Abstract
It has not been easy to identify mechanical failure of the sacroiliac joint (SIJ) with traditional imaging. The integrated model of function (Lee and Vleeming, 1998) suggests that under normal circumstances, form and force closure combined contribute to sacral nutation and “locking” the SIJ for optimal load transfer. This model is supported by clinical evidence and scintigraphic findings that contribute to successful therapy in 80% of cases. Single-photon emission computed tomography and x-ray computed tomography (SPECT-CT), a hybrid device, was used in a study of 1200 patients (64% female and 36% male patients with an average age of 42 years; range, 15–78 years) with a clinical diagnosis of SIJ incompetence (pelvic girdle pain syndrome). Standard clinical testing and an alternate series of tests were used as a reference standard for imaging. Symptoms were present for a mean of 43 months. Imaging finding were of increased uptake in the upper SIJ (S1–S2), with extension into the dorsal interosseous ligament and measurable by count profile. Associated findings of tendon enthesopathy reflected altered biomechanics around the pelvis. Ipsilateral adductor enthesopathy was found in 70% and contralateral hamstring enthesopathy in 60% of patients. SPECT-CT criteria for the diagnosis of SIJ incompetence were developed and validated. SPECT-CT is a valid and reproducible technique for the diagnosis of SIJ incompetence with high concordance and specificity compared to the reference standards. Findings are supportive of the integrated model of SIJ function proposed by Lee and Vleeming.
Highlights
Low back pain (LBP), a common ailment, afflicts 85% of people at one time or another, with a high proportion reporting chronicity (Ͼ12-week duration) or frequent recurrences that are disabling [1]
Epidemiological studies indicate that ϳ15% of chronic LBP is caused by an intervertebral disc pathology and the remaining 85% of LBP is classified as nonspecific low back pain (NSLBP) [1]
single-photon emission CT (SPECT) and x-ray computed tomography (CT) (SPECT-CT) is a valid and reproducible technique for the diagnosis of sacroiliac joint (SIJ) incompetence with high concordance and specificity compared to the reference standards
Summary
Low back pain (LBP), a common ailment, afflicts 85% of people at one time or another, with a high proportion reporting chronicity (Ͼ12-week duration) or frequent recurrences that are disabling [1]. NSLBP is a term of convenience that hides ignorance of the actual pathophysiology in the vast bulk of patients with the condition. It is a descriptor, not a diagnosis. A high proportion of these patients will have essentially normal finding or “disc bulges” without neural compromise. This group is invariably labeled as NSLBP in a nihilistic exercise that raises unresolvable and often damaging questions of psychological or psychiatric overlays and may result in secondary depression
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