MRI of the sacroiliac joints in the network of clinics "Policlinika.ru", get an MRI in Moscow

Indications for MRI

Computed tomography, ultrasound or radiography do not allow full visualization of the iliosacral joints. For this reason, this part of the body is diagnosed using magnetic resonance imaging. As a rule, this research method can be prescribed in the following cases:

Congenital structural anomalies.
Traumatic injuries of the lower spine.
Change in gait.
The patient complains of pain in the lower back.
Limitation of mobility of the lumbar spine.
Suspicion of an inflammatory process.

Back pain with a predominant localization in the lumbosacral region, which can limit movement in the lumbar spine, radiate to the buttock and along the back of the leg, is most often associated with neurological manifestations of degenerative changes in the lumbosacral spine, especially since these changes, as a rule, are detected by magnetic resonance imaging and are often combined with protrusions of the discs of this department. However, such complaints may be a manifestation of damage to the sacroiliac joint - sacroiliitis (SI), and degenerative changes in the spine may accompany it, but not be the cause of pain.

So what does a neurologist need to know about sacroiliitis, which can masquerade as degenerative spinal diseases (DSDs), and is similar to myofascial syndromes and radiculitis, in order to begin proper treatment on time?

Sacroiliitis is an inflammatory process in the sacroiliac joint, which can be either an independent disease or a symptom of other infectious or autoimmune diseases. Typically, SI develops on one side, but the lesion can also be bilateral. Simultaneous involvement of both sacroiliac joints can be observed with brucellosis (less commonly with tuberculosis). Bilateral SI is also a constant symptom of ankylosing spondylitis (BD), although the presence of unilateral or bilateral lesions of the sacroiliac joint cannot be a decisive symptom in making a diagnosis.

Depending on the prevalence of the inflammatory process, the following types of SI are distinguished: synovitis, osteoarthritis and panarthritis. According to the nature of inflammation, SI can be nonspecific (it has a non-infectious nature, when the lesion is caused by degenerative-dystrophic processes in the joint area or inflammation of the sacrolumbar ligament), specific (syphilitic, tuberculosis, brucellosis, yersinia), as well as aseptic (autoimmune).

Particular attention is paid to the early diagnosis of infectious sacroiliitis, the treatment of which requires antibacterial therapy at an early stage of the disease so that irreversible changes in the joint do not develop, and in some cases, progressive autoimmune changes requiring lifelong treatment.

Tuberculous sacroiliitis

Mostly adult women get sick, for some unknown reason, 2 times more often than men. Clinical diagnosis, despite a number of fairly characteristic symptoms, is difficult and unreliable, so in practical life many mistakes are made here in the direction of both over- and under-diagnosis. X-ray examination can help diagnose tuberculous lesions of the sacroiliac joint (which, as a rule, is unilateral). The initial destructive changes come from either the ilium or the sacrum, and then the process usually spreads to the joint. A pronounced inflammatory process on an x-ray looks like massive destruction in the area of the ilium or sacrum. Sequestra may occupy a third or more of the affected bone. In this case, the contours of the joint are blurred, the edges are corroded. In some cases, partial or complete disappearance of the joint space is observed.

During the chronic course, sooner or later, edema abscesses always or almost always appear in different places. X-ray diagnostics becomes more convincing when the pathological process is one-sided and there is a criterion for comparison with the other side.

Sacroiliitis with syphilis

In secondary syphilis, sacroiliitis rarely develops and usually occurs in the form of arthralgia, which quickly resolves under the influence of specific antibiotic therapy.

With tertiary syphilis, gummous SI may be observed in the form of synovitis or osteoarthritis. Mild diffuse pain (mainly at night) and some stiffness of antalgic origin are noted. With synovitis, changes are not detected on the x-ray. With osteoarthritis, the X-ray picture may vary - from minor changes to partial or complete destruction of the articular surfaces. The X-ray picture of the affected joint is not always informative, since changes can be minor, becoming more pronounced over time.

