Sacroiliac joint malposition is one of the main causes evoking lumbocrural pain. Because its clinical symptoms are similar to those induced either by lumbar intervertebral disc protrusion or by ankylosing spondylitis ...Sacroiliac joint malposition is one of the main causes evoking lumbocrural pain. Because its clinical symptoms are similar to those induced either by lumbar intervertebral disc protrusion or by ankylosing spondylitis （AS） at the early stage, and because X-ray results taken at its early stage were not evident for differentiating the diseases,展开更多
AIM To analyze how various implants placement variables affect sacroiliac(SI) joint range of motion. METHODS An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusio...AIM To analyze how various implants placement variables affect sacroiliac(SI) joint range of motion. METHODS An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the SI joint using various placement configurations of triangular implants(iF use Implant System~?). Placement configurations were varied by changing implant orientation, superior implant length, and number of implants. The range of motion of the SI joint was calculated using a constant moment of 10 N-m with a follower load of 400 N. The changes in motion were compared between the treatment groups to assess how the different variables affected the overall motion of the SI joint. RESULTS Transarticular placement of 3 implants with superior implants that end in the middle of the sacrum resulted in the greatest reduction in range of motion(flexion/extension = 73%, lateral bending = 42%, axial rotation = 72%). The range of motions of the SI joints were reduced with use of transarticular orientation(9%-18%) when compared with an inline orientation. The use of a superior implant that ended mid-sacrum resulted in median reductions of(8%-14%) when compared with a superior implant that ended in the middle of the ala. Reducing the number of implants, resulted in increased SI joint range of motions for the 1 and 2 implant models of 29%-133% and 2%-39%, respectively,when compared with the 3 implant model.CONCLUSION Using a validated finite element model we demonstrated that placement of 3 implants across the SI joint using a transarticular orientation with superior implant reaching the sacral midline resulted in the most stable construct. Additional clinical studies may be required to confirm these results.展开更多
Background: The sacroiliac joint (SIJ) is an important cause of chronic low back pain, implicated in 15% - 30% of all cases. While radiofrequency neurotomy (RFN) is the interventional treatment of choice for spinal pa...Background: The sacroiliac joint (SIJ) is an important cause of chronic low back pain, implicated in 15% - 30% of all cases. While radiofrequency neurotomy (RFN) is the interventional treatment of choice for spinal pain originating from the facet joints, fewer studies have investigated its potential for treating SIJ pain, and its long-term efficacy is unknown. Objectives: To obtain a real-world view of RFN treatment outcomes for SIJ pain by conducting an observational study within a community pain practice, among a heterogeneous patient group receiving standard-of-care diagnostic workup and treatment. Study Design: A prospective, observational study, with data collection over five years, was conducted at the authors' private practice. Patients & Methods: A cohort of 215 patients underwent fluoroscopically guided SIJ RFN of the dorsal and lateral branches of S1-S3 and the descending branch of L5. All patients had previously had their diagnosis of SIJ pain confirmed by controlled comparative analgesic blocks of relevant nerves, and recorded pre-procedure pain levels on the 11-point Numerical Rating Scale (NRS). Outcome measures included pain, and a Likert scale to measure alterations to analgesic use, changes to paid employment status and patient satisfaction. Results: We demonstrate an average pain reduction of 2.3 ± 2.1 NRS points following RFN (baseline pain score of 6.9 ± 1.7 to a follow-up average of 4.6 ± 2.7 NRS points;p ≤ 0.01). At a mean follow-up period of 14.9 ± 10.9 months (range 6 - 49 months), an overall 42.2% of patients reduced their analgesic use. Of the patients for whom employment capacity was applicable (82 patients), 21 patients reported an improvement. Overall, 67% of patients were satisfied with their outcome of post-RFN treatment. No complications occurred. Limitations: This observational study had no independent control group and only included a single study site. Conclusions: RFN is a safe and effective treatment for pain confirmed to originate from the sacroiliac joint.展开更多
BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in wh...BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.CASE SUMMARY A 65-year-old Asian man presented with severe pain and numbness in his left lower limb,which became aggravated during walking and showed intermittent claudication.The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive.Computed tomography(CT)and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint.The results of electrophysiological examination showed peripheral neuropathy.A CT-guided obturator nerve block significantly reduced the severity of pain in this patient.According to the above findings,ONI caused by the osteophyte in the sacroiliac joint was diagnosed.This patient underwent an operation to remove the bone spur and symptomatic treatment.After therapy,the patient's pain and numbness were significantly relieved.The last follow-up was performed 6 mo after the operation,and the patient recovered well without other complications,returned to work,and resumed his normal lifestyle.CONCLUSION Osteophytes of the sacroiliac joint can cause ONI,which leads to symptoms including severe radiative pain in the lower limb in patients.The diagnosis and differentiation of this disease should attract the attention of clinicians.Surgical excision of osteophytes should be considered when conservative treatment is not effective.展开更多
Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluor...Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement;however,image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement.In the following cases,we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm^（？）multidimensional surgical imaging with StealthStation^（？）navigation（Medtronic,Inc.Minneapolis,MN）.Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site.O-arm^（？） integrated with StealthStation^（？） allowed immediate autoregistration.The skin incision was planned with an image-guidance probe.An image-guided awl,drill and tap were utilized to choose a starting point and trajectory.Threaded titanium cage（s） packed with autograft and/or allograft were then placed.O-arm^（？） image-guidance allowed for implant placement in the SIJ with a small skin incision.However,we could not track the cage depth position with our current system,and in one patient,the SIJ cage had to be revised secondary to the anterior breach of sacrum.展开更多
Background: Sacroiliac joint (SIJ) pain presents as a deep and somatic pain, predominantly affecting the lower back and buttock and referring down the leg, sometimes as far as the foot. Given that the features of SIJ ...Background: Sacroiliac joint (SIJ) pain presents as a deep and somatic pain, predominantly affecting the lower back and buttock and referring down the leg, sometimes as far as the foot. Given that the features of SIJ pain are non-specific and that this referred pain is similar to lumbar facet joint and lumbar disc pain, diagnostic local anesthetic injections (diagnostic blocks) into the SIJ are used to identify the source of pain. Despite wide use, little is known about the false positive rate of a single diagnostic sacroiliac (SI) block and the requirement for a control block. Objective: To determine whether a control SI block is necessary and to monitor the false positive rate for a single injection. Study Design: A prospective and observational study was conducted as part of a practice audit, with data collected over 3.5 years at the authors’ private practice. Patients & Methods: Under fluoroscopic guidance, 1408 consecutive patients presenting with prominent deep somatic pain over the SIJ region were sterilely injected with anesthetic into the SIJ and/or the deep interosseous ligament (DIL). Pain was measured on the 11-point Numerical Rating Scale (NRS) prior to injection and incrementally over the following 1- 2 weeks. Fully completed and unequivocal data sets were available for 1060 patients. Decreases in pain scores (of >80%) at >2 hours of post-injection were indicative of SIJ pain and recorded as a positive SIJ block. Results: Of 1060 patients receiving a first SIJ diagnostic block, 680 (64.1%) recorded a positive result. Subsequently, 271 positive patients and 22 who were negative for SIJ pain opted to receive a second control block. SIJ pain diagnosis was confirmed in 237/271 (87.5%) of those with an initial positive response, while 18/22 patients (81%) had their initial negative result confirmed. The false positive rate of a single block is therefore calculated at 12.5%, and on a contingency table analysis, a single anesthetic SIJ injection has diagnostic accuracy of 87.03%, with high sensitivity (98.3%), when compared with a second control diagnostic block. Limitations: All injections were performed at one clinical centre. A proportion (348/1408) of initial patients did not return fully completed pain records or had equivocal responses (≥80% pain relief, but transiently, for ≤30 min) and were excluded from further analysis. Conclusion: Given the observed high rates of accuracy in this study, it is reasonable to suggest the use of one diagnostic block as the criterion standard for assessing the SIJ as the source of a patient’s pain.展开更多
BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a go...BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.展开更多
Objective:To explore the clinical value of dual energy CT(DECT)virtual noncalcium(VNCa)in the diagnosis of sacroiliac joint bone marrow edema(BME).Methods:A collection of 45 patients(21 males,24 females,and an average...Objective:To explore the clinical value of dual energy CT(DECT)virtual noncalcium(VNCa)in the diagnosis of sacroiliac joint bone marrow edema(BME).Methods:A collection of 45 patients(21 males,24 females,and an average age of 34 years)who underwent MRI and DECT(Siemens Somatom definition force)examinations for the sacroiliac joints in our hospital from January 2019 to August 2020.After the DECT scan,the bone marrow pseudo-color map was obtained after VNCa processing.The bone marrow pseudo-color map was evaluated by two physicians.Take MRI test results as the gold standard,the application value of DECT VNCa technology in the diagnosis of sacroiliac joint BME was analyzed.Results:The positive predictive value(PPV),negative predictive value(NPV),sensitivity(Sen),specificity(Spe)and accuracy(Acc)of the qualitative diagnosis of iliac bone and sacral BME with DECT VNCa technology was:80.6%,85.2%,78.4%,86.8%,83.3%and 100%,64.9%,32.5%,100%,70.0%,respectively.The area of edema displayed by quantitative measurement of DECT VNCa image is smaller than the area measured by MRI image.The VNCa CT value(-71.66±72.97Hu)of the iliac edema area was higher than that of the non-edema area(-90.27±65.85Hu),and the VNCa CT value of the sacral edema area(-62.90±46.87Hu)was higher than that of the non-edema area(-101.08±134.02Hu),the best cut-off values(Cut-off values)for the quantitative diagnosis of iliac bone and sacral BME by VNCa are-66.40Hu and-50.60Hu,respectively.The curve of the receiver operating characteristic(ROC)of the iliac bone and sacrum area under the cure(AUC)is 0.720 and 0.706 respectively.There is a moderate negative correlation between the VNCa CT values of the ilium and sacrum in the edema area and the conventional CT values.Conclusion:The DECT VNCa technique has certain effectiveness in the diagnosis of sacroiliac joint BME,and its effectiveness in the diagnosis of ilium BME is better than sacrum.展开更多
We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or w...We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.展开更多
文摘Sacroiliac joint malposition is one of the main causes evoking lumbocrural pain. Because its clinical symptoms are similar to those induced either by lumbar intervertebral disc protrusion or by ankylosing spondylitis （AS） at the early stage, and because X-ray results taken at its early stage were not evident for differentiating the diseases,
文摘AIM To analyze how various implants placement variables affect sacroiliac(SI) joint range of motion. METHODS An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the SI joint using various placement configurations of triangular implants(iF use Implant System~?). Placement configurations were varied by changing implant orientation, superior implant length, and number of implants. The range of motion of the SI joint was calculated using a constant moment of 10 N-m with a follower load of 400 N. The changes in motion were compared between the treatment groups to assess how the different variables affected the overall motion of the SI joint. RESULTS Transarticular placement of 3 implants with superior implants that end in the middle of the sacrum resulted in the greatest reduction in range of motion(flexion/extension = 73%, lateral bending = 42%, axial rotation = 72%). The range of motions of the SI joints were reduced with use of transarticular orientation(9%-18%) when compared with an inline orientation. The use of a superior implant that ended mid-sacrum resulted in median reductions of(8%-14%) when compared with a superior implant that ended in the middle of the ala. Reducing the number of implants, resulted in increased SI joint range of motions for the 1 and 2 implant models of 29%-133% and 2%-39%, respectively,when compared with the 3 implant model.CONCLUSION Using a validated finite element model we demonstrated that placement of 3 implants across the SI joint using a transarticular orientation with superior implant reaching the sacral midline resulted in the most stable construct. Additional clinical studies may be required to confirm these results.
