Arthrosis of the sacroiliac joint, grade 1-2, surgery

September 24, 2019

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Arthrosis of the sacroiliac joint is an inflammatory degenerative-dystrophic disease that affects not only the joints connecting the pelvic bones and the sacrum, but also all nearby tissues. Its development can provoke severe pain and significant limitation of mobility, since it is the area of the sacromovable joint that bears a large load when walking. Therefore, it is important to detect the disease as early as possible and carry out proper treatment, which will prevent the loss of a person’s ability to move freely.

“SL Clinic” invites you to undergo diagnostics of diseases of the musculoskeletal system using modern equipment and receive a detailed consultation with a doctor. You will be able to ask any questions you are interested in, receive a carefully written treatment regimen, an objective assessment of the situation, and, if necessary, solve the problem surgically.

Reasons for development

The sacroiliac joint is a paired joint that is the junction of the spinal column and the pelvis. In the sacral region, the vertebrae are firmly fused to each other, forming an almost monolithic bone. Both of its lateral surfaces are covered with hyaline cartilage. The ilium is tightly adjacent to them.

The joint or articulation thus formed is strengthened by numerous rigid, practically immovable ligaments. It has a slit-like shape, and the articular cavity itself is filled with synovial fluid and acts as a shock absorber during movement.

The sacroiliac joint is practically motionless, but at the same time provides stability when standing, is responsible for stabilizing the body position when performing certain movements, when sitting, and distributes the load on the pelvis and legs when walking. Therefore, the slightest disturbances in its functioning affect the condition of the spinal column and can provoke the development of a wide variety of complications.

Over the years, the sacroiliac joint gradually changes and becomes prone to degenerative and dystrophic changes. The following can provoke the development of arthrosis:

various types of injuries to the lower back and tailbone;
multiple pregnancies and births, especially when carrying a large fetus;
abnormalities of bone tissue development;
infectious diseases affecting bone tissue;
obesity;
metabolic disorders that provoke calcium deficiency in the body;
sedentary lifestyle;
autoimmune disorders, in particular ankylosing spondylitis;
excessive physical activity.

A genetic predisposition to it significantly increases the risk of pathology. Most people diagnosed with this condition are over 55 years of age. Although recently there has been a tendency towards rejuvenation of diseases of the musculoskeletal system, therefore today it is no longer uncommon to find arthrosis of the sacroiliac joint in people from 25 to 35 years old. Most often, the pathology is diagnosed in women, due to the peculiarities of the anatomy.

Definition

The ilium is the largest of all paired bone formations in the human body; it, together with other bone bodies, creates the pelvic bone.

The ilium also connects the hip joint to the spine.

Both iliac bones have the same appearance and structure and are located in the hip region mirroring each other.

Symptoms of arthrosis of the sacroiliac joint

In the early stages of development, the disease practically does not manifest itself. Signs of a degenerative process occur when cartilage tissue is destroyed. This may be accompanied by:

discomfort in the lumbosacral spine and buttocks, aggravated by physical work, bending, turning, prolonged sitting or walking;
increased muscle tone in the sacral area;
limitation of motor activity and range of motion, feeling of stiffness;
the appearance of a characteristic crunch when bending or turning the body;
gait disturbance;
increased urge to urinate;
decreased libido.

The pain can initially usually be described as pulling, aching. They tend to radiate to the groin, legs, perineum, and buttocks.

The inflammatory process quickly worsens, which is accompanied by redness, increased sensitivity and swelling of the soft tissues in the projection of the diseased joint, impaired circulation in the affected area and a decrease in the amount of nutrients supplied. As a result, osteophytes are formed. As arthrosis progresses, the symptoms intensify, and in advanced cases the person almost completely loses the ability to move independently.

Stages of the disease

The intensity of signs of arthrosis of the sacroiliac joint depends on the stage of its development. There are 4 stages:

At first, the disease practically does not manifest itself. After physical work, long walking or sitting, minor short-term discomfort may occur in the sacrum and buttocks, which quickly disappears after rest. At the same time, the functions of the joints are completely preserved, so the person does not notice the limitation of mobility. Attacks of acute pain that interfere with standing are rare.
The pain intensifies and occurs more frequently, and can only be relieved by taking painkillers. This is triggered by the appearance of irreversible changes in the state of the cartilage tissue of the joint.
Due to severe deformation of the cartilage, osteophytes are formed along the entire surface of the joint, and the bone surfaces are exposed. In some cases, separation of the sacrum is observed. This is accompanied by severe pain, completely incapacitating the person.
Degenerative-dystrophic processes lead to complete stiffness and constant severe pain.