Sacroiliitis in brucellosis

Typically, joint damage in brucellosis is transient and occurs in the form of volatile arthralgia. However, in some cases, persistent, long-term, difficult-to-treat inflammation occurs in the form of synovitis, periarthritis, arthritis or osteoarthritis. At the same time, SI is observed quite often (42% of the total number of joint lesions).

Sacroiliitis with brucellosis can be either unilateral or bilateral. A patient with sacroiliitis complains of pain in the sacroiliac region, which intensifies with movements, especially with extension and flexion of the spine. Rigidity and stiffness are noted. There are no changes on the radiograph with brucellosis sacroiliitis, even in the presence of severe clinical symptoms.

Even less pathognomonic signs of damage to the sacroiliac joint can be seen on radiographs in patients in the early stages of brucellosis SI.

Sacroiliitis with yersiniosis

At first glance, this is a rare disease, but in fact it is often not detected due to a lack of alertness. In addition, laboratory confirmation of the diagnosis of yersiniosis is rarely possible the first time. The share of positive results does not exceed 20%. This indicator is due to the low concentration of the infectious agent in the blood and biological material. In the manifest course, this figure can reach 50%.

When it comes to SI, which was a consequence of yersiniosis, it should be remembered that this infectious anthropozoonotic disease is characterized by an enteral phase. Further in its course, the disease can go through generalized, regional, secondary and allergic stages with exacerbations and the possible development of mesadenitis, infectious-allergic myocarditis, erythema nodosum, uveitis. Carriers of Yersinia are wild animals - pigs, rodents, dogs, cows and cats. Infection occurs due to contamination of food with excrement. Another way is contaminated water from open reservoirs.

The main symptoms of the acute phase of yersiniosis are enterocolitis. Abdominal syndrome (clinic of appendicitis) may also be observed; mesadenitis; infectious-allergic myocarditis; erythema nodosum; fever (38–39 °C); increased erythrocyte sedimentation rate (ESR); leukocytosis; eye lesions (conjunctivitis, episcleritis, uveitis). Gastrointestinal manifestations can be erased, mild and short-term, recalled retrospectively when the cause of SI is determined, which begins to develop 1-3 weeks after the manifestations of enterocolitis. Yersinia arthritis, and in particular SI, is a reactive disease. However, inflammation of the joints of a septic nature is also sometimes observed. Medium and large joints are in the affected area (the lower limbs are most often affected, sometimes the hands). Arthritis, when examined superficially, is similar to rheumatic arthritis. Isolated SI is often observed.

The duration of the disease is about 1–5 months. Then complete recovery occurs or the disease becomes recurrent. A chronic course is also possible. Relapses and exacerbations of yersiniosis occur with a frequency of 8 to 55%. Moreover, in 3–10% of cases the disease develops into a subacute and chronic form. The first relapses can occur as early as the beginning of the third week of the disease. As for complications, they are numerous. In addition to chronic progressive joint damage, the disease can cause complications in the form of myocarditis, cholecystitis, hepatitis, pancreatitis, appendicitis, peritonitis, etc.

Aseptic (infectious-allergic) sacroiliitis

Aseptic SI can occur in many rheumatic diseases, including rheumatoid arthritis, psoriatic arthritis, and Reiter's disease.

Bilateral SI has a particular diagnostic value in BD. The X-ray picture characteristic of SI in such cases ensures early diagnosis and allows treatment to begin in the most favorable period for this.

The genetic determination of ankylosing spondylitis is evidenced by the presence of the HLA-B27 antigen (HLA - Human Leukocyte Antigen) in more than 90% of patients, while in the general population this antigen is found in only 7% of individuals. It is detected in other spondyloarthritis, but much less frequently - in 30-60% of cases, which indicates the pathogenetic proximity of ankylosing spondylitis and Reiter's disease.