文摘Background: The sacroiliac joint (SIJ) is an important cause of chronic low back pain, implicated in 15% - 30% of all cases. While radiofrequency neurotomy (RFN) is the interventional treatment of choice for spinal pain originating from the facet joints, fewer studies have investigated its potential for treating SIJ pain, and its long-term efficacy is unknown. Objectives: To obtain a real-world view of RFN treatment outcomes for SIJ pain by conducting an observational study within a community pain practice, among a heterogeneous patient group receiving standard-of-care diagnostic workup and treatment. Study Design: A prospective, observational study, with data collection over five years, was conducted at the authors' private practice. Patients & Methods: A cohort of 215 patients underwent fluoroscopically guided SIJ RFN of the dorsal and lateral branches of S1-S3 and the descending branch of L5. All patients had previously had their diagnosis of SIJ pain confirmed by controlled comparative analgesic blocks of relevant nerves, and recorded pre-procedure pain levels on the 11-point Numerical Rating Scale (NRS). Outcome measures included pain, and a Likert scale to measure alterations to analgesic use, changes to paid employment status and patient satisfaction. Results: We demonstrate an average pain reduction of 2.3 ± 2.1 NRS points following RFN (baseline pain score of 6.9 ± 1.7 to a follow-up average of 4.6 ± 2.7 NRS points;p ≤ 0.01). At a mean follow-up period of 14.9 ± 10.9 months (range 6 - 49 months), an overall 42.2% of patients reduced their analgesic use. Of the patients for whom employment capacity was applicable (82 patients), 21 patients reported an improvement. Overall, 67% of patients were satisfied with their outcome of post-RFN treatment. No complications occurred. Limitations: This observational study had no independent control group and only included a single study site. Conclusions: RFN is a safe and effective treatment for pain confirmed to originate from the sacroiliac joint.
文摘BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.CASE SUMMARY A 65-year-old Asian man presented with severe pain and numbness in his left lower limb,which became aggravated during walking and showed intermittent claudication.The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive.Computed tomography(CT)and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint.The results of electrophysiological examination showed peripheral neuropathy.A CT-guided obturator nerve block significantly reduced the severity of pain in this patient.According to the above findings,ONI caused by the osteophyte in the sacroiliac joint was diagnosed.This patient underwent an operation to remove the bone spur and symptomatic treatment.After therapy,the patient's pain and numbness were significantly relieved.The last follow-up was performed 6 mo after the operation,and the patient recovered well without other complications,returned to work,and resumed his normal lifestyle.CONCLUSION Osteophytes of the sacroiliac joint can cause ONI,which leads to symptoms including severe radiative pain in the lower limb in patients.The diagnosis and differentiation of this disease should attract the attention of clinicians.Surgical excision of osteophytes should be considered when conservative treatment is not effective.
文摘Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement;however,image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement.In the following cases,we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm^（？）multidimensional surgical imaging with StealthStation^（？）navigation（Medtronic,Inc.Minneapolis,MN）.Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site.O-arm^（？） integrated with StealthStation^（？） allowed immediate autoregistration.The skin incision was planned with an image-guidance probe.An image-guided awl,drill and tap were utilized to choose a starting point and trajectory.Threaded titanium cage（s） packed with autograft and/or allograft were then placed.O-arm^（？） image-guidance allowed for implant placement in the SIJ with a small skin incision.However,we could not track the cage depth position with our current system,and in one patient,the SIJ cage had to be revised secondary to the anterior breach of sacrum.
