The pediatric accessory sacroiliac joint: does it exist?
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SCIENTIFIC ARTICLE
The pediatric accessory sacroiliac joint: does it exist? Allison Rixey 1 & Naveen Murthy 1 & Kimberly Amrami 1 & Matthew Frick 1 & Gavin McKenzie 1 Received: 6 August 2020 / Revised: 7 September 2020 / Accepted: 10 September 2020 # ISS 2020
Abstract Objective Determine the prevalence of the accessory sacroiliac joint in the pediatric population and describe variant sacroiliac joint morphology that may predispose patients to the development of an accessory sacroiliac joint. Materials and methods One hundred and seventy-eight high-resolution pelvic CT scans of patients aged 0 to 15 years were reviewed for the presence of an accessory sacroiliac joint. Patients were stratified based on age and gender. Morphology of the sacroiliac joints was detailed to assess the degree of curvature in the expected characteristic location of the accessory sacroiliac joint. Results No accessory sacroiliac joint was identified on any of the pediatric pelvic CT scans. The sacroiliac joints demonstrated varying degrees of unilateral or bilateral curvature in the expected region of the accessory sacroiliac joint which increased in both severity and prevalence with age. Conclusion The pediatric accessory sacroiliac joint may not exist and is unlikely to be a congenital variant present at birth. However, curvature of the sacroiliac joint in the expected location of the accessory sacroiliac joint which increases in severity and prevalence with age may predispose patients to the formation of an accessory sacroiliac joint later in life. Keywords Accessory sacroiliac joint . Pediatric sacroiliac joint . CT
Introduction The sacroiliac (SI) joint is a complex articulation with both a fibrocartilaginous/ligamentous and a synovial portion [1, 2]. Described anatomical variations, most to least common, include the accessory sacroiliac joint (ASIJ), iliosacral complex, bipartite iliac bony plate, and crescent-like bony plate [3]. The most common variant, the ASIJ, has a wide prevalence ranging from 3.6 to 50% and is bilateral in up to 53% of patients [4–6]. Recognizing the ASIJ is important as it is the variant that is most prone to degenerative changes and hence the most commonly symptomatic [3, 7–9]. One study demonstrated that up to 64% of patients with an ASIJ present with low back pain and degenerative findings on CT [3]. As it is prone to degeneration, the ASIJ becomes a potential pain generator that may have clinical relevance in patients presenting with lumbosacral pain and can serve as a target for therapeutic injection [10]. * Gavin McKenzie [email protected] 1
Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
The articulation of the ASIJ is characteristically located just lateral to the second sacral neuroforamen near the posterior superior iliac spine (PSIS) (Fig. 1) [3, 5, 7, 9, 11]. Crosssectional imaging is preferred for identification of the ASIJ, specifically CT given its high spatial resolution and superior osseous detail in comparison with MRI. Identification and analysis of the ASIJ on radiographs a
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