.001).Conclusion:In patients with low back pain, the bone SPECT/CT has a high negative predictive value that can exclude AS. In addition, when contraindication in MRI the bone SPECT/CT can be an alternative test.References:[1]Rahul V. Parghane, Baljinder Singh, Aman Sharma, Harmandeep Singh, Paramjeet Singh, and Anish Bhattacharya. Role of 99mTc-Methylene Diphosphonate SPECT/CT in the Detection of Sacroiliitis in Patients with Spondyloarthropathy: Comparison with Clinical Markers and MRI. J Nucl Med Technol 2017; 45:280–28[2]Anuj Jain, Suruchi Jain, w A n i l A g a r w a l, Sanjay Gambhir, Chetna Shamshery, and Amita Agarwal(2015). Evaluation of Efficacy of Bone Scan With SPECT/CT in the Management of Low Back Pain. A Study Supported by Differential Diagnostic Local Anesthetic Blocks. Clin J Pain 2015;31:1054–1059[3]Yong-il Kim, Minseok Suh, Yu Kyeong Kim, Ho-Young Lee and Kichul Shin. The usefulness of bone SPECT/CT imaging with volume of interest analysis in early axial spondyloarthritis. BMC Musculoskeletal Disorders (2015) 16:9[4]Jennifer Saunders, Mel Cusi, and Hans Van der Wall. What’s Old Is New Again: The Sacroiliac Joint as a Cause of Lateralizing Low Back Pain. Tomography (2018) VOLUME 4 NUMBER 2[5]Satoshi Kato, Satoru Demura, Hidenori Matsubara, Anri Inak2, Kazuya Shinmura, Noriaki Yokogawa, Hideki Murakam1, Seigo Kinuya and Hiroyuki Tsuchiya. Utility of bone SPECT/CT to identify the primary cause of pain in elderly patients with degenerative lumbar spine disease. Journal of Orthopaedic Surgery and Research (2019) 14:185[6]Romain De Laroche, Erwan Simon, Nicolas Suignard, Thomas Williams, Marc-Pierre Henry, Philippe Robin, Ronan Abgral, David Bourhis Pierre-Yves Salaun, Frédéric Dubrana, Solène Querellou. Clinical interest of quantitative bone SPECT-CT in the preoperative assessment of knee osteoarthritis. De Laroche et al. Medicine (2018) 97:35[7]Inki Lee, Hendra Budiawan, Jee Youn Moon, Gi Jeong Cheon, Yong Chul Kim, Jin Chul Paeng, Keon Wook Kang, June-Key Chung, and Dong Soo Lee. The Value of SPECT/CT in Localizing Pain Site and Prediction of Treatment Response in Patients with Chronic Low Back Pain. J Korean Med Sci 2014; 29: 1711-1716Disclosure of Interests:None declared.

scholarly journals The Anatomy of the Lateral Branches of the Sacral Dorsal Rami: Implications for Radiofrequency Ablation

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. 459-464
Author(s):  
Joseph Fortin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Radiofrequency Ablation ◽  
Sacroiliac Joint ◽  
Low Back ◽  
Sacral Foramina ◽  
Dorsal Rami ◽  
Lateral Branches ◽  
The Right ◽  
Segmental Innervation

Background: The sacroiliac joint (SIJ) is a major source of pain in patients with chronic low back pain. Radiofrequency ablation (RFA) of the lateral branches of the dorsal sacral rami that supply the joint is a treatment option gaining considerable attention. However, the position of the lateral branches (commonly targeted with RFA) is variable and the segmental innervation to the SIJ is not well understood. Objectives: Our objective was to clarify the lateral branches’ innervation of the SIJ and their specific locations in relation to the dorsal sacral foramina, which are the standard RFA landmark. Methods: Dissections and photography of the L5 to S4 sacral dorsal rami were performed on 12 hemipelves from 9 donated cadaveric specimens. Results: There was a broad range of exit points from the dorsal sacral foramina: ranging from 12:00 – 6:00 position on the right side and 6:00 – 12:00 on the left positions. Nine of 12 of the hemipelves showed anastomosing branches from L5 dorsal rami to the S1 lateral plexus. Limitations: The limitations of this study include the use of a posterior approach to the pelvic dissection only, thus discounting any possible nerve contribution to the anterior aspect of the SIJ, as well as the possible destruction of some L5 or sacral dorsal rami branches with the removal of the ligaments and muscles of the low back. Conclusion: Widespread variability of lateral branch exit points from the dorsal sacral foramen and possible contributions from L5 dorsal rami and superior gluteal nerve were disclosed by the current study. Hence, SIJ RFA treatment approaches need to incorporate techniques which address the diverse SIJ innervation. Key words: Sacroiliac joint pain, radiofrequency ablation, dorsal sacral rami, low back pain

scholarly journals Role of Ashwagandha Taila Matrabasti in the Management of Katigraha