文摘Background: Sacroiliac joint (SIJ) pain presents as a deep and somatic pain, predominantly affecting the lower back and buttock and referring down the leg, sometimes as far as the foot. Given that the features of SIJ pain are non-specific and that this referred pain is similar to lumbar facet joint and lumbar disc pain, diagnostic local anesthetic injections (diagnostic blocks) into the SIJ are used to identify the source of pain. Despite wide use, little is known about the false positive rate of a single diagnostic sacroiliac (SI) block and the requirement for a control block. Objective: To determine whether a control SI block is necessary and to monitor the false positive rate for a single injection. Study Design: A prospective and observational study was conducted as part of a practice audit, with data collected over 3.5 years at the authors’ private practice. Patients & Methods: Under fluoroscopic guidance, 1408 consecutive patients presenting with prominent deep somatic pain over the SIJ region were sterilely injected with anesthetic into the SIJ and/or the deep interosseous ligament (DIL). Pain was measured on the 11-point Numerical Rating Scale (NRS) prior to injection and incrementally over the following 1- 2 weeks. Fully completed and unequivocal data sets were available for 1060 patients. Decreases in pain scores (of >80%) at >2 hours of post-injection were indicative of SIJ pain and recorded as a positive SIJ block. Results: Of 1060 patients receiving a first SIJ diagnostic block, 680 (64.1%) recorded a positive result. Subsequently, 271 positive patients and 22 who were negative for SIJ pain opted to receive a second control block. SIJ pain diagnosis was confirmed in 237/271 (87.5%) of those with an initial positive response, while 18/22 patients (81%) had their initial negative result confirmed. The false positive rate of a single block is therefore calculated at 12.5%, and on a contingency table analysis, a single anesthetic SIJ injection has diagnostic accuracy of 87.03%, with high sensitivity (98.3%), when compared with a second control diagnostic block. Limitations: All injections were performed at one clinical centre. A proportion (348/1408) of initial patients did not return fully completed pain records or had equivocal responses (≥80% pain relief, but transiently, for ≤30 min) and were excluded from further analysis. Conclusion: Given the observed high rates of accuracy in this study, it is reasonable to suggest the use of one diagnostic block as the criterion standard for assessing the SIJ as the source of a patient’s pain.
文摘BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.
基金Project:Outstanding Youth Startup Foundation of Shanxi Province(No.2019YJ08)。
文摘Objective:To explore the clinical value of dual energy CT(DECT)virtual noncalcium(VNCa)in the diagnosis of sacroiliac joint bone marrow edema(BME).Methods:A collection of 45 patients(21 males,24 females,and an average age of 34 years)who underwent MRI and DECT(Siemens Somatom definition force)examinations for the sacroiliac joints in our hospital from January 2019 to August 2020.After the DECT scan,the bone marrow pseudo-color map was obtained after VNCa processing.The bone marrow pseudo-color map was evaluated by two physicians.Take MRI test results as the gold standard,the application value of DECT VNCa technology in the diagnosis of sacroiliac joint BME was analyzed.Results:The positive predictive value(PPV),negative predictive value(NPV),sensitivity(Sen),specificity(Spe)and accuracy(Acc)of the qualitative diagnosis of iliac bone and sacral BME with DECT VNCa technology was:80.6%,85.2%,78.4%,86.8%,83.3%and 100%,64.9%,32.5%,100%,70.0%,respectively.The area of edema displayed by quantitative measurement of DECT VNCa image is smaller than the area measured by MRI image.The VNCa CT value(-71.66±72.97Hu)of the iliac edema area was higher than that of the non-edema area(-90.27±65.85Hu),and the VNCa CT value of the sacral edema area(-62.90±46.87Hu)was higher than that of the non-edema area(-101.08±134.02Hu),the best cut-off values(Cut-off values)for the quantitative diagnosis of iliac bone and sacral BME by VNCa are-66.40Hu and-50.60Hu,respectively.The curve of the receiver operating characteristic(ROC)of the iliac bone and sacrum area under the cure(AUC)is 0.720 and 0.706 respectively.There is a moderate negative correlation between the VNCa CT values of the ilium and sacrum in the edema area and the conventional CT values.Conclusion:The DECT VNCa technique has certain effectiveness in the diagnosis of sacroiliac joint BME,and its effectiveness in the diagnosis of ilium BME is better than sacrum.
文摘We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.
