Abstract
Objective
The purpose of the present study was to evaluate the role of diagnostic tools and management options for patients with pyogenic sacroiliitis, including potential complications.
Materials and methods
This retrospective study included 16 patients with pyogenic sacroiliitis who were admitted to a single orthopaedic centre between 2007 and 2012. The following data were collected: demographics, history, radiography, magnetic resonance images (MRI), biological data, type of pathogenic agent, abscess formation, type of management, and clinical outcome.
Results
Our study demonstrated that only one-fifth of the patients with lumbogluteal or hip pain had established diagnoses of suspected pyogenic sacroiliitis upon admission. MRIs confirmed this diagnosis in all cases. MRI examinations revealed joint fluid in the sacroiliac joint and significant oedema of the adjacent bone and soft tissues. In 12 of the 16 cases, erosions of the subchondral bone were encountered. Contrast-enhanced MRI revealed that 9 patients had abscesses. All patients received antibiotic therapy. Antibiotic treatment was only successful in 9 cases. The other 7 patients underwent computed tomography (CT)-guided abscess drainage. Drainage was sufficient for 4 patients, but 3 patients required open surgery. One patient required sacroiliac arthrodesis. The clinical outcomes included minimal disability (n = 10), moderate disability (n = 5), and full disability (n = 1) of the spine.
Conclusions
Contrast-enhanced MRI is mandatory for a reliable diagnosis. Abscess formation was observed in approximately half of the MRI-diagnosed sacroiliitis cases and required minimally invasive drainage under CT guidance or frequently open surgery.
Similar content being viewed by others
References
Wu MS, Chang SS, Lee SH, et al. Pyogenic sacroiliitis—a comparison between paediatric and adult patients. Rheumatology. 2007;46:1684–7.
Stephen MC, David JS. Pyogenic sacroiliitis. Another imitator of the acute abdomen. Surgery. 1986;100:95–8.
Laslett M, Aprill CN, McDonald B, et al. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther. 2005;10:207–18.
Lewit K. Manipulative therapy: myoskeletal medicine. Philadelphia: Churchill Livingstone; 2009.
Fairbank JCT, Pynsent PB. The Oswestry disability index. Spine. 2000;25:2940–53.
Roland M, Morris R. A study of the natural history of back pain. I. Development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8:141–50.
Hermet M, Minichiello E, Flipo RM, et al. Infectious sacroiliitis: a retrospective, multicentre study of 39 adults. BMC Infect Dis. 2012;12:305. doi:10.1186/1471-2334-12-305.
Vyskocil JJ, McIlroy MA, Brennan TA, et al. Pyogenic infection of the sacroiliac joint. case reports and review of the literature. Medicine (Baltimore). 1991;70:188–97.
Doita M, Yoshia S, Nabeshima Y, et al. Acute pyogenic sacroiliitis without predisposing conditions. Spine. 2003;28:384–9.
Taylor ZW, Ryan DD, Ross LA. Increased incidence of sacroiliac joint infection at a children’s hospital. J Pediatr Orthop. 2010;30:893–8.
Osman AA, Govender S. Septic sacroiliitis. Clin Orthop Relat Res. 1995;313:214–9.
Chan DSY, Saklani A, Shah PR, et al. Laparoscopic drainage of retroperitoneal abscess secondary to pyogenic sacroiliitis. Ann R Coll Surg Engl. 2010;92:32–4.
Bellussi A, Busi Rizi E, Schinina V, et al. STIR sequence in infectious sacroiliitis in three patients. Clin Imaging. 2002;26:212–5.
Helms CA, Major NM, Anderson MW, et al. Musculoskeletal MRI second edition. Philadelphia: Saunders Elsevier; 2009.
Stürzenbecher A, Braun J, Paris S, et al. MR imaging of septic sacroiliitis. Skeletal Radiol. 2000;29:212–5.
Ferraro K, Cohen MA. Acute septic sacroiliitis in an injection drug users. Am J Emerg Med. 2004;22:60–1.
Turan H, Serefhanoglu K, Karadeli E, et al. Osteoarticular involvement among 202 brucellosis cases identified in Central Anatolia region of Turkey. Intern Med. 2011;50:421–8.
Chauhan S, Wakhlu A, Agarwal V. Arthritis in leprosy. Rheumatology (Oxford). 2010;49:2237–42.
Mancarella L, De Santis M, Magarelli N, et al. Septic sacroiliitis: an uncommon septic arthritis. Clin Exp Rheumatol. 2009;27:1004–8.
Roblot F, Besnier JM, Juhel L, et al. Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum. 2007;36:269–77.
Buchowski JM, Kebaish KM, Sinkov V, et al. Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint. Spine. 2005;5:520–9.
Al-Khayer A, Hegarty J, Hahn D, et al. Percutaneous sacroiliac joint arthrodesis: a novel technique. J Spinal Disord Tech. 2008;21:359–63.
Khurana A, Guha AR, Mohanty K, et al. Percutaneous fusion of the sacroiliac joint with hollow modular anchorage screws: clinical and radiological outcome. J Bone Joint Surg. 2009;91:627–31.
Wise CL, Dall BE. Minimally invasive sacroiliac arthrodesis: outcomes of a new technique. J Spinal Disord Tech. 2008;21:579–84.
Conflicts of interest
This study was supported by the programme PRVOUK P37/04 and by MHCZ—DRO (UHHK, 00179906).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kucera, T., Brtkova, J., Sponer, P. et al. Pyogenic sacroiliitis: diagnosis, management and clinical outcome. Skeletal Radiol 44, 63–71 (2015). https://doi.org/10.1007/s00256-014-1999-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-014-1999-y