In addition, acquired factors, mainly infection, may play an important role in the development of BD. Recently, a discussion has been developing around the potential provocateur of this serious progressive relapsing autoimmune disease - microorganisms of the intestinal group, in particular Klebsiella

Ankylosing spondylitis requires differential diagnosis with manifestations of degenerative changes in the spine. The age of the patient helps to distinguish between these conditions. BD mainly develops in young men, while DZD, despite the tendency towards rejuvenation, occurs after 35–40 years. In BD, the sacroiliac joint is primarily affected, then the intervertebral and costovertebral joints, in which, at the onset of the disease, chronic inflammation of the synovium primarily develops, histologically similar to synovitis in rheumatoid arthritis. Clinical manifestations of sacroiliitis in BD are mild, in the form of mild or moderate pain in the lower back, sacrum, radiating to the buttock, thigh. The pain intensifies at rest and decreases with movement. It is noteworthy that with BD, pain intensifies at rest or with prolonged stay in one position, especially in the second half of the night. Patients report morning stiffness that disappears after exercise. And in the case of DZP, the pain component occurs or intensifies after physical activity, at the end of the working day.

One of the early signs of BD is tension in the back muscles, their gradual atrophy and stiffness of the spine. At the same time, with DZP, restriction of movement occurs at the height of pain, and its relief makes it possible to restore the mobility of the spine. When objectively examining a patient at an early stage of pathology, it is of great importance to identify pain when loading the sacroiliac joint (positive Kushelevsky and Mennel symptoms, less often - Thomayer). For

Early diagnosis is also important for such rare symptoms as arthralgia or arthritis in the area of the sternoclavicular and sternocostal joints, the presence of iritis, heel pain, muscle tension in the lumbar region, smoothness of the lumbar lordosis, a feeling of difficulty when bending at the lower back.

Laboratory data: detection of HLA-B27, increased ESR add confidence in the diagnosis.

It should be remembered that the radiographic signs of damage to the sacroiliac joints, characteristic of the early stage of BD, do not occur in DZD. At the first stage of sacroiliitis with BD, moderate subchondral sclerosis and widening of the joint space are determined on the radiograph. The contours of the joints are unclear. At the second stage of sacroiliitis, subchondrosis becomes pronounced, the joint space narrows, and single erosions are detected. In the third, partial, and in the fourth, complete ankylosis of the sacroiliac joints is formed.

Early diagnosis of BD is extremely important, since in this disease it is not the restriction of movements, but rather correctly planned motor activity that helps prevent rapidly developing irreversible joint changes in the form of ankylosis.

Sacroiliitis of non-infectious nature

Non-infectious lesions of the sacroiliac joint can hardly be called sacroiliitis, since in such cases either degenerative changes in the sacroiliac joint or inflammation of the sacroiliac ligament are observed. However, in clinical practice in such cases the diagnosis of “sacroiliitis of unknown etiology” is often made. Such pathological changes may be caused by previous injuries, constant overload of the joint due to pregnancy, sports, carrying heavy objects or sedentary work. The risk of developing this pathology increases with poor posture, an increase in the angle of the lumbosacral junction, and non-fusion of the arch of the fifth lumbar vertebra. Patients complain of paroxysmal or spontaneous pain in the sacral region, usually aggravated by movement, prolonged standing, sitting, or bending forward. Possible irradiation to the lower back, thigh or buttock. Upon examination, mild to moderate tenderness in the affected area and some stiffness are revealed. In some cases, a duck's walk develops (swaying from side to side when walking). Ferguson's symptom is pathognomonic: the patient stands on a chair, first with the healthy and then the sore leg, and then gets off the chair, lowering first the healthy and then the sore leg. In this case, pain occurs in the area of the sacroiliac joint.

The most informative tests for diagnosing damage to the sacroiliac joint

Stretching

Tensile force is applied to the anterior surface of the joints affected by SI.

— The patient lies on his back and is asked to place his forearm under the lower back to maintain the curve of the spine and support the lumbar region. A pillow is placed under the patient's knees. The doctor places his hands on the anterior and medial surfaces of the patient’s left and right superior anterior iliac spines, crossing his arms and leaving his elbows straight.

— A slow and steady posterior force is applied while leaning toward the patient.