Structure

The right and left segments on both sides are attached to the sacrum and structurally have rounded apices. The lower part is noticeably thickened and shortened, and in medicine is called the body of the ilium, which together with the pubic and ischial elements form the upper part of the acetabulum. The femur and sacrum bones are attached to the body.

In the upper part of the ilium there is an expansion, which precisely forms the wing of the ilium. This is a more fragile structure. Its outer curved edge is called the iliac crest, has the shape of a protrusion, and below is the sciatic notch. The concave part of the wing forms the iliac fossa, the convex part forms the surface of the buttocks, and in the posterior region inside the place of articulation of the sacrum and pelvic bone is concentrated, which is called the auricular surface.

Diagnostics

It is impossible to establish the cause of pain only on the basis of the existing clinical picture, since more than 15 different diseases are accompanied by symptoms typical for arthrosis of the sacroiliac joint. In particular, ankylosing spondylosis, L5-S1 hernias, spinal canal stenosis, scleroderma and other diseases manifest themselves in a similar way.

To diagnose the disease, the following are prescribed:

CBC - used to detect signs of an inflammatory process (with arthrosis, the number of leukocytes in the blood and ESR are usually not much higher than normal);
biochemical blood test - necessary to assess the functioning of internal organs;
X-ray or CT - each method allows you to detect narrowing of the joint space, signs of destruction of cartilage tissue and osteophytes;
MRI is the most informative diagnostic procedure, with which you can detect even minimal deviations from the norm in the condition of ligaments, muscles and joints;
Osteoporosis screening – prescribed to identify bone weakness.

At SL Clinic you can get advice from a specialist who has been treating this problem for many years. Therefore, when undergoing treatment with us, you will definitely not miss the progression and development of the disease when you contact immediately after the first symptoms appear.

Tests for appendicitis

General clinical blood test (shows signs of inflammation in the form of increased ESR, C-reactive protein, leukocytosis, neutrophilia).
General urine test (for differential diagnosis).
Determination of alpha-amylase in urine (including pancreatic) - this enzyme allows you to identify inflammation of the abdominal organs.
Culture of abdominal exudate for sensitivity to antibiotics.
Histological examination of the appendix.

The material for the last two studies is taken during the operation.

Treatment of arthrosis of the iliosacral joint

The effectiveness of treatment largely depends on how early it was started. Along with conservative therapy, radiofrequency ablation of the joint is prescribed, in a set of measures that together help eliminate the inflammatory process and stop the destruction of the joint. It includes:

drug therapy;
physiotherapy;
manual therapy;
Exercise therapy.

In case of exacerbation of the disease, bed rest is recommended until the severity of pain decreases. In the future, patients are advised to give up heavy physical work, sports and long running. But moderate physical activity is an integral part of the fight against arthrosis of the sacroiliac joint. When working in a sedentary or standing position, it is important to take regular breaks and walk around.

A vertebrologist may recommend that the patient wear a special orthopedic corset. It will help reduce stress on the back muscles and pressure on the affected joints. The bandage is selected individually by the doctor. It should be worn for several hours during the day.

If conservative treatment is completely ineffective or advanced forms of arthrosis have led to the formation of osteophytes, patients can be helped surgically. This will protect the person from pain, preserve his ability to work and avoid disability.

Drug therapy

In order to relieve pain and eliminate the inflammatory process, patients are prescribed drugs from different groups. They, as well as the route of administration (oral, intramuscular, intravenous) and doses are selected individually, based on the stage of development of arthrosis of the sacroiliac joint. In this case, existing concomitant diseases must be taken into account.

Patients are advised to use:

NSAIDs – used for moderate pain. In addition to the analgesic effect, they have anti-inflammatory properties. They are most often used in the form of drugs for oral use, but if they are ineffective, intramuscular injections can be prescribed. The negative side of drugs in this group is their negative effect on the condition of the mucous membranes of the gastrointestinal tract with long-term use.
Corticosteroids - indicated for severe inflammatory processes that cannot be treated with NSAIDs. They are prescribed in short courses and have a powerful anti-inflammatory effect.
Muscle relaxants are drugs that relieve muscle spasms. They are used to eliminate reflex spasms caused by pain. This reduces the intensity of pain and improves blood circulation in the area.
Chondroprotectors - drugs in this group are designed to stop the destruction of cartilage tissue and improve its structure. They are intended for long-term use.
Vitamin complexes – help increase the effectiveness of drugs from other groups and normalize metabolic processes.
Local remedies in the form of ointments, creams or gels most often contain NSAIDs and are used to relieve mild pain.

