Osteitis Condensans Ilii Research Articles

Clinical and imaging mimickers of axial spondyloarthritis.

The first step in the diagnosis of a patient with suspected axial spondyloarthritis is to differentiate the signs and symptoms of the disease from other disorders, potentially manifesting with similar clinical and imaging features. This review examines diffuse idiopathic skeletal hyperostosis, osteitis condensans ilii, and other developmental and metabolic disorders that may mimic axial spondyloarthritis, highlighting the diagnostic caveats and discussing shared and distinguishing aspects of these conditions in order to improve the clinician's ability to set them apart.

Sacroiliitis mimics: a case report and review of the literature

BackgroundRadiographic sacroiliitis is the hallmark of ankylosing spondylitis (AS), and detection of acute sacroiliitis is pivotal for early diagnosis of AS. Although radiographic sacroiliitis is a distinguishing feature of AS, sacroiliitis can be seen in a variety of other disease entities.Case presentationWe present an interesting case of sacroiliitis in a patient with Paget disease; the patient presented with inflammatory back pain which was treated with bisphosphonate. This case demonstrates comorbidity with Paget disease and possible ankylosing spondylitis. We also present a review of the literature for other cases of Paget involvement of the sacroiliac joint.ConclusionsIn addition, we review radiographic changes to the sacroiliac joint in classical ankylosing spondylitis as well as other common diseases. We compare and contrast features of other diseases that mimic sacroiliitis on a pelvic radiograph including Paget disease, osteitis condensans ilii, diffuse idiopathic skeletal hyperostosis, infections and sarcoid sacroiliitis. There are some features in the pelvic radiographic findings which help distinguish among mimics, however, one must also rely heavily on extra-pelvic radiographic lesions. In addition to the clinical presentation, various nuances may incline a clinician to the correct diagnosis; rheumatologists should be familiar with the imaging differences among these diseases and classic spondylitis findings.

Parturition pit: the bony imprint of vaginal birth.

To retrospectively evaluate for pits along the dorsum of the pubic body in females and compare the presence/absence of these pits to vaginal birth data. We retrospectively reviewed females with vaginal birth data who underwent pelvic CT. The presence of pits along the dorsum of the pubic body, pit grade (0 = not present; 1 = faintly imperceptible; 2 = present; 3 = prominent), and the presence of osteitis condensans ilii, preauricular sulcus, and sacroiliac joint vacuum phenomenon were assessed on imaging. Musculoskeletal radiologists who were blinded to the birth data evaluated the CTs. 48 males were also evaluated for the presence of pits. 482 female patients underwent CT pelvis and 171 were excluded due to lack of vaginal birth data. Of the 311 study patients, 262 had prior vaginal birth(s) and 194 had pits on CT. Only 7 of the 49 patients without prior vaginal birth had pits. There was a statistically significant association between vaginal birth and presence of pits (p < 0.0001). Patients with more prominent pits (grades 2/3) had a greater number of vaginal births. As vaginal deliveries increased, the odds of having parturition pits greatly increased, adjusting for age and race at CT (p < 0.0001). No males had pits. Our study indicates that parturition pits are associated with prior vaginal birth and should be considered a characteristic of the female pelvis. The lytic appearance of prominent pits on imaging can simulate disease and create a diagnostic dilemma for interpreting radiologists.

Minimally Invasive Sacroiliac Joint Arthrodesis: Experience in a Prospective Series with 24 Patients