FABER (Flexion, ABduction, External Rotation) sign, or Patrick test

The patient lies on his back, one leg is straightened, the other is bent at the knee joint. The outer ankle of the bent leg is located across and above the patella of the opposite leg. It is possible to place the foot of the bent leg on the medial surface of the opposite knee joint. The doctor applies pressure to the area of the knee joint of the bent leg, while simultaneously fixing the pelvis on the opposite side with his hand. Normally, abduction is possible almost until the knee touches the couch. With a positive hyperabduction test, movement is limited, tension in the adductor muscles is detected, and the patient feels pain when the limb reaches a position at which the adductor muscles begin to tense.

Compression

Iliac pressure test

The patient lies on his side. The doctor uses two hands placed on the ilium on the affected side to apply compression to the pelvis. The appearance of pain during the test is associated with pathology of the sacroiliac joint.

Gaenslen's test

The patient lies on his back, positioned as close as possible to the edge of the table or hanging from it on the affected side. In order to stabilize this position and fix the lumbar spine, the opposite leg is bent at the knee and hip joints so that it is pulled as close to the body as possible. The doctor performs passive hyperextension of the leg hanging over the edge of the table. When the sacroiliac joint is affected, pain occurs or intensifies (Fig. 4).

Radiological examination reveals the following signs of sacroiliitis:

- narrowing of the joint space of the sacroiliac joint up to its complete absence;

- unevenness, blurring of the contours of the articular surfaces of the bones;

- compaction of bone tissue;

— the presence of erosions and subchondral sclerosis (replacement of normal connective tissue in the area under the articular cartilage) in both articulating bones (II–III radiological stages according to the Kellgren classification);

- with purulent sacroiliitis, there is an expansion of the joint space and moderate osteoporosis (decreased bone density) of the articular parts of the sacrum and ilium.

Endplate erosions appear on CT scans as localized marginal defects of cortical bone. Erosion is the result of inflammatory lesions of the marginal parts of the bone. Sclerotic changes are associated with hardening of the articular surfaces in response to the inflammatory process and represent a zone of increased bone density of varying sizes located near the iliac endplate and/or the lateral mass of the sacrum. Subchondral sclerosis with sacroiliitis occurs more on the side of the ilium.

The joint space is considered widened if its width was 5 mm or more, and narrowed if its width was less than 2 mm. Ankylosis is the absence of visualization of the joint space along the entire length (complete ankylosis) or in a limited area (partial ankylosis). Partial ankylosis appears on radiographs and computed tomograms as a bone bridge between the articulating surfaces. Complete ankylosis is characterized by the absence of visualization of the joint space throughout the entire joint cavity due to fusion of the articular surfaces.

The success of treatment for specific SI directly depends on the prescription of etiotropic therapy. At the same time, regardless of the cause, severe and persistent pain syndrome due to damage to the sacroiliac joint requires quick measures to relieve the inflammation that is the cause of the pain.

In most cases, treatment tactics may require long-term use of anti-inflammatory drugs with a favorable safety profile, which, if necessary, could be prescribed long-term.

In this regard, the prescription of lornoxicam (Xefocam, Takeda) seems appropriate.

Why Xefokam?

Xefocam is an original non-steroidal anti-inflammatory drug of European quality, which has a pronounced analgesic and anti-inflammatory effect.

The analgesic and anti-inflammatory effect of Xefocam is based on a balanced inhibition of cyclooxygenase-1 (COX-1) and COX-2, which is complemented by stimulation of the production of endogenous dynorphin and endorphin and inhibition of the production of interleukin-6 (IL-6), nitric oxide, as well as inhibition migration of polymorphonuclear leukocytes.

J. Berg (1999) showed that lornoxicam in vitro

significantly inhibited the formation of IL-6, thereby confirming its anti-inflammatory and analgesic activity. As is known, IL-6 is one of the most important mediators of the acute phase of inflammation, the excess production of which causes tissue damage, in particular cartilage. Some studies have shown the possibility of lornoxicam preventing the destruction of cartilage tissue.

In addition, Xefocam uniformly suppresses COX-1 and COX-2, while at the same time it has a short half-life, which ensures a fairly low likelihood of side effects (Antman et al., 2007; J. Pleiner et al., 2009 ).

