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Morphometric anatomical and CT study of the human adult sacroiliac region

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Abstract

Purpose

To identify and describe the morphometry and CT features of the articular and extra-articular portions of the sacroiliac region. The resulting knowledge might help to avoid complications in sacroiliac joint (SIJ) fusion.

Methods

We analyzed 102 dry hemi-sacra, 80 ilia, and 10 intact pelves and assessed the pelvic computerized tomography (CT) scans of 90 patients, who underwent the examination for conditions not involving the pelvis. We assessed both the posterior aspect of sacrum with regard to the depressions located externally to the lateral sacral crest at the level of the proximal three sacral vertebrae and the posteroinferior aspect of ilium. Coronal and axial CT scans of the SIJ of patients were obtained and the joint space was measured.

Results

On each side, the sacrum exhibits three bone depressions, not described in anatomic textbooks or studies, facing the medial aspect of the posteroinferior ilium, not yet described in detail. Both structures are extra-articular portions situated posteriorly to the SIJ. Coronal CT scans of patients showing the first three sacral foramens and the interval between sacrum and ilium as a continuous space display only the S1 and S3 portions of SIJ, the intermediate portion being extra-articular. The S2 portion is visible on the most anterior coronal scan. Axial scans show articular and extra-articular portions and features improperly described as anatomic variations.

Conclusions

Extra-articular portions of the sacroiliac region, not yet described exhaustively, have often been confused with SIJ. Coronal CT scans through the middle part of sacrum, the most used to evaluate degenerative and inflammatory conditions of SIJ, show articular and extra-articular portions of the region.

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References

  1. Borlaza GS, Seigel R, Kuhns LR, Good AE, Rapp R, Martel W (1981) Computed tomography in the evaluation of sacroiliac arthritis. Radiology 139:437–444

    Article  CAS  PubMed  Google Scholar 

  2. Carrera GF, Foley WD, Kozin F, Ryan L, Lawson TL (1981) CT of sacroiliitis. AJR 136:41–46

    Article  CAS  PubMed  Google Scholar 

  3. Cheng JS, Song JK (2003) Anatomy of the sacrum. Neurosurg Focus 15:E3

    Article  PubMed  Google Scholar 

  4. Demir M, Mavi A, Gümüsburun E, Baytram M, Gürsoy S (2007) Anatomical variations with joint space measurement on CT. Kobe J Med Sci 53:209–217

    PubMed  Google Scholar 

  5. Devauchelle-Pensec V, D’Agostino MA, Marion J, Lapierre M, Jousse-Joulin S, Colin D et al (2012) Computed tomography scanning facilitates the diagnosis of sacroiliitis in patients with suspected spondylarthritis: results of a prospective multicenter French cohort study. Arthritis Rheum 64:1412–1419. doi:10.1002/art.33466

    Article  PubMed  Google Scholar 

  6. Ehara S, El-Khoury GY, Bergman RA (1988) The accessory sacroiliac joint: a common anatomic variant. AJR 150:857–859

    Article  CAS  PubMed  Google Scholar 

  7. Elgafy H, Semaan HB, Ebraheim NA, Coombs RJ (2001) Computed tomography findings in patients with sacroiliac pain. Clin Orthop Relat Res 82:112–118

    Article  Google Scholar 

  8. Faflia CP, Prassopoulos PK, Daskalogiannaki ME, Gourtsoyiannis NC (1998) Variation in the appearance of the normal sacroiliac joint on pelvic CT. Clin Radiol 53:742–746

    Article  CAS  PubMed  Google Scholar 

  9. Gaspersic N, Sersa I, Jevtic V, Tomsic M, Praprotnik S (2008) Monitoring ankylosing spondylitis therapy by dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging. Skeletal Radiol 37:123–131

    Article  PubMed  Google Scholar 

  10. Gray H (1918) Anatomy of human body. Lea & Febiger, Philadelphia

    Book  Google Scholar 

  11. Guglielmi G, Cascavilla A, Scalzo G, Carotti M, Salaffi F, Grassi W (2011) Imaging findings of sacroiliac joints in spondyloarthropathies and other rheumatic conditions. Radiol Med 116:292–301. doi:10.1007/s11547-010-0607-z

    Article  CAS  PubMed  Google Scholar 

  12. Ha K-Y, Lee J-S, Kim K-W (2008) Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion. Spine 33:1192–1198. doi:10.1097/BRS.0b013e318170fd35

    Article  PubMed  Google Scholar 

  13. Kozin F, Carrera GF, Ryan LM, Foley D, Lawson T (1981) Computed tomography in the diagnosis of sacroiliitis. Arthritis Rheum 24:1479–1485

    Article  CAS  PubMed  Google Scholar 

  14. Lawson TL, Foley WD, Carrera GF, Berland LL (1982) The sacroiliac joints: anatomic, plain roentgenographic, and computed tomographic analysis. J Comput Assist Tomogr 6:307–314

    Article  CAS  PubMed  Google Scholar 

  15. Mahato NK (2010) Variable positions of the sacral auricular surface: classification and importance. Neurosurg Focus 28:E12

    Article  PubMed  Google Scholar 

  16. Mason LW, Chopra I, Mohanty K (2013) The percutaneous stabilisation of the sacroiliac joint with hollow modular anchorage screws: a prospective outcome study. Eur Spine J 22:2325–2331. doi:10.1007/s00586-013-2825-2