Background: Sacroiliac (SI) joint pain conservative treatments show poor outcomes. Hypothesis: surgical treatment will show better results. Patients and methods: Prospective series: 24 patients undergoing SI fusion after failure of medical treatment and showing temporary relief with SI infiltration. Period: Nov 2009-July 2013. Gender: 9/15. 11 cases bilaterally (all ). Age: 32-71 years (mean 47.4 years). Height: 161-178 cm (mean 168.2 cm). Weight: 56-84 kg (mean 68.4 kg). Etiology: 12 degenerative/spontaneous, 7 fall on buttocks, 3 coincident with lumbar disc and 2 with lumbar posterolateral fusion. Exclusion criteria: ankylosing spondylitis, osteitis condensans ilii, sacro-iliac joint arthropaty. Demographics, analgesics and NSAID’s consumption, incidence and severity of complications, clinical outcome using a visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) and time to returning to work were collected postoperatively at 1, 3 and 6 months, and then at six months interval until last follow-up. Results: Follow-up: 1-4.5 years (mean 23.3 months). No intra-operative or post-operative major complications. No blood transfusions. Patients stayed over-night, and discharged next morning. No crutches used. Time to returning to work: 47.4 days (range 30-67 days). Post-op: marked reduction in VAS and analgesic consumption (preop 8.7, post-op 1 month 3.2, 3 months 2.8, 6 months post-op 2.1, 12 months 1.7, 18 months 1.7, 2 years 1.9, 2½ years 1.8, 3 years 2.0, at 3½ years 2.1, 4 years 2.1 and 4½ 2.1). Mean ODI scores improved from 54.1 preoperatively to 23.9, 21.2, 20.4 and 14.3 at 1, 3, 6 and 12 months postoperatively, and 15.1, 15.5 15.8, 16.0, 16.1, 16.3 and 16.3 at 1½, 2, 2½, 3, 3½, 4 and 4½ years (p<.001). 1 year post-op 22/24 patients would undergo the procedure again. Conclusion: Percutaneous SI joint arthrodesis is effective and safe to treat chronic SI joint pain.

MRI of the SI joints commonly shows non-inflammatory disease in patients clinically suspected of sacroiliitis

PurposeTo determine the prevalence of clinically relevant non-inflammatory disease on MRI of the sacroiliac (SI) joints in patients suspected of sacroiliitis. To assess the added value of axial imaging of the pelvis in these patients. MethodsIn a retrospective study of 691 patients undergoing MRI of the SI joints from January 2006 to December 2012 for inflammatory back pain the prevalence of sacroiliitis and non-inflammatory disease was recorded. ResultsIn 285 (41%) patients MRI did not show any abnormal findings. In 36% of patients MRI features of sacroiliitis were present. Spinal degenerative changes were the most common non-inflammatory finding in 305 patients (44.1%) and consisted of disc degeneration in 222 (32%) patients, facet joint arthrosis in 58 (8.4%) patients and disc herniation in 25 (3.6%) patients. Hip joint disease in 44 (6.4%) patients, lumbosacral transitional anomaly in 41 (5.9%) patients, SI joint degenerative changes in 25 (3.6%) patients and diffuse idiopathic skeletal hyperostosis in 24 (3.5%) patients were also common. Osteitis condensans ilii in 17 (2.5%) patients, tumour in 11 (1.6%) patients, fracture in 8 (1.2%) patients, infection in 4 (0.6%) patients and acute spondylolysis in 2 patients (0.3%) were less frequently seen. ConclusionOur study shows that non-inflammatory disease is more common than true sacroiliitis on MRI of the SI joints in patients with inflammatory type back pain. Axial pulse sequences may demonstrate unexpected findings that remain undetected if only coronal images are obtained. Clinical relevance statement:, MRI of the SI joints may demonstrate conditions that clinically mimic sacroiliitis. Axial imaging of the pelvis may help detect these unexpected findings.

Osteitis Kondensans İlii’e Bağlı Bel Ağrısı

Osteitis Condensans Ilii (OCI) is a rare condition causing low back pain. It is generally seen in women related to pregnancy. Well defined triangular sclerotic area on the iliac part of the sacroiliac articulation can be seen on x-rays. The most accepted hypothesis is the extra mechanical loading of the sacroiliac joints leading to sclerosis during the pregnancy. The differential diagnosis between mechanical and inflammatory disease in patients with low back pain is usually difficult and the presence of sclerosis may be confusing. OCI is a benign form of sclerosis, not a form of inflammatory lesions. A case of woman with low back pain due to the OCI is presented. Physical and neurological examinations are unremarkable. The radiograph of the pelvis shows bilateral-symmetrical sclerosis localized to the lower part of the sacroiliac joints. This case report reviews the literature and mentions the main features and differentional diagnosis of OCI. (Turkish Journal of Osteoporosis 2013;19: 48-51)

SAT0288 Prevalence of sacroiliitis in the general population: Comparative analysis with cutaneous psoriasis and psoriatic arthritis

BackgroundAt least grade 2 unilateral sacroiliitis in the presence of spinal symptoms (defined as a combination of inflammatory back pain plus back stiffness) in our criteria allows to classify axial...

