Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review

Imaging study of adult coccygeal morphology using direct digital radiography technology in China

Extensive studies on the morphological characteristics of the coccyx, using CT or MRI techniques, have been conducted in some European and Asian countries. However, research on coccyx morphology in China remains scarce. A total of 300 subjects, who underwent sacrococcygeal digital radiological scans at the third affiliated hospital of Zhejiang Chinese Medical University between January 2022 and December 2023, were analyzed in this retrospective study. Modified coccyx morphology classification was applied. Imaging focused on the type of coccyx and the number of coccygeal segments. The subjects exhibited coccyx type III (33.3%), type II (32.7%), type I (16.7%), type IV (16%), type V (0.3%), and type VI (1%). 32 males with coccygeal type II; 76 females with coccygeal type III. Significant differences in coccyx morphology were observed between male and female (p < 0.05). Coccygeal morphology showed correlations with age (p = 0.009), body weight (p = 0.01), and BMI (p = 0.039). Among Chinese adults, type III coccyx is the most common, and the 3-segment configuration is the most prevalent. Coccyx types differ by gender, coccyx morphology is correlated with age, weight, and BMI. Our study lays the foundation for future clinical applications of these findings.

CT-guided joint cavity release for postpartum sacroiliac joint pain management: an evaluation of its efficacy, safety, and clinical outcomes

Objective

The central aim of this study was to evaluate the safety and effectiveness of Computed Tomography (CT)-guided joint cavity release in treating patients suffering from postpartum sacroiliac joint pain.

Methods

A retrospective analysis was conducted on a sample of 37 patients who presented with postpartum sacroiliac joint pain and underwent CT-guided sacroiliac joint release treatment at The Affiliated Hospital of North Sichuan Medical College. General clinical attributes of the patients were recorded, and the intensity of their pain before and after the operation was compared using the Numeric Pain Rating Scale (NRS). The effectiveness of the surgical treatment was assessed using the Modified MacNab criteria. The functional status of the sacroiliac joint at 3-and 6-month intervals post-operation was examined, and any complications related to surgery were documented.

Results

The follow-up period was completed by all patients, with the successful implementation of CT-guided unilateral/bilateral sacroiliac joint release undertaken in 37 patients. Patient reported pain, as measured by the Numeric Pain Rating Scale (NRS), was considerably reduced postoperatively with scores showing significant decrement from 7.14 ± 1.23 preoperatively to 1.26 ± 0.53 at 1 week, 1.86 ± 0.62 at 1 month, 1.92 ± 0.48 at 3 months, and 1.97 ± 0.61 at 6 months postoperatively, respectively (p < 0.05). The comprehensive record of treatment response rates, interpreted as excellent and good, were consistent, standing at 100% (37/37), followed by 97.30% (35/37) and concluding with 91.89% (33/37). The Oswestry Disability Index (ODI) scores reflecting the patient's perceived level of disability prior to the surgery, and at 3 and 6 month intervals post-surgery were 45.12 ± 6.01, 18.14 ± 2.23, and 14.25 ± 2.15, respectively, demonstrating a significant improvement in postoperative scores when compared with preoperative scores (p < 0.05). The surgeries conducted were devoid of any complications such as bleeding, infection, cardiovascular or cerebrovascular incidents, or decline in joint functionality in any of the patients.

Conclusion

Evidently, CT-guided joint cavity release presents as an effective therapeutic approach for the management of postpartum sacroiliac joint pain, enhancing quality of life and preserving patient safety.

Critical distance of the sacroiliac joint for open reduction using screw fixation for traumatic sacroiliac joint diastasis: a retrospective study

BACKGROUND

Osteosynthesis for sacroiliac joint (SIJ) diastasis using an iliosacral screw (ISS) and a trans-iliac-trans-sacral screw (TITSS) can be performed using a closed or an open method. However, no clear indication for open reduction has been established.

METHODS

Data on patients with unilateral traumatic SIJ diastasis who underwent ISS and TITSS fixation were retrospectively collected and separated into groups according to the reduction method: closed reduction group (C group) and open reduction group (O group). Demographic data and perioperative image assessments were compared between the groups. The critical distance of the SIJ was identified to elucidate the indication for open reduction of the diastatic SIJ.

RESULTS

Fifty-six patients met the inclusion criteria over a 3-year period. There was no significant difference in the reduction quality of pelvic ring injuries between the groups, according to Matta's and Lefaivre's criteria. The improvement in the SIJ distance was significantly greater in the O group than in the C group in the axial plane on multiplanar computed tomography (p = 0.021). This model predicted that a difference of > 3.71 mm between the injured and healthy SIJ was a recommended indication for open reduction, with an area under the curve of 0.791 (95% confidence interval 0.627-0.955, p = 0.004).

CONCLUSIONS

Open reduction for SIJ diastasis might achieve better reduction quality than does closed reduction in the axial plane in selected cases. When the difference between the injured and healthy SIJ was wider than 3.71 mm, open reduction was recommended for satisfactory radiological outcomes.