2020 ◽  
Vol 11 (2) ◽  
pp. 310-313
Author(s):  
Snehal Vasant Bhende ◽  
Shweta Parwe
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Psychological Factors ◽  
Life Time ◽  
Low Back ◽  
Test Results ◽  
Relieve Pain ◽  
Paired T Test ◽  
Inpatient Department

Background: Katigraha (lumbago)is the condition which is characterised by Stiffness and Pain. Due to Vitiation of Vata in the Katipradesh. About 80% of the industrial population and 60% of the general population experience low back pain at some point of their life time due to wrong postural habits and psychological factors. Basti chikitsa is mainly useful in disorders related to Vata Doshas. Matrabasti is a type of Sneha Basti which can be given in all seasons without any strict regimen of Diet. It has Brumhana and Vatashamaka in nature. And Madhur Dravya (Ashwagandha Taila) is one such combination to pacify the Vata in Katigraha. Objectives: To evaluate the efficacy of Madhur Dravya (Ashwagandha Taila) Matrabasti in Katigraha for relieving Pain and Stiffness. Settings and design: This was an open-labelled single arm interventional clinical study. Methods: Fifteen diagnosed case of katigraha were registered from the outpatient and inpatient department of Panchakarma and Madhur Dravya (Ashwagandha Taila) Matrabasti administered for 9 days. Statistical Analysis- The data were statistically analysed by using paired t test. Results: Highly significant (P< 0.0001) result was found in all the assessment parameter like Pain, Stiffness Schober’s Test and functional rating Index quaternary. Conclusion: Madhur Dravya (Ashwagandha Taila) Matrabasti is one of the best to relieve Pain and Stiffness in Katigraha.

scholarly journals Relationship between Low Back Pain and Lumbar Proprioception, Functional Stability, Static Endurance of Trunk Muscles and Balance in Adolescents

2019 ◽  
Vol 2 (13) ◽  
Author(s):  
Lina Varnienė ◽  
Tomas Aukštikalnis ◽  
Gabrielė Andrejevaitė ◽  
Romualdas Sinkevičius ◽  
Juozas Raistenskis ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Trunk Muscles ◽  
Control Group ◽  
Low Back ◽  
Functional Stability ◽  
Test Results ◽  
Balance Tests ◽  
Lumbar Proprioception ◽  
Balance Error

Research background. Core management is particularly important for uninterrupted and continuous movement. Proprioceptive information is important to maintain the position of the body and control the centre of gravity. Low back pain ultimately affects motor control and leads to proprioceptive changes in injured structures and also can cause balance disorders. Unfortunately, it is unclear until now how low back pain affects proprioception. The aim of this study was to evaluate the relationship between low back pain and lumbar proprioception, functional stability, static endurance of trunk muscles and balance in adolescents. Methods. 42 adolescents participated in the study: 18 control subjects and 24 subjects with low back pain. We used the following assessment methods: the visual pain intensity scale (VAS) for pain evaluation, “flamingo” test, single leg test and balance error score system for balance assessment, Matthiass functional stability test for functional stability, and Biodex 4 Pro isokinetic dynamometer using trunk extension-flexion modular component and four points kneeling methodology for the evaluation of static endurance of trunk muscles, and proprioception. Results. After the assessment of balance, functional stability and proprioception, the results of the control group were statistically signifcantly better (p < 0.05). There was a moderate correlation between low back pain and Biodex 30 degree target reposition sense (r = 0.55), four points kneeling target position sense (r = 0.66), between low back pain and balance tests – “flamingo” and single leg test (r = 0.68, r = 0.61), between pain and Mathiass test (r = 0.52), also between proprioception and balance tests’ results (r = 0.44, r = 0.44, r = 0.46), proprioception and Mathiass test (r = 0.52). There was a strong correlation between pain and balance error scoring test (r = 0.85), balance error scoring test and four points kneeling test results (r = 0.71). All these correlationswere statistically signifcant. Conclusions. After the assessment of balance, functional stability and proprioception, the results of the control group were statistically signifcantly better (p < α). There was a moderate correlation between pain and proprioception, balance tests, Mathiass test results, also between proprioception and balance tests, Mathiass test. There was a strong correlation between pain and balance error scoring test results, between proprioception and balance error scoring test results.Keywords: Low back pain, proprioception, balance, functional stability.