Refractory osteitis condensans ilii: Outcome of a novel mini-invasive surgical approach

Osteitis condensans Ilii (OCI) is an orthopaedic mystery until now and the refractory type poses a great challenge in its management. Surgical resection and sacroiliac arthrodesis are major procedures with no guarantee of success for an unknown disease entity with a normal sacroiliac joint. The aim of this retrospective study was to evaluate results of a novel mini-invasive surgical approach for the refractory type after failure of conservative management. Fourteen females were included with an average age 35.5 ± 5.8 years. Nine cases were multiparous and five were nulliparous. The pathology was bilateral in all cases; however, seven cases suffered bilateral symptoms, while seven cases had only unilateral complaints. Preoperative computed tomography was mandatory. All cases had three to five percutaneous iliac core decompressions through a cannulated drill bit. The Bath ankylosing spondylitis functional index (BASFI) was used for functional outcome evaluation. The mean follow up was 23.3 ± 4.1 months. The mean BASFI improved from 3.7 ± 0.6 preoperatively to 1.3 ± 0.2 during follow up (P = <0.001). There was a significant improvement with the four drillings over five decompression drillings (P = 0.011). Sacral side sclerosis was associated significantly (P = 0.009) with less improvement. No relapse or substantial complications were encountered. This novel approach can be of great benefit for refractory OCI cases with almost no added morbidity or complications. It has advantages of the mini-invasive techniques in addition to sparing the physiological functions of the affected sacroiliac joints.

FDG Uptake in Sacroiliac Joint Due to Osteitis Condensans Ilii Shown on PET/CT in a Patient With Breast Cancer

A 56-year-old woman with breast cancer underwent FDG PET/CT at follow-up. The PET images showed increased FDG uptake along right sacroiliac joint. The coregistered CT images showed diffuse sclerosis around the sacroiliac joints, but no bony destruction, periarticular erosion, or joint space narrowing. She had been complaining of intermittent lower back pain since her last pregnancy. The radiologic pictures and history of postpartum back pain were considered as typical characteristics for osteitis condensans ilii. This case reminds us that careful inspection of the coregistered CT images is important to avoid potential misinterpretation because of osteitis condensans ilii.

Osteitis condensans ilii in differential diagnosis of patients with chronic low back pain: a review of the literature

Osteitis condensans ilii (OCI) is a benign pathology causing chronic back and hip pain. Although the definitive cause is uncertain, mechanical stress is a significant factor in the development of the disease. Bilateral involvement of the sacroiliac joint is typical. We describe a case of unilateral OCI with unilateral sclerosis observed at radiography in a 34-year-old patient presenting with chronic back and hip pain, together with a review of the literature.