Radiological Insights into Sacroiliitis: A Narrative Review

Sacroiliitis is the inflammation of the sacroiliac joint, the largest axial joint in the human body, contributing to 25% of lower back pain cases. It can be detected using various imaging techniques like radiography, MRI, and CT scans. Treatments range from conservative methods to invasive procedures. Recent advancements in artificial intelligence offer precise detection of this condition through imaging. Treatment options range from physical therapy and medications to invasive methods like joint injections and surgery. Future management looks promising with advanced imaging, regenerative medicine, and biologic therapies, especially for conditions like ankylosing spondylitis. We conducted a review on sacroiliitis using imaging data from sources like PubMed and Scopus. Only English studies focusing on sacroiliitis's radiological aspects were included. The findings were organized and presented narratively.

Comparison of High Uterosacral and Sacrospinous Ligament Suspension Surgeries for the Treatment of Pelvic Organ Prolapse in Women

Background

Pelvic floor disorders include urinary incontinence, fecal incontinence, and pelvic floor prolapse, which are common complaints in women. Patients that suffer from uterine prolapse could benefit from surgical procedures that stabilize pelvic ligaments. Here, we aimed to compare the high uterosacral and sacrospinous ligament suspension surgeries.

Materials and Methods

This clinical trial was performed in 2019-2021 on 64 women with uterine prolapse. Demographic data of the patients, including age, body mass index (BMI), past medical diseases, history of delivery, type of delivery, and duration of hospitalization, were collected. We assessed their urinary symptoms, prolapse degree, and sexual symptoms using the Female Sexual Function Index (FSFI) and Pelvic Floor Disability Index (PFDI-20) questionnaires before surgical interventions. Patients were divided into two groups undergoing high uterosacral and sacrospinous ligament suspension. They were followed up 6 and 12 months after surgeries.

Results

Patients treated with sacrospinous ligament suspension had higher frequencies of surgical complications (P = 0.039), and the most common complication was low back pain (15.6%). The uterine prolapse andC point degree improved significantly in all cases after 6 and 12 months (P < 0.001). The Pelvic Organ Prolapse Quantifications System (POP-Q) scores improved significantly in both groups 6 and 12 months after surgery (P < 0.001), and patients who underwent sacrospinous ligament suspension had significantly lower pain intensity compared to the other group (P = 0.003). FSFI scores improved significantly in patients treated in both groups (P < 0.001).

Conclusion

Both high uterosacral and sacrospinous ligament suspension techniques significantly improved pain, uterine prolapse, and C point degree.

Biomechanics evaluation of sacroiliac joint pain after lumbosacral fusion: A finite element analysis

The sacroiliac joint (SIJ) constitutes the predominant pain source following lumbar or lumbosacral fusion. Although studies have investigated the biomechanical patterns of SIJ behaviors after lumbosacral fusion, the relationship between ligament strain and SIJ pain following lumbosacral fusion remains unclear. The present study developed a three-dimensional finite element model including L4, L5, sacrum, ilium, SIJ, and seven mainly ligaments. After successful validation, the model was used to investigate the biomechanics of SIJ and ligaments in simulating lumbosacral fusion process. Our results showed that small motion in a stable SIJ may significantly increases the contact pressure and stress of the SIJ, which increase the maximum contact pressure by 171%, 676%, 199%, and 203% and stress by 130%, 424%, 168%, and 241% for flexion, extension, bending, and axial rotation, respectively. An increase in contact pressure and stress in SIJ possibly causes pain at the SIJ, especially in extension and axial rotation. A comparison between the lumbosacral and intact models exhibited the maximum strain increase in the iliosacral ligament (ISL) and the ileal ligament (IL) under all loading conditions. The present study suggests that after lumbosacral fusion process, the ligament sudden increase or decrease is likely to lead sprain or strain ligament, especially ISL and IL thereby causing SIJ pain. This study may contribute to understand the relationship between SIJ ligaments and SIJ pain.

Revision of Failed Sacroiliac Joint Posterior Interpositional Structural Allograft Stabilization with Lateral Porous Titanium Implants: A Multicenter Case Series

Background

Distraction arthrodesis (DA) and stabilization of the sacroiliac (SI) joint by placing standalone structural allograft (SA) into the joint from a posterior trajectory has recently been introduced as a surgical procedure for chronic SI joint pain refractory to non-operative care.

Methods

Retrospective case series of patients with recurrent and/or persistent pain after placement of one or more interpositional/intraarticular standalone SAs between the ilium and sacrum using a posterior procedure to treat SI joint pain/dysfunction. Patients subsequently underwent surgical revision with porous titanium fusion implants using a lateral transfixing procedure. The demographic, clinical, and radiographic features of these cases are described.

Results

Data were available for 37 patients. The average (SD) age was 57 (13) years, 62% were female, and the average BMI was 31 (5.4). On average, two SA implants were placed per joint; 46% of cases were bilateral. At follow-up, two common themes were identified: lucencies around the implants and suboptimal implant position. None of the cases showed radiographic fusion of the SI joint prior to revision. One patient had an inflammatory reaction to the SA. All patients presented for revision due to either continued (49%) or recurrence (51%) of pain. In one revision case, the SA was forced ventrally, resulting in a sacral fracture, which was treated conservatively without sequelae.

Conclusions

The popularity of standalone SA for SI joint stabilization/fusion with a posterior procedure is increasing. This case series demonstrates that clinical failures from this procedure may require surgical revision. The proposed fusion strategy (DA) for these products is unproven in the SI joint, and, therefore, properly conducted prospective randomized clinical trials with long-term clinical and radiographic follow-up are important to establish the safety and efficacy of this approach. In the meantime, the placement of lateral titanium implants appears to be an effective revision strategy.