Clinical features and surgical management of tuberculous arthritis of the sacroiliac joint: a retrospective analysis of 33 patients

Abstract

Background: Tuberculous sacroiliac joints are relatively rare. Due to the insidious onset and easy misdiagnosis, they often develop into later severe joint destruction without effective treatment in the early stage. There are few existing studies on tuberculous sacroiliitis. In our study, we reviewed 3 different types of tuberculous sacroiliitis via anterior and posterior approaches to determine the efficacy and safety of this surgical approach by describing clinical presentation, imaging, and surgical treatment.Methods: We reviewed 33 patients with 3 different types of severe tuberculous sacroiliitis, of which 16 patients with anterior iliac abscess underwent anterior debridement and bone graft fusion. 17 patients underwent posterior debridement and bone graft fusion. Among them, 5 patients with lumbar tuberculosis underwent lesion debridement through fenestration, joint fusion, and interbody fusion and internal fixation. One patient with anterior paravertebral abscess underwent lesion debridement through posterior fenestration and bone graft fusion in the first operation, and the anterior abscess was removed and intervertebral fusion in the second operation. The mean postoperative follow-up was 16.9 months (12-25 months).Erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to judge the postoperative condition and functional recovery. X-ray and CT scan were used to evaluate the fusion of sacroiliac joints.Results: All patients' hip, back and lower back pain symptoms were significantly relieved after surgical treatment. At 3 months after operation, the VAS and ODI scores of all patients decreased significantly. At 12 months after operation, the patients had no obvious pain or only slight discomfort during activities, and the lower limb function basically recovered, which could meet the needs of daily work and life.All cases had sacroiliac joint fusion within 12 months after operation.Conclusion: Tuberculous sacroiliitis is easy to be misdiagnosed due to its insidious onset.Therefore, patients with hip, groin and lower back pain must be carefully checked to avoid misdiagnosis.Surgical treatment should be performed as soon as possible under the adjuvant chemotherapy of anti-tuberculosis drugs. According to the different characteristics of sacroiliac joint tuberculosis, appropriate surgical operations should be adopted according to our classification criteria.