Refractory osteitis condensans ilii: outcome of a novel mini-invasive surgical approach

Int Orthop. 2013 Jul;37(7):1251-6. doi: 10.1007/s00264-013-1901-x. Epub 2013 May 5.

Abstract

Purpose: Osteitis condensans Ilii (OCI) is an orthopaedic mystery until now and the refractory type poses a great challenge in its management. Surgical resection and sacroiliac arthrodesis are major procedures with no guarantee of success for an unknown disease entity with a normal sacroiliac joint. The aim of this retrospective study was to evaluate results of a novel mini-invasive surgical approach for the refractory type after failure of conservative management.

Materials and methods: Fourteen females were included with an average age 35.5 ± 5.8 years. Nine cases were multiparous and five were nulliparous. The pathology was bilateral in all cases; however, seven cases suffered bilateral symptoms, while seven cases had only unilateral complaints. Preoperative computed tomography was mandatory. All cases had three to five percutaneous iliac core decompressions through a cannulated drill bit. The Bath ankylosing spondylitis functional index (BASFI) was used for functional outcome evaluation.

Results: The mean follow up was 23.3 ± 4.1 months. The mean BASFI improved from 3.7 ± 0.6 preoperatively to 1.3 ± 0.2 during follow up (P = <0.001). There was a significant improvement with the four drillings over five decompression drillings (P = 0.011). Sacral side sclerosis was associated significantly (P = 0.009) with less improvement. No relapse or substantial complications were encountered.

Conclusions: This novel approach can be of great benefit for refractory OCI cases with almost no added morbidity or complications. It has advantages of the mini-invasive techniques in addition to sparing the physiological functions of the affected sacroiliac joints.

MeSH terms

  • Adult
  • Disability Evaluation
  • Disease Management
  • Female
  • Follow-Up Studies
  • Humans
  • Minimally Invasive Surgical Procedures / methods*
  • Orthopedic Procedures / methods*
  • Osteitis / diagnostic imaging
  • Osteitis / surgery*
  • Retrospective Studies
  • Sacroiliac Joint / diagnostic imaging
  • Sacroiliac Joint / pathology
  • Sacroiliac Joint / surgery*
  • Sclerosis
  • Tomography, X-Ray Computed
  • Treatment Outcome