Sacroiliac joint involvement in spinal tuberculosis
Background: A discussion of the incidence and pathogenesis of tuberculosis of the sacroiliac joint and a description of an association with spinal tuberculosis.
Methods: A retrospective chart review was conducted in the spine unit on all inpatients admitted between 1 July 2014 and 30 June 2015. Patients with confirmed tuberculous spondylitis and/or sacroiliitis, who underwent adequate radiological examination of their sacroiliac joints, were included in the study. Available clinical and radiological investigations including plain X-rays, CT and MRI scans, were scrutinised to actively exclude sacroiliac joint involvement.
Results: Sixty-six patients with tuberculous spondylitis and one patient with isolated tuberculous sacroiliitis were included in the study. Seventeen patients had multilevel (>2 levels) contiguous involvement, while 14 patients had multilevel non-contiguous lesions. Thirty-four patients had associated iliopsoas abscesses. Thirteen patients (19.4%) were identified as having involvement of their sacroiliac joint(s). Six had bilateral involvement, five with right-sided and two patients with left-sided involvement. Eleven of the patients identified had associated iliopsoas abscesses, two of whom had gluteal and iliopsoas abscesses. The patient with isolated sacroiliac joint involvement had a gluteal abscess.
Conclusion: Concurrent radiographic evidence of sacroiliac joint involvement is not uncommon in patients with spinal tuberculosis, more so when abscess formation is associated, and should be actively looked for and excluded in such cases.
Level of evidence: Level 4