Abstract
Background: A discussion of the incidence and pathogenesis of tuberculosis of the sacroiliac joint and a description of an association with spinal tuberculosis. Methods: A retrospective chart review was conducted in the spine unit on all inpatients admitted between 1 July 2014 and 30 June 2015. Patients with confirmed tuberculous spondylitis and/or sacroiliitis, who underwent adequate radiological examination of their sacroiliac joints, were included in the study. Available clinical and radiological investigations including plain X-rays, CT and MRI scans, were scrutinised to actively exclude sacroiliac joint involvement. Results: Sixty-six patients with tuberculous spondylitis and one patient with isolated tuberculous sacroiliitis were included in the study. Seventeen patients had multilevel (>2 levels) contiguous involvement, while 14 patients had multilevel non-contiguous lesions. Thirty-four patients had associated iliopsoas abscesses. Thirteen patients (19.4%) were identified as having involvement of their sacroiliac joint(s). Six had bilateral involvement, five with right-sided and two patients with left-sided involvement. Eleven of the patients identified had associated iliopsoas abscesses, two of whom had gluteal and iliopsoas abscesses. The patient with isolated sacroiliac joint involvement had a gluteal abscess. Conclusion: Concurrent radiographic evidence of sacroiliac joint involvement is not uncommon in patients with spinal tuberculosis, more so when abscess formation is associated, and should be actively looked for and excluded in such cases. Level of evidence: Level 4
Highlights
Tuberculous involvement of the sacroiliac joint is reported as rare in the literature and is estimated to account for 0.3 to 0.5 % of all tuberculosis cases.[1,2,3,4]. While this may be true in the developed world or when looked at in isolation, the incidence is much higher in less developed countries,[5,6] with ever-increasing rates of retroviral disease (RVD) associated with atypical pathology and multifocal skeletal involvement
Numerous studies have noted an association of tuberculous sacroiliitis with concurrent spinal tuberculosis.[1,2,5,11,12]
Patients with spondylitis and/or sacroiliitis arising from pathogens other than mycobacterium tuberculosis, outpatients, and those with confirmed tuberculous spondylitis without adequate radiological visualisation of their sacroiliac joints were excluded from the study
Summary
Tuberculous involvement of the sacroiliac joint is reported as rare in the literature and is estimated to account for 0.3 to 0.5 % of all tuberculosis cases.[1,2,3,4] While this may be true in the developed world or when looked at in isolation, the incidence is much higher in less developed countries,[5,6] with ever-increasing rates of retroviral disease (RVD) associated with atypical pathology and multifocal skeletal involvement. Patients with confirmed tuberculous spondylitis and/or sacroiliitis, who underwent adequate radiological examination of their sacroiliac joints, were included in the study. Available clinical and radiological investigations including plain X-rays, CT and MRI scans, were scrutinised to actively exclude sacroiliac joint involvement. The patient with isolated sacroiliac joint involvement had a gluteal abscess. Conclusion: Concurrent radiographic evidence of sacroiliac joint involvement is not uncommon in patients with spinal tuberculosis, more so when abscess formation is associated, and should be actively looked for and excluded in such cases
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