Open AccessSacroiliac Joint Ligaments and Sacroiliac Pain: A Case–Control Study on Micro- and Ultrastructural Findings on Morphologic Alterations
Author(s) -
Niels Hammer,
Benjamin Ondruschka,
Volker Fuchs
Publication year - 2019
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.22.e615
Subject(s) - medicine , sacroiliac joint , ligament , ultrastructure , low back pain , pathological , arthrodesis , pathology , anatomy , alternative medicine
Background: The sacroiliac joint (SIJ) is a common source of low back pain. SIJ pain hasshown to have negative impact on patients’ quality of life. Although clinically there is anincreasing interest to treat SIJ-related pain both conservatively and surgically, the underlyingmechanisms related to pathology in that region are poorly understood. One hypothesis is thatthe SIJ ligaments are structurally altered in SIJ pain.Objectives: The given study investigated patient cases with different pain durationsundergoing posterior distraction arthrodesis of the SIJ, with subsequent micro- andultrastructural assessment of the interosseous and posterior SIJ ligaments compared withautopsy controls without known history of low back pain.Study Design: Case–control study. Morphologic-pathological analysis of tissue samplesobtained 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 forhistological 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, namelyligament disruption, collagen loosening and coiling, vascularization, and hemorrhage. Insome areas, these changes were observed in proximity to healthy (structurally unaltered andintact tissues), indicative of a potential disease progression. Comparison to controls yieldeda significant correlation between SIJ pathology and the level of collagen degeneration (φ ≥0.82; P < 0.001).Limitations: Small sample size, method of tissue removal from patients may have influencedtissue integrity.Conclusions: The combined clinical, histological, and ultrastructural analysis provided, toour knowledge, first-time evidence of morphologic SIJ ligament alteration of a nontraumaticand noninflammatory cause. Further research is necessary to elucidate these structuralchanges and to substantiate pain duration and patient-history-dependent changes at theligaments of the posterior pelvis