Hip Injury - Soccer

HISTORY: 16 year-old male competitive soccer player with insidious onset of right hip pain since soccer pre-season conditioning two years ago. The pain is located over the right anterior inferior iliac spine (AIIS). Described as "pulling" and dull in nature, worse with running and especially kicking. Denies paresthesia or radiating pain. Denies inciting events or history of trauma. He has been unable to sustain sports activities due to the pain. He has undergone several work-ups and conservative treatment without resolution of symptoms. PHYSICAL EXAMINATION: Normal inspection, without discoloration, deformity, or asymmetry. Mild tenderness over right AIIS area. Mild pain with active and passive motion of the right hip, notably with active flexion and passive extension. No tenderness of Anterior Superior Iliac Spine. Range of motion within normal limits. Strength and sensation intact. Normal gait. DIFFERENTIAL DIAGNOSIS: 1. Chronic Rectus femoris tendinosis 2. Apophysitis 3. AIIS avulsion fracture 4. Osteitis Condensans Ilii 5. Lower Thoracic Entrapment Neuropathy TEST AND RESULTS: Serum Phosphate, Alkaline Phosphatase, Erythrocyte Sedimentation Rate - normal AP Pelvis and Frog-Leg views -No fractures, normal bone mineralization 1st MRI of Hip (7 months from symptom onset) -Musculature and soft tissues within normal limits 2nd MRI Hip (22 months from symptom onset) - Minimal asymmetric irregular signal in the Right AIIS likely very mild chronic avulsive changes. Ultrasound (US) Right Hip - Small discontinuous cortical irregularity of the chronic avulsion changes of AIIS FINAL WORKING DIAGNOSIS: Chronic Avulsion Fracture of Right AIIS TREATMENT AND OUTCOMES: 1. Oral NSAID treatment provides no relief. 2. Several week cessation of impact activity provides temporary relief. 3. Physical Therapy focused on strengthening/flexibility provides minor improvement. 4. Orthopedic consult decided no indication for surgery. 5. Steroid injection at tendon-bone interface at AIIS under US guidance resulted in minimal response at 4 weeks. 6. Prolotherapy with 50% dextrose injected to the tendon-bone interface at AIIS under US guidance repeated at 2 and 4 weeks resulted in improvement of the symptoms on 3-week and 6-week follow-up. 7. Resume sports specific activities as tolerated and full return to play.

SPECT/CT of Osteitis Condensans Ilii

A 16-year-old, nonpregnant, healthy, and sportive teenager suffers from intermittent low back pain. Pelvic x-ray complemented by bone-SPECT/CT demonstrated an uncommon benign condition called osteitis condensans ilii. In the early phase, it is of paramount importance to distinguish osteitis condensans ilii from sacroiliitis or ankylosing spondylitis. This case report highlights the incremental value of performing one-stop shop hybrid SPECT/low-dose CT bone imaging in diagnosing and managing this rare benign skeletal condition.

Osteitis Condensans Ilii: Case Report

Back pain is one of the most frequent complaints during the last period of pregnancy. In a small group of patients the persistent pain during the postpartum period may be secondary to osteitis condensans ilii (OCI), and rarely can occur suddenly in the elderly. OKI is a rare benign pathology, low back or buttock pain should be suspected in patients coming from. Although the exact etiology is unknown, the most accepted hypothesis, get on the sacroiliac joint, depending on the mechanical stress, changes may develop in the iliac bone. In practice, It is important to recognise this disease as it can be potentially confused with similar causes of axial low back pain such as seronegative spondyloarthropathy, metastatic disease, or sacroilitis. Here two woman patients with low back pain and buttock pain secondary to unilateral an uncommon benign condition called osteitis condensans ilii is presented. This report emphasis the salient features and the differential diagnosis in diagnosing and managing this rare pathology.

Osteitis Condensans Ilii

Osteitis Condensans Ilii (OCI) is a benign cause of axial low back pain. Although no clear etiology has been identified, the prevailing theory is that mechanical strain affects the auricular portion of the ilium and causes premature arthritis. The location of the sclerosis has been traditionally confined to the ilium and may give the false impression of sacro-iliac joint involvement. Clinicians must be guided by history, radiographic findings, and laboratory studies in differentiating OCI with other disorders; furthermore additional causes of low back pain including metastatic disease and ankylosing spondylitis must be ruled out. Treatments for the condition are primarily conservative (therapies, non-steroidal anti-inflammatory medications, and steroid injections), with surgical resection being reserved for refractory cases.

Osteitis condensans ilii: a significant association with sacroiliac joint tenderness in women