    Article  PubMed  PubMed Central  Google Scholar 

  17. Muche B, Bollow M, François RJ, Sieper J, Hamm B, Braun J (2003) Anatomic structures involved in early- and late-stage sacroiliitis in spondylarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum 48:1374–1384

    Article  CAS  PubMed  Google Scholar 

  18. Prakash D, Prabhu SM, Irodi A (2014) Seronegative spondyloarthropathy-related sacroiliitis: CT, MRI features and differentials. Indian J Radiol Imaging 24:271–278. doi:10.4103/0971-3026.137046

    Article  PubMed  PubMed Central  Google Scholar 

  19. Prassopoulos PK, Faflia CP, Voloudaki AE, Gourtsoyiannis NC (1999) Sacroiliac joints: anatomical variants on CT. J Comput Assist Tomogr 23:323–327

    Article  CAS  PubMed  Google Scholar 

  20. Renick D, Niwayama G, Goergen TG (1975) Degenerative disease of the sacroiliac joint. Invest Radiol 10:608–621

    Article  Google Scholar 

  21. Rudolf L (2012) Sacroiliac joint arthrodesis-MIS technique with titanium implants: report of the first 50 patients and outcomes. Open Orthop J 6:495–502. Available via DIALOD. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529399

  22. Rudolf L, Capobianco R (2014) Five-year clinical and radiographic outcomes after minimally invasive sacroiliac joint fusion using triangular implants. Open Orthop J 8:375–383. doi: 10.2174/1874325001206010495. Available via DIALOG. http://creativecommons.org/licenses/by-nc/3.0

  23. Sachs D, Capobianco R, Cher D et al (2014) One-year outcomes after minimally invasive sacroiliac joint fusion with a series of triangular implants: a multicenter, patient-level analysis. Med Devices (Auckl) 7:299–304. Available via DIALOG. http://creativecommons.org/licenses/by-nc/3.0

  24. Schünke M, Schulte E, Schumacher U (2011) Allgemeine Anatomie und Bewegungssystem, 3rd edn. Thieme Verlag, Stuttgart

    Google Scholar 

  25. Shibata Y, Shirai Y, Miyamoto M (2002) The aging process in the sacroiliac joint: helical computed tomography analysis. J Orthop Sci 7:712–718

    Article  Google Scholar 

  26. Sudoł-Szopinska I, Urbanik A (2013) Diagnostic imaging of sacroiliac joints and the spine in the course of spondyloarthropathies Pol. J Radiol 78:43–49. doi:10.12659/PJR.889039

    Google Scholar 

  27. Testut L, Latarjet A (1948) Traité d’anatomie humaine. Nouvième édition revue par Latarjet A. Doin G and Cie, Paris

  28. Vogler III Jr, Brown WH, Helms CA, Genant HK (1984) The normal sacroiliac joint: a CT study of asymptomatic patients. Radiology 151:433–437

    Article  PubMed  Google Scholar 

  29. Whelan MA, Gold RP (1982) Computed tomography of the sacrum: 1. Normal anatomy. AJR Am J Roentgenol 139:1183–1190

    Article  CAS  PubMed  Google Scholar 

  30. Williams PL (1995) Sacrum and lumbosacral joints. Gray’s anatomy. Churchill Livingstone, London, pp 531–533

    Google Scholar 

  31. Wise CL, Dall BE (2008) Minimally invasive sacroiliac arthrodesis: outcomes of a new technique. J Spinal Disord Tech 21:579–584. doi:10.1097/BSD.0b013e31815ecc4b

    Article  PubMed  Google Scholar 

  32. Yagan R, Khan MA, Marmolya G (1987) Role of abdominal CT, when available in patients’ records, in the evaluation of degenerative changes of the sacroiliac joints. Spine 12:1046–1051

    Article  CAS  PubMed  Google Scholar 

  33. Yusof NA, Soames RW, Cunningham CA, Black SM (2013) Growth of the human ilium: the anomalous sacroiliac junction. Anat Rec 296:1688–1694. doi:10.1002/ar.22785

    Article  Google Scholar 

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Authors and Affiliations

  1. Israelitic Hospital, P. S. Bartolomeo all’Isola 21, Rome, Italy

    Roberto Postacchini

  2. Department of Movement, Human and Health Sciences, “Foro Italico” University, P. Lauro de Bosis 15, Rome, Italy

    Roberto Postacchini

  3. Department NESMOS, Section Neuroradiology, Sant’Andrea Hospital, Via di Grottarossa, 1035/39, Rome, Italy

    Guido Trasimeni

  4. Sapienza University, P. Aldo Moro 5, Rome, Italy

    Guido Trasimeni

  5. Department of Anatomy, Istology, Legal Medicine and Locomotor Apparatus, Section of Orthopaedic Surgery, Sapienza University, P. Aldo Moro 5, Rome, Italy

    Francesca Ripani, Pasquale Sessa & Franco Postacchini

  6. Department of Radiology, “Sapienza” University, P. Aldo Moro 5, Rome, Italy

    Stefano Perotti

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  1. Roberto Postacchini
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  2. Guido Trasimeni
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Correspondence to Roberto Postacchini.

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Postacchini, R., Trasimeni, G., Ripani, F. et al. Morphometric anatomical and CT study of the human adult sacroiliac region. Surg Radiol Anat 39, 85–94 (2017). https://doi.org/10.1007/s00276-016-1703-0

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  • DOI: https://doi.org/10.1007/s00276-016-1703-0

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