In patients with SIJ pain unresponsive to CM, SIJF resulted in excellent long-term clinical responses, with low opioid use and better work status compared to other treatments.
Summary.A retrospective, population-based registry was established in the Comunidad of Madrid, Spain (total population: 4,780,572; under age 15: 1,105,243) to investigate the epidemiology of Type 1 (insulin-dependent) diabetes mellitus. Included were all cases diagnosed with diabetes between 1985 and 1988, with age onset less than 15 years, and using insulin at discharge from hospital. Using the capture-recapture method employing hospital records as the primary source and membership files of the Spanish Diabetic Association as the secondary source, the ascertainment was 90%. The overall annual incidence was estimated to be 11.3/100,000 (Poisson 95% confidence interval: 10.3-12.4). There was no ternporal increase in incidence, nor was there a significant sex difference in incidence rates, either overall or by year. The seasonal onset pattern showed the highest incidence in winter (December-February) and lowest in summer (June-August) (r = 7.36,p < 0.05). The age-adjusted (world standard) incidence of 10.9/100,000 was inconsistent with the hypothesis of a north-south gradient in diabetes risk.
Chronic pain originating from the sacroiliac joint (SI) can cause severe dysfunction. Although many patients respond to conservative management with NSAIDs, some do need further treatment in the form of SI joint fusion (SIJF). To achieve safe and successful SIJF, intraoperative x-ray fluoroscopy is mandatory to avoid serious damages to nearby vascular and neural structures. Each step of the procedure has to be confirmed by anteroposterior (AP) and lateral projections. With a single-arm x-ray, the arch has to be moved back and forth for the AP and lateral projections, and this lengthens the procedure. To achieve the same results in less time, the authors introduced simultaneous biplanar fluoroscopy with 2 x-ray arches. After the patient is positioned prone with the legs spread apart in the so-called Da Vinci position, one x-ray arch for the lateral projection is placed at a right angle to the patient, and a second x-ray machine is placed with its arch between the legs of the patient. This allows simultaneous AP and lateral x-ray projections and, in the authors' hands, markedly speeds up the procedure. Biplanar fluoroscopy allows excellent AP and lateral projections to be made quickly at any time during the surgical procedure. This is particularly useful in cases of bilateral SI joint fusion if both sides are done at the same time.The video can be found here: https://youtu.be/TX5gz8c765M.
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