All of the above information is confirmed by the fact that Xefocam has been successfully used in European countries for more than 20 years.

When myofascial syndrome accompanies sacroiliitis (for example, piriformis syndrome), compression syndrome of the sciatic nerve often develops, followed by the development of neuropathy. In this case, given the presence of a neuropathic component of pain, it would be appropriate to include a combination of nucleotides, the drug Keltican, in the treatment regimen. It is a combination of two nucleotides, cytidine and uridine, which play an important role in the synthesis of nucleic acids, lipids and proteins. Having the ability to promote the regeneration of affected structures of the peripheral nervous system, Keltikan ensures a reduction in the severity of pain symptoms, thereby increasing the patient’s quality of life.

Contraindications

Magnetic resonance imaging does not harm the body, but only if you have no contraindications to the procedure. The main contraindication is the presence of metal objects in the body (pins, knitting needles, implants, pacemakers) because under the influence of the magnetic field of the tomograph, they can heat up and move.

Other contraindications include the following factors:

Presence of pregnancy. During the first 2 months of pregnancy, it is not recommended to do an MRI without good reason.
Patients weighing more than 250 kg are not allowed to participate in the study.
Claustrophobia. Fear of closed spaces is included in the list of contraindications, since it will be difficult for the patient to spend half an hour motionless in a closed tomograph.
Allergic reaction. This contraindication is relevant if magnetic resonance imaging is performed with contrast agents.

The specialist also has the right to refuse to allow a patient to undergo magnetic resonance imaging of the iliosacral joints in case of epilepsy or convulsive syndrome.

Contraindications for radiation examination

The X-ray diagnostic method, including X-ray of the sacroiliac joints, is contraindicated for pregnant women, children under 14 years of age, and patients in serious condition. The image will be uninformative if the subject is obese. The procedure is not recommended for women during lactation. However, in some cases, the value of x-ray diagnostics outweighs the possible risks from radiation. Moreover, digital radiography has become available, which has up to 40% less radiation exposure to organs.

The German Family Clinic is equipped with modern digital equipment produced by GE. Qualified specialists will always give a detailed, high-quality interpretation of the radiograph, and if necessary, specialized doctors will always help determine the diagnosis.

Do I need to prepare for an MRI?

Doctors say that magnetic resonance imaging of the iliosacral joints does not require special preparation. This means that the patient can lead a normal lifestyle, not limit himself in physical activity, or change his diet. But if diagnostics are carried out using contrast agents, you should refuse food 4-5 hours before the upcoming diagnosis.

You should not drink a lot of water so that the patient does not want to go to the toilet during the diagnosis.
If you have ever had to examine the iliosacral joints, take with you the results of previous diagnostics (computed tomography, ultrasound, radiography, MRI, etc.).
You cannot bring any metal products into the tomograph, so remove all jewelry at home in advance: rings, piercings, bracelets, chains, etc.
For severe pain in the lumbar region, a non-steroidal anti-inflammatory drug is administered intramuscularly 20 minutes before the procedure so that the patient can lie still during the diagnosis.
Women are advised to remove makeup from their faces.

How is the X-ray diagnostic procedure of the sacroiliac joint performed?

There are three ways to obtain an X-ray of the sacroiliac joint:

direct projection (the patient lies on his back). In this case, it is very important that the subject lies down exactly at the positioning point specified for this purpose. This is necessary so that the next image obtained can be compared with the previous one, otherwise there is a high probability of a diagnostic error.
oblique projection (the patient lies on his back, turning 15 - 20ᵒ in the direction opposite to the joint being examined).
axial projection (the patient tilts the torso forward or backward while sitting)

Preparation for x-rays of the sacroiliac joints involves avoiding foods rich in fiber at least 24 hours before: rye bread, fresh fruits and vegetables, legumes, mushrooms. This is due to the fact that the gases that accumulate in the intestines when consuming such foods can significantly degrade the quality of the X-ray image. The procedure must be done on an empty stomach. It is recommended to do an enema the night before to get the best results.

How is MRI of the iliosacral joints done?

