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

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.

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

Physical Therapy ◽

10.1093/ptj/79.11.1043 ◽

1999 ◽

Vol 79 (11) ◽

pp. 1043-1057 ◽

Cited By ~ 63

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.

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COOLED RADIOFREQUENCY LATERAL BRANCH NEUROTOMY FOR THE TREATMENT OF SACROILIAC JOINT MEDIATED LOW BACK PAIN

10.26226/morressier.598b05dad462b80290b53721 ◽

2017 ◽

Author(s):

Gilles Maxime

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Sacroiliac Joint ◽

Lateral Branch ◽

Low Back

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External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain

PLoS ONE ◽

10.1371/journal.pone.0131963 ◽

2015 ◽

Vol 10 (7) ◽

pp. e0131963 ◽

Cited By ~ 14

Author(s):

Lonneke van Hoeven ◽

Yvonne Vergouwe ◽

P. D. M. de Buck ◽

Jolanda J. Luime ◽

Johanna M. W. Hazes ◽

...

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Axial Spondyloarthritis ◽

External Validation ◽

Low Back ◽

Primary Care Patients

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

January 2018 - Pain Physician ◽

10.36076/ppj.2014/17/459 ◽

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

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PHYSIOTHERAPY TREATMENT IN LOW BACK PAIN PATIENTS WITH SACROILIAC JOINT DYSFUNCTION – A COMPARATIVE STUDY BETWEEN JOINT MANIPULATION WITH EXERCISES AND CONVENTIONAL PHYSIOTHERAPY EXERCISES

International Journal of Physiotherapy and Research ◽

10.16965/ijpr.2018.192 ◽

2018 ◽

Vol 6 (6) ◽

pp. 2948-2951

Author(s):

Digvijay Sharma ◽

◽

Mukesh Goyal ◽

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Comparative Study ◽

Sacroiliac Joint ◽

Low Back ◽

Physiotherapy Treatment ◽

Sacroiliac Joint Dysfunction ◽

Conventional Physiotherapy ◽

Pain Patients

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

10.21203/rs.3.rs-272234/v1 ◽

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.

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

Military Medicine ◽

10.1093/milmed/usz398 ◽

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.

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