Sacroiliac tuberculosis - A neglected differential in refractory low back pain - Our series of 35 patients

Prakash, J. (2014) Sacroiliac tuberculosis - A neglected differential in refractory low back pain - Our series of 35 patients Journal of Clinical Orthopaedics and Trauma, 5. I 46-I 53.

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Abstract

Introduction: Osteo-articular tuberculosis accounts for 1e3% of which 5e8% involves sacroilliac joint. Isolated sacroiliac involvement is very rare. It usually presents as vague back pain. Plain radiographs are often inconclusive. Due to rarity of lesion, vague symptoms and non-conclusive X-rays the diagnosis is further delayed. We present a series of 35 patients presented with sacroiliac tuberculosis. Methods: 35 patients were diagnosed of sacroiliac tuberculosis from January 2008 to December 2011. After a thorough history and clinical examination, patients were taken up for X-rays and MRI scans. Ultrasound guided needle aspiration was done from suspected area. After histological confirmation of the diagnosis, patients were treated with anti tubercular therapy. Results: Persistent low back pain and difficulty with walking were noted in all patients. There were 21 males (60%) and 14 females and the age ranged from 22 to 55 years (mean: 27 years). Most of the patients (91.4%) had unilateral disease (32 patients). Results of conservative management were good. 21 (60%) of our patients achieved bony ankylosis at the end of study. 9 patients did not respond to conservative management where surgical debridement was done. 4 of these cases had MDR tuberculosis. Conclusion: Sacroiliac tuberculosis must be kept as a differential in all refractory low back pain particularly in endemic areas. MRI is very helpful in early diagnosis of disease. In the early stages of the infection aspiration using a closed needle biopsy is recommended. An open biopsy is essential when the aspirate yields no growth. Open debridement should be done in those not responding to conservative management.

Item Type: Article
Uncontrolled Keywords: Adult; Sacroiliac joint; Infection; Tuberculosis
Subjects: Tuberculosis > Clinical
Tuberculosis > Extra Pulmonary TB
Institutions: National Task Force, Zonal Task Force & State Task Force of Medical Colleges
Depositing User: Mr SANJAY SINGH
Date Deposited: 16 Jul 2015 06:56
Last Modified: 16 Jul 2015 06:56
URI: http://tbresearch.ntiindia.org.in/id/eprint/2152

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