To determine whether subjects with radiological evidence of osteitis condensans ilii exhibit symptoms and signs in common with sacroiliitis when compared with an age-matched control group and to examine demographic features. The Dunedin Hospital radiology database was searched for all subjects with changes of osteitis condensans ilii over a 10-year period. An age-matched control group with plain X-rays of the pelvis was recruited from the same database. All subjects were sent a questionnaire enquiring about back pain and details of previous pregnancies. Those who responded to the questionnaire were invited for clinical assessment. Thirty-five individuals with osteitis condensans ilii were identified over the 10-year period. All were female and reported prior pregnancy supporting an association between osteitis condensans ilii and pregnancy. Stress testing of the sacroiliac joints was associated with greater tenderness in the osteitis condensans ilii group with a mean of 1.8 positive tests out of a possible 4, compared to 0.8 in the control group (Wilcoxon rank-sum test P = 0.02). Comparison between the two groups showed no difference in number of pregnancies, newborn weight, presence of back pain, back pain assessed by the Oswestry Low Back Pain Questionnaire or loss of function using the Bath Ankylosing Spondylitis Functional Index (BASFI). Osteitis condensans ilii is associated with tenderness during sacroiliac joint compression tests and should be considered in the differential diagnosis when sacroiliac joint tenderness is elicited.

Sacroiliac Joint Imaging

The sacroiliac (SI) joint has several unique anatomical features that make it one of the more challenging joints to image. The joint is difficult to profile well on radiographic views, and therefore the radiographic findings of sacroiliitis are often equivocal. Computed tomography images can usually show the findings of sacroiliitis and osteoarthritis earlier than radiographs. Magnetic resonance imaging performed with proper sequences is excellent for diagnosing even very early sacroiliitis and for following treatment response. The SI joint is often involved in patients with osteoarthritis or one of the inflammatory spondyloarthritides, most notably ankylosing spondylitis. Ankylosing spondylitis often presents with sacroiliitis, which appears as erosions, sclerosis, and joint space narrowing, eventually leading to ankylosis. Several disorders can cause sacroiliitis-like changes of the joint, including hyperparathyroidism and repetitive shear-stress injuries in athletes. The joint can become painful during pregnancy as it widens and develops increased motion, and some postpartum women develop iliac sclerosis adjacent to the joint termed osteitis condensans ilii. Another cause of SI joint pain is a disorder called sacroiliac joint dysfunction, which typically has few abnormal imaging findings. Patients with SI joint dysfunction, as well as sacroiliitis, often get relief from image-guided SI joint therapeutic injections.

Radiology of the paraglenoid sulcus

The paraglenoid sulcus is a variable groove in the ilium adjacent to the inferior end of the sacroiliac joint. This study investigates the hypothesis that the groove is due to resorption at the insertion of the anterior sacroiliac ligament in response to stress. The anatomical relationships of the groove are shown with plain films, arteriography and computed tomography. Relationship to parity was tested in 70 adult female subjects; a statistically significant relationship was found, with deep grooves occurring only in parous women. An association with osteitis condensans ilii was also demonstrated. Relationship to lumbosacral posture was tested in 102 adult females, and an association with increased lumbar lordosis was found. These findings are consistent with our initial hypothesis.

A Case with Osteitis Condensans Ilii Occured in Man

A Case with Osteitis Condensans Ilii Occured in Man

Case report 623

A case of OCC in a 35-year-old woman is presented. Proof was obtained by open biopsy. This rare entity is benign and its etiology is still obscure. No definite association with osteitis pubis or osteitis condensans ilii has been reported. The involvement of the clavicle is invariably unilateral. The clinical and radiographic characteristics of this benign condition have been discussed and the differential diagnosis has been considered. Consideration should be given to the concept that if the imaging features are characteristic, as in this case, biopsy may not be necessary.

COMPUTED TOMOGRAPHY OF THE SACROILIAC JOINTS IN FOUR PATIENTS WITH BEHCÇET'S SYNDROME-CONFIRMATION OF SACROILIITIS

In order to reduce the subjective factor in evaluating sacroiliac joint radiographs we further evaluated changes seen on standard plain films of patients suffering from Behçet's syndrome (BS) by using computed tomography (CT). Sacroiliac joint films of 20 consecutive patients with BS were mixed with those of 20 consecutive control patients and read blindly and independently by two observers. Six patients with BS met the New York criteria for sacroiliitis. Of the control patients, one had monolateral grade 1 sacroiliitis and two revealed findings consistent with osteitis condensans ilii. CT confirmed the diagnosis of sacroiliitis in patients with BS showing a high degree in at least one joint. The results of the present study suggest that the use of CT for BS patients showing sacroiliac joint changes on pelvic plain films may limit the confusion which exists about this finding in BS.