Sacroiliac joint tuberculosis revisited - A clinico-radiological review

Abstract

Osteoarticular Tuberculosis (TB) of the Sacroiliac (SI) joint is an uncommon site affected by Mycobacterium Tuberculosis infection. The SI joint is involved in approximately 5-10% of all cases of TB. Diagnosis of SI joint TB can be delayed in early stages due to its varied and hidden presentation and probability of being confused with other spinal diseases. Delay in diagnosis can lead to chronic pain, joint destruction, and a natural progression to symptomatic bony ankylosis. A focused clinical examination, complementary imaging, microbiological and histopathological confirmation of Mycobacterium tuberculosis can direct a targeted therapy. Anti-Tubercular Therapy (ATT) regime remains a cornerstone in the overall management of SI joint TB. Early diagnosis allows conservative or non-operative management. Surgical interventions like abscess drainage, debridement, and arthrodesis with or without bone grafting may be required to achieve an excellent functional outcome.

Keywords: Diagnosis; Mycobacterium tuberculosis; Osteoarticular; Sacroiliac joint; Treatment; Tuberculosis.

Fig. 1

a: AP radiograph (a) showing osteopenia and loss of indistinct right SIJ Fig. 1b and c: Axial T1(b) and STIR coronal (c) showing right infective sacroiliitis.

Fig. 2

Coronal T2FS (a,b) and axial T1(c) showing right infective sacroiliitis with large collection (white arrow).

Fig. 3

Axial T1(a) and T2FS(b) showing right infective sacroiliitis with large collection.

Fig. 4

Axial T2FS (a,b,c) showing bilateral infective sacroiliitis with large presacral, posterior collection(arrows) tracking into the left sciatic notch.

Fig. 5

Graphical representation showing Kim classification normal SI joint (A); Joint space widening and Blurred joint margin Type 1 (B); Erosions Type 2 (C); Severe joint destruction with cyst formation and marginal sclerosis Type 3 (D); SI joint lesion with abscess or with involvement of vertebra Type 4 (F).

Fig. 6

Graphical representation of Zhu et al. Severe joint destruction, with or without a posterior abscess of SI joint, Type A (Kim type 2) (A); Severe joint destruction with an anterior abscess of sacroiliac joint, with or without a posterior abscess, Type B (Kim type 3) (B); Severe joint destruction with spinal tuberculosis, Type C (Kim type 4) (C).