Diagnostics are carried out in a special closed-type tomograph. The patient must not move during the examination. A specific feature of the tomograph is noise during the examination. It is for this reason that in some clinics, before the diagnosis, the patient is asked to wear noise-isolating headphones or regular earplugs.

Before starting the examination, the doctor must provide instructions. Inside the capsule there is lighting and ventilation. You also have the opportunity to contact the doctor who performs the diagnosis at any time.

Before the examination, the patient must change clothes and remove all clothing that has metal inserts, such as buttons, zippers, and so on.
You need to lie on the extendable table on your back. To avoid unnecessary movements, the doctor may secure your legs and arms using special straps.
If an MRI with contrast is planned, the doctor will inject the drug into a vein. Within a few minutes, the substance will be distributed throughout the circulatory system.
The table will slide into the tomograph capsule, where the examination will take place. Typically the diagnosis takes no more than half an hour. When contrast agents are used, the duration of the study may increase slightly.

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.

Is a contrast agent required?

The use of contrast agents when performing magnetic resonance imaging of the iliosacral joints is required if the purpose of diagnosis is to search for a neoplasm, clarify its origin and location. In some cases, contrast imaging may also be recommended for inflammatory processes. After the administration of a contrast agent, an increase in signal intensity is observed from the pathologically altered articular cartilage, capsule and periarticular tissues.

The use of contrast agents is absolutely safe for the body. Modern drugs do not cause side effects and are well tolerated. In rare cases, you may experience slight dizziness, but it quickly goes away on its own and does not require treatment.

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.

Decoding the results

After the magnetic resonance imaging is completed, the specialist’s task is to decipher the images. When performing magnetic resonance imaging, the following abnormalities can be detected:

The presence of inflammatory processes localized in the spinal cord, intervertebral discs or joint.
Joint space and bone growths.
Malignant or benign neoplasms.
Calcium deposition in joints.
Joint injuries.
Osteochondrosis.
Protrusion of intervertebral discs.
Ankylosing spondylitis.
Ankylosing spondylitis.

Based on the diagnostic results, your doctor will be able to make an accurate diagnosis and determine its severity. See a doctor in time and stay healthy!

Diagnosis of sacroiliitis

The entire diagnostic technique of the disease in question lies in the study of clinical manifestations identified during the examination of the patient. A clarifying addition can be the results of additional research methods, the most important of which is considered to be x-ray.

The following diagnostic criteria are determined:

intensity and nature of manifestation of existing symptoms;
waking up at night due to discomfort;
presence/absence of pain in the thoracic spine;
study of existing inflammation;
patient's medical history, taking into account various factors.

The main clinical signs remain:

degree of limitation of mobility in the affected area;
changes, violations of posture and the intensity of their manifestation.

Degrees of sacroiliitis

The degree of pathology is determined taking into account the collected medical history, as well as the results of an x-ray examination, which make it possible to determine not only the focus, but also the intensity of the spread of inflammation.

Let's consider the main indicators characteristic of each degree.

1st degree of sacroiliitis

Symptoms are mild. It is impossible to track any changes in the image.

2nd degree sacroiliitis

The outlines of the joint are extremely indistinct, one might even say blurry.

There is significant compaction of bone tissue and numerous erosions.

3rd degree of sacroiliitis

The narrowing of the joint space noticeably increases, the signs of ankylosis intensify (loss of mobility).

With the purulent type of lesions, bone tissue loses density, creating the preconditions for the development of osteoporosis.

4th degree of sacroiliitis

The joint gap completely disappears, and the final fusion of bone tissue occurs, accompanied by destruction of their structure.

The outlines of the joint become extremely uneven.

Danger and forecasts

The disease extremely rarely acts as an independent pathology, being in most known cases a symptom. Lack of timely diagnosis can lead to a sharp deterioration in the mobility of the spinal column. There are real risks of achieving a situation of complete immobility and disability of the patient.

Timely elimination of pathologically dangerous causes for joint tissues and the use of correct therapy will lead to favorable prognoses.

The method and timing of treatment are determined taking into account the existing clinical picture and the characteristics of the individual patient.