scholarly journals SACROILIAC JOINT PATHOLOGY IN ELDERLY PATIENTS WITH LOW BACK PAIN (OBSERVATION PROGRAM “IOLANTA”)

2018 ◽  
Vol 24 (3) ◽  
pp. 55-64
Author(s):  
G. P. Kotelnikov ◽  
I. A. Zolotovskaia ◽  
I. L. Davydkin ◽  
I. E. Poverennova ◽  
D. A. Dolgushkin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Bone Resorption ◽  
Elderly Patients ◽  
Sacroiliac Joint ◽  
Transforming Growth Factor ◽  
Type I ◽  
Low Back ◽  
Joint Pathology ◽  
Tgf Β1

Pain in the lower back is one of the frequent reasons for seeking medical help among people over 60 years of age. The study of this problem is of interest to specialists of various profiles, including neurologists, rheumatologists, orthopedic surgeons and therapists. Purpose — to determine prevalence rate of sacroiliac joint pathology in elderly patients with low back pain (LBP) in conjunction with evaluation of clinical significance of bone resorption and cytokines markers. Materials and Methods.The study was conducted with consecutive inclusion of patients (n = 259) with mean age of 65.5 year old [62.5; 69.5] who addressed the hospital for the first time in calendar year with complaints for low back pain. The authors performed MRI examination of lumbar-sacral spine and sacroiliac joint, assessed transforming growth factor β1 (TGF β1), interleukin (IL) 1β and IL-6, Beta-Crosslaps (β-CrossLaps) criteria, P1NP (N-terminal propeptide of procollagen type I) concentration and deoxypyridinoline (DPD) level. Results. 39.4% of patients older 60 years with low back pain on MRI demonstrated changes in sacroiliac joints with statistically significant higher (p = 0.037) pain level as compared to patients without pathology of sacroiliac joint, as well as higher values of TGF-β1 (p = 0.033), IL-1β (p = 0.028), IL-6 (p = 0.041), β-CrossLaps (p = 0.028), P1NP (p = 0.037) and DPD (p = 0.002). Conclusion. Reported alterations in sacroiliac joint conditioned by degenerative and dystrophic processes are associated with distinctive signs of osteoarthrosis and confirm non-specific inflammation active with bone resorption in patients with low back pain.

scholarly journals The main clinical and diagnostic characteristics of patients with low back pain and sacroiliac joint diseases (results of the IOLANTA-II study)

2020 ◽  
Vol 12 (4) ◽  
pp. 57-64
Author(s):  
I. A. Zolotovskaya ◽  
I. L. Davydkin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Bone Resorption ◽  
Pain Syndrome ◽  
Low Back ◽  
Disease Group ◽  
Bone Resorption Markers ◽  
Diagnostic Characteristics ◽  
Group 2 ◽  
Tgf Β1

Objective: to investigate the clinical and diagnostic characteristics of patients with low back pain in the presence of sacroiliac joint (SIJ) disease.Patients and methods. The investigation design involved three visits: V 1 (inclusion); V 2 (after 7 days), and V 3 (after 3 months); after the screening period, the investigation enrolled 259 patients aged 65.5 [62.5; 69.5] years; of them there were 165 (63.7%) women. At V 1 , according to magnetic resonance imaging findings, the patients were divided into two groups: 1) 157 patients without confirmed SIJ disease; 2) 102 patients with confirmed SIJ disease. During all visits, the investigators made general clinical and neurological examinations and assessed the intensity of pain syndrome according to a visual analogue scale (VAS) for pain in millimeters, a neuropathic pain component according to the DN4 questionnaire, by determining the blood parameters: transforming growth factor-β1 (TGF-β1), interleukin-1β (IL-1β), IL-6, Beta-Crosslaps, the indicator of bone matrix formation procollagen type 1 N-terminal propeptide (P1NP) and by estimating the urinary level of deoxypyridinoline.Results and discussion. At all visits, Group 2 patients with higher VAS pain scores had a pain history that was statistically significantly longer (p<0.001). The ANOVA analysis showed that the patients in Group 2 had statistically significantly higher values of TGF-β1, IL-1β, IL-6, and bone resorption markers than those in Group 1, which suggests the relationship between pain syndrome and the presence of an inflammatoryresorptive process in patients with SIJ disease.Conclusion. A high (39.4%) prevalence of SIJ disease was noted in patients over 60 years of age with low back pain. During the follow-up period, there was a decrease in bone resorption markers and cytokines; however, the SIJ disease group showed less pronounced changes with statistically significant differences in all parameters than in the non-SIJ disease group. It is advisable to consider an algorithm for diagnosing a patient over 60 years of age with low back pain, by mandatorily examining his/her SIJ. Treatment policy, including methods for correction with drugs, should be discussed based on the findings.

COMPARATIVE ANALYSIS OF POSTURAL DISORDERS IN ELDERLY PATIENTS WITH HEADACHES, LOW BACK PAIN AND MULTISENSORY INSUFFICIENCY

2019 ◽  
Vol 21 (12) ◽  
pp. 22-26
Author(s):  
Ахмадеева Л.Р. ◽  
◽  
Харисова Э.М. ◽  
Наприенко М.В. ◽  
◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Comparative Analysis ◽  
Elderly Patients ◽  
Low Back ◽  
Postural Disorders

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 ASSOCIATION OF LOW BACK PAIN AND SCIATICA WITH SIGNAL CHANGES IN THE VERTEBRAL ENDPLATE

2020 ◽  
Vol 19 (3) ◽  
pp. 213-217
Author(s):  
ALBERTO OFENHEJM GOTFRYD ◽  
DÉLIO EULÁLIO MARTINS FILHO ◽  
MARCELO WAJCHENBERG ◽  
MICHEL KANAS ◽  
SAULO DE TARSO DE SÁ PEREIRA SEGUNDO ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Type I ◽  
Low Back ◽  
Vertebral Endplate ◽  
Level Of Evidence ◽  
Signal Changes ◽  
Treatment Responses

ABSTRACT Objective To evaluate whether vertebral endplate signal changes (VESCs) influence the prognosis of patients submitted to conservative or surgical treatment for low back pain and lumbosciatica. Methods Study with 241 patients who underwent conservative treatment, infiltration or surgery with 12 months of follow-up. They were evaluated for pain by the Visual Analog Scale for Pain (VAS), for function by the Roland Morris questionnaire and for quality of life by the EuroQoI5 (EQ-5D). Results The VESCs did not have a significant effect on the treatment responses for the VAS (F = 0.03; P = 0.97), Roland Morris (F = 0.51; P = 0.60) and EQ-5D (F = 2.67; P = 0.07) variables, nor was there any interaction between VESC and treatment for VAS (F = 2.15; P = 0.08), Roland Morris (F = 1.55; P = 0.19) and EQ-5D (F = 2.15; P = 0.08). There was a significant effect for all treatments, however, the effect of the surgical procedure was superior when compared to the others (P <0.001). The VESC frequency was 48.33% for type 0, 29.17% for type I and 22.50% for type II. Conclusions The presence of VESC and its different types is not associated with a worse prognosis, nor was a higher prevalence of VESC observed in the patients with low back pain and lumbosciatica. Level of Evidence II; Retrospective cohort study.

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.

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