Lidocaine or novocaine blockades can quickly relieve unbearable pain. They are performed exclusively under completely sterile conditions, i.e. in a medical facility. The essence of the procedure is to inject anesthetic solutions into precisely defined points in the sacral area. The manipulation brings relief within 2–5 minutes. It can also be carried out at the SL Clinic.

But the blockade cannot be performed during pregnancy or the presence of pustular rashes on the skin in the projection of the affected joint.

Physiotherapy

Physiotherapeutic procedures that are correctly selected in terms of duration and frequency of implementation significantly increase the effectiveness of drug therapy and can reduce the intensity of pain. Patients are recommended:

electrophoresis with the introduction of drugs from the NSAID group - the procedure involves the introduction of drugs through a weak electric current directly into the lesion;
laser therapy – the thermal effect of the laser activates the processes of regeneration of cartilage tissue cells;
reflexology - influencing biologically active points helps improve blood circulation and reduce pain;
Magnetic therapy - a method that helps reduce the intensity of pain and reduce the rate of degenerative processes.

Usually a course of procedures is prescribed, consisting of 10–12 sessions. They can only be carried out during remission. Contraindications to physiotherapeutic treatment are serious diseases of the cardiovascular system, severe renal or respiratory failure, febrile conditions, and epilepsy.

Manual therapy

Manual therapy sessions conducted by a specialist, taking into account the characteristics of the patient’s condition, can not only activate blood circulation in the area of the sacroiliac joint and thereby improve tissue nutrition, but also slow down the course of degenerative processes.

The procedures are carried out in courses. They should be started only after the acute phase of arthrosis is completed.

Exercise therapy

Although rest helps relieve pain, a specific set of exercises can be even more helpful. Moreover, physical therapy plays an important role in the conservative treatment of arthrosis of the sacroiliac joint. Depending on the stage and general condition of the patient, a training schedule and workload are individually developed for him. It is usually necessary to do therapeutic exercises daily for 20–30 minutes.

The first sessions of exercise therapy are recommended to be carried out under the supervision of a specialist. This will help not only to master the necessary set of exercises, but also to maintain an optimal rhythm when performing it. In most cases, patients are prescribed body turns, bends, rotations, etc. When performing any exercise, it is important to avoid sudden movements and overexertion, and if pain occurs, you should definitely consult a doctor.

Swimming and yoga have a beneficial effect on the patient's condition. But they are only permissible outside of exacerbation of arthrosis.

Surgical treatment of arthrosis of the sacroiliac joint

In some cases, the only way for patients to get rid of excruciating pain and avoid long-term back pain and joint pain is surgical treatment of arthrosis. It is indicated when attempts to cope with the disease using conservative methods are unsuccessful, as well as in severely advanced cases, i.e., stage 3 arthrosis of the sacroiliac joint.

The essence of surgical intervention depends on the nature of the existing changes. Radiofrequency ablation of nerve endings can be used to eliminate pain. Its essence consists in introducing a special electrode through a pinpoint puncture of soft tissue directly to the pain-causing nerve and its destruction by the generated thermal energy.

The procedure in most cases leads to immediate pain relief. In other situations, there is a progressive decrease in their intensity over 6-8 weeks. After it is completed, the patient can almost immediately move independently and return home on the same day.

If irreversible changes have occurred in the sacroiliac joint, the surgeon may recommend arthrodesis to the patient. The operation is performed on both sides in 2 stages:

With the patient lying on his stomach after treatment of the surgical field, an incision about 2 cm long is made and a channel is formed into the articulation cavity through the posterior portion of the sacroiliac ligament. Using special instruments, a thorough curettage is carried out, i.e., cleaning the articular surfaces. The cavity is washed with solutions of antiseptics and antibiotics and the wound is sutured. Drainage is inserted into it and an antiseptic bandage is applied.
The patient is turned over onto his back and a cushion is placed under the lumbar curve. An incision up to 4–5 cm long is made along the iliac crest, through which a bone canal is formed in the crest using an awl. Also, 2 more channels are created at a distance of 1–2 cm from the first. 3 rods are inserted into them and the rigidity of the installation is carefully controlled. An external fixation device is mounted on them and the necessary compression parameters are set.

