Sacroiliac Joint Ligaments and Sacroiliac Pain: A Case-Control Study on Micro- and Ultrastructural Findings on Morphologic Alterations.
Journal
Pain physician
ISSN: 2150-1149
Titre abrégé: Pain Physician
Pays: United States
ID NLM: 100954394
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
entrez:
29
11
2019
pubmed:
30
11
2019
medline:
9
4
2020
Statut:
ppublish
Résumé
The sacroiliac joint (SIJ) is a common source of low back pain. SIJ pain has shown to have negative impact on patients' quality of life. Although clinically there is an increasing interest to treat SIJ-related pain both conservatively and surgically, the underlying mechanisms related to pathology in that region are poorly understood. One hypothesis is that the SIJ ligaments are structurally altered in SIJ pain. The given study investigated patient cases with different pain durations undergoing posterior distraction arthrodesis of the SIJ, with subsequent micro- and ultrastructural assessment of the interosseous and posterior SIJ ligaments compared with autopsy controls without known history of low back pain. Case-control study. Morphologic-pathological analysis of tissue samples obtained during surgery with controls from legal medicine. Rural hospital setting in Halberstadt, Germany. SIJ ligaments were removed from 6 patients undergoing SIJ arthrodesis for histological and ultrastructural assessment in scanning and transmission electron microscopy, and compared with 6 controls without known history of SIJ pathology. A number of alterations were observed in the ligaments of patients with SIJ, namely ligament disruption, collagen loosening and coiling, vascularization, and hemorrhage. In some areas, these changes were observed in proximity to healthy (structurally unaltered and intact tissues), indicative of a potential disease progression. Comparison to controls yielded a significant correlation between SIJ pathology and the level of collagen degeneration (Phi >/= 0.82; P < 0.001). Small sample size, method of tissue removal from patients may have influenced tissue integrity. The combined clinical, histological, and ultrastructural analysis provided, to our knowledge, first-time evidence of morphologic SIJ ligament alteration of a nontraumatic and noninflammatory cause. Further research is necessary to elucidate these structural changes and to substantiate pain duration and patient-history-dependent changes at the ligaments of the posterior pelvis. Collagen, electron microscopy, histological and ultrastructural assessment, interosseous sacroiliac ligament, low back pain, sacroiliac joint.
Sections du résumé
BACKGROUND
The sacroiliac joint (SIJ) is a common source of low back pain. SIJ pain has shown to have negative impact on patients' quality of life. Although clinically there is an increasing interest to treat SIJ-related pain both conservatively and surgically, the underlying mechanisms related to pathology in that region are poorly understood. One hypothesis is that the SIJ ligaments are structurally altered in SIJ pain.
OBJECTIVES
The given study investigated patient cases with different pain durations undergoing posterior distraction arthrodesis of the SIJ, with subsequent micro- and ultrastructural assessment of the interosseous and posterior SIJ ligaments compared with autopsy controls without known history of low back pain.
STUDY DESIGN
Case-control study. Morphologic-pathological analysis of tissue samples obtained during surgery with controls from legal medicine.
SETTING
Rural hospital setting in Halberstadt, Germany.
METHODS
SIJ ligaments were removed from 6 patients undergoing SIJ arthrodesis for histological and ultrastructural assessment in scanning and transmission electron microscopy, and compared with 6 controls without known history of SIJ pathology.
RESULTS
A number of alterations were observed in the ligaments of patients with SIJ, namely ligament disruption, collagen loosening and coiling, vascularization, and hemorrhage. In some areas, these changes were observed in proximity to healthy (structurally unaltered and intact tissues), indicative of a potential disease progression. Comparison to controls yielded a significant correlation between SIJ pathology and the level of collagen degeneration (Phi >/= 0.82; P < 0.001).
LIMITATIONS
Small sample size, method of tissue removal from patients may have influenced tissue integrity.
CONCLUSIONS
The combined clinical, histological, and ultrastructural analysis provided, to our knowledge, first-time evidence of morphologic SIJ ligament alteration of a nontraumatic and noninflammatory cause. Further research is necessary to elucidate these structural changes and to substantiate pain duration and patient-history-dependent changes at the ligaments of the posterior pelvis.
KEY WORDS
Collagen, electron microscopy, histological and ultrastructural assessment, interosseous sacroiliac ligament, low back pain, sacroiliac joint.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM