Abstract
BackgroundSacroiliac joint tuberculosis(SJT) is relatively uncommon, but it may cause severe sacroiliac joint destruction and functional disorder. Few studies in the literature have been presented on SJT, reports of surgical treatment for SJT are even fewer. In this study, we retrospectively reviewed surgical management of patients with severe SJT of 3 different types and proposed to reveal the clinical manifestations and features and aim to determine the efficiency and security of such surgical treatment.MethodsWe reviewed 17 patients with severe SJT of 3 different types who underwent posterior open-window focal debridement and bone graft for joint fusion. Among them,five patients with anterior sacral abscess had anterior abscess curettage before debridement. Two patients with lumbar vertebral tuberculosis received one-stage posterior tuberculous debridement, interbody fusion and instrumentation. Follow-up was performed 36 months (26 to 45 months) using the following parameters: erythrocyte sedimentation rate(ESR), status of joint bony fusion on CT scan, visual analogue scale (VAS) and the Oswestry Disability Index (ODI).ResultsButtock pain and low back pain were progressively relieved with time. 6 months later, pain was not obvious, and ESR resumed to normal levels within 3 months. Solid fusion of the sacroiliac joint occurred within 12 months in all cases. No complications or recurrence occurred. At final follow-up, all patients had no pain or only minimal discomfort over the affected joint and almost complete functional recovery.ConclusionsPosterior open-window focal debridement and joint fusion is an efficient and secure surgical method to treat severe SJT. If there is an abscess in the front of the sacroiliac joint, anterior abscess curettage should be performed as a supplement.
Highlights
Sacroiliac joint tuberculosis(SJT) is relatively uncommon, but it may cause severe sacroiliac joint destruction and functional disorder
Bones and joints infected with tuberculosis (TB) are relatively uncommon, accounting for approximately 2–5% of all TB cases in Europe and the USA and approximately 10–15% of extrapulmonary tuberculosis (EPTB) cases
Severe destruction of the sacroiliac joint was indicated on CT scans: broadened joint gaps or cystic changes of different extents, bone erosion of various ranges on the sacrum or iliac side, and diverse amounts of sequestra were found
Summary
Sacroiliac joint tuberculosis(SJT) is relatively uncommon, but it may cause severe sacroiliac joint destruction and functional disorder. We retrospectively reviewed surgical management of patients with severe SJT of 3 different types and proposed to reveal the clinical manifestations and features and aim to determine the efficiency and security of such surgical treatment. Delayed and inappropriate treatments occur frequently and cause remarkable pain, extensive destruction and instability of the sacroiliac joint. There are only a few studies that have reported about surgical treatment and the types of cases were simple and lacked variation [6,7,8,9,10]. We retrospectively reviewed 17 surgical cases that covered 3 types of sacroiliac tuberculosis in our classification and try to fill up the deficiency of previous studies
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