Bart N Green1, Gary Schultz, Mark Stanley. 1. Department of Physical and Occupational Therapy, Chiropractic Division, Naval Medical Center San Diego, MCAS Miramar Branch Medical Clinic, PO Box 452002, San Diego, CA 92145-2002, USA. bart.green@med.navy.mil
Abstract
BACKGROUND CONTEXT: Persistence of a