Automated detection of sacroiliitis on plain radiograph using EfficientDet algorithm in young patients with back pain: a pilot study

2021 ◽  
Author(s):  
Sung Hyun Noh ◽  
Chansik An ◽  
Dain Kim ◽  
Seung Hyun Lee ◽  
Min-Yung Chang ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Deep Learning ◽  
Back Pain ◽  
Object Detection ◽  
Sacroiliac Joint ◽  
Plain Radiograph ◽  
Young Patients ◽  
Training Dataset ◽  
Detection Accuracy ◽  
Low Back

Abstract Background A computer algorithm that automatically detects sacroiliac joint abnormalities on plain radiograph would help radiologists avoid missing sacroiliitis. This study aimed to develop and validate a deep learning model to detect and diagnose sacroiliitis on plain radiograph in young patients with low back pain. Methods This Institutional Review Board-approved retrospective study included 478 and 468 plain radiographs from 241 and 433 young (< 40 years) patients who complained of low back pain with and without ankylosing spondylitis, respectively. They were randomly split into training and test datasets with a ratio of 8:2. Radiologists reviewed the images and labeled the coordinates of a bounding box and determined the presence or absence of sacroiliitis for each sacroiliac joint. We fine-tined and optimized the EfficientDet-D4 object detection model pre-trained on the COCO 2107 dataset on the training dataset and validated the final model on the test dataset. Results The mean average precision, an evaluation metric for object detection accuracy, was 0.918 at 0.5 intersection over union. In the diagnosis of sacroiliitis, the area under the curve, sensitivity, specificity, accuracy, and F1-score were 0.932 (95% confidence interval, 0.903–0.961), 96.9% (92.9–99.0), 86.8% (81.5–90.9), 91.1% (87.7–93.7), and 90.2% (85.0–93.9), respectively. Conclusions The EfficientDet, a deep learning-based object detection algorithm, could be used to automatically diagnose sacroiliitis on plain radiograph.

scholarly journals Use of Ultrasound-Guided Platelet-Rich Plasma Injection of the Sacroiliac Joint as a Treatment for Chronic Low Back Pain

2019 ◽  
Vol 185 (7-8) ◽  
pp. e1312-e1317
Author(s):  
Devin Y Broadhead ◽  
Hannah E Douglas ◽  
Laurie M Bezjian Wallace ◽  
Patrick J Wallace ◽  
Sarah Tamura ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Sacroiliac Joint ◽  
Functional Disability ◽  
Platelet Rich Plasma ◽  
Common Source ◽  
Low Back ◽  
Ultrasound Guided ◽  
Long Term Treatment

ABSTRACT Back pain and its associated complications are of increasing importance among military members. The sacroiliac joint (SIJ) is a common source of chronic low back pain (LBP) and functional disability. Many patients suffering from chronic LBP utilize opioids to help control their symptoms. Platelet-rich plasma (PRP) has been used extensively to treat pain emanating from many different musculoskeletal origins; however, its use in the SIJ has been studied only on a limited basis. The patient in this case report presented with chronic LBP localized to the SIJ and subsequent functional disability managed with high-dose opioids. After failure of traditional treatments, she was given an ultrasound-guided PRP injection of the SIJ which drastically decreased her pain and disability and eventually allowed for complete opioid cessation. Her symptom relief continued 1 year after the injection. This case demonstrates the potential of ultrasound-guided PRP injections as a long-term treatment for chronic LBP caused by SIJ dysfunction in military service members, which can also aid in the weaning of chronic opioid use.

scholarly journals Randomized Trial of Sacroiliac Joint Arthrodesis Compared with Conservative Management for Chronic Low Back Pain Attributed to the Sacroiliac Joint

2019 ◽  
Vol 101 (5) ◽  
pp. 400-411 ◽  
Author(s):  
Julius Dengler ◽  
Djaya Kools ◽  
Robert Pflugmacher ◽  
Alessandro Gasbarrini ◽  
Domenico Prestamburgo ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Randomized Trial ◽  
Conservative Management ◽  
Chronic Low Back Pain ◽  
Sacroiliac Joint ◽  
Low Back
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