PYOGENIC SACROILIITIS REPORT OF 11 CASES AND REVIEW OF LITERATURE

Abstract

The general principle of treatment of pyogenic sacroiliitis is antibiotic therapy over a six-week duration with or without surgery. Surgery is believed to be reserved for drainage of local abscess, obtaining specimens for pathologic diagnosis, and for cases with poor medical responses. From 1987 to 1999, there were 11 cases (6 women and 5 men) with confirmed diagnosis of pyogenic sacroiliitis treated at the authors' institute. The average age was 42 years. The onset of disease was acute in 8, subacute in 2, and chronic in 1 case. The most common causative pathogen was staphylococcus aureus. Among the 11 cases, only 2 cases were treated by surgery and the remaining 9 cases were treated medically. All the 11 patients recovered well without major complication. To re-examine whether an abscess formation warrants surgical drainage, 193 cases collected from the literature were analyzed with specific attention to the reported surgical indication. The results indicated that an abscess need not be drained surgically and the surgically treated patients were neither more toxic nor with more favorable outcomes than the medically treated patients. In conclusion, the authors suggest that pyogenic sacroiliitis can primarily be treated conservatively with antibiotics and image-guided drainage. It is thought that surgery should be reserved for cases with poor medical response or for advanced sacroiliac destruction.