During the rehabilitation process, surgeons change compression modes, thereby achieving effective arthrodesis of the sacroiliac joint. Patients can get up already on the second day after surgery. In the absence of adverse events, he can stand up independently and begin learning to walk. A control x-ray is performed on day 5 and, if there are no complications, the patient can return home, receiving detailed recommendations on the specifics of recovery.

Every 2–3 days, the patient must independently or with the help of relatives carry out dressings and take prescribed medications. After 8–10 weeks, a repeat X-ray examination is performed and part of the external fixation device is removed. After this, the patient needs to walk for about an hour, leaning on crutches and without them. In the absence of pain, final dismantling is performed, which leads to normalization of range of motion.

You can undergo conservative and surgical treatment for arthrosis of the sacroiliac joint at the SL Clinic. Our highly qualified vertebrologists are able to accurately determine the causes of pain and stiffness of movement, and select the optimal treatment tactics, which are sure to give positive results.

In severe cases, you can receive professional surgical care from us and regain the ability to move calmly. We provide medical services at the level of well-known clinics in Germany, Israel and the Czech Republic, but at the same time make them accessible to a wide range of patients. The cost of all types of services, including specialist consultations, blockades, surgical treatment, is given in the price list. Entrust your health to us, and we will do everything possible so that pain does not bother you anymore.

Appendicitis in children

The highest incidence occurs between the ages of 9 and 12 years, and in general, acute appendicitis occurs in 3-6 out of 1000 children [3].
Appendicitis in children over 3 years of age occurs almost the same as in adults. Young patients are characterized by:

long-term localization of pain in the epigastrium, then throughout all parts of the abdomen;
constipation or repeated diarrhea;
repeated vomiting;
restlessness, crying, lack of appetite;
fever up to 39 °C;
slight bloating, constant tension in the muscles of the abdominal wall.

In children, especially in the first three years of life, inflammation develops faster and complications are more frequent.

Disease prevention

Since arthrosis is an age-related disease, it is impossible to guarantee its absence, especially if there is a hereditary predisposition. But it is possible to reduce the risk of its development. For this purpose it is recommended:

regular moderate physical activity;
avoid prolonged sitting or standing;
promptly treat any infectious disease;
avoid stress and nervous tension;
do not lift too heavy objects;
maintain normal weight.

Bibliography

Barsukova, I.M. Acute appendicitis: history and modern organization of medical care// I.M. Barsukova, M.V. Gavshchuk, A.P. Krivov. - text: direct // Scientific notes of St. Petersburg State Medical University named after. I. P. Pavlova, 2021.- No. 3 – P. 43-49, DOI: 10.24884/1607-4181-2018-25-3-43-49.
Clinical guidelines “Acute appendicitis in adults”, 2021, Developers: All-Russian public association “Russian Society of Surgeons”, All-Russian public organization “Russian Society of Endoscopic Surgeons”. - Text: electronic. - URL: (access date: 09/29/2021).
Draft clinical guidelines “Acute appendicitis in children”, 2016. Developer: Russian Association of Pediatric Surgeons, -Text: electronic.- URL: (access date: 09.29.2021).

Author:

Pugonina Tatyana Alekseevna, Therapist

Cost of treatment for arthrosis of the sacroiliac joint at SL Clinic

Treatment of SI joint arthrosis involves inserting needles into the projections of the diseased joint and treating them in a temperature regime. The procedure is minimally invasive and outpatient i.e. you can go home the same day.

The cost of radiofrequency treatment of arthrosis of the SIJ is 68,000 rubles and depends on: - The cost of needles for radiofrequency ablation; — Clinics and class wards. The price includes: — Stay at the clinic before and after surgery; — Operation; — Cost of needles for radiofrequency ablation; — Observation and consultation during the rehabilitation period. All clinic services and costs are listed in the price list.

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How does chondrosarcoma manifest?

The severity of clinical manifestations of chondrosarcoma depends on its morphological structure. Well-differentiated tumors are characterized by long-term slow growth (over 4-5 years) with low severity of symptoms. Such formations can reach significant sizes. With anaplastic chondrosarcomas, which often affect young people, symptoms develop faster, on average within 3 months.

The main symptoms of the disease are pain in the area of tumor growth. The pain is constant, characterized by a progressive increase in intensity. Other local manifestations (increased venous pattern, local increase in temperature, dysfunction of a nearby joint) are less common than with osteosarcoma and are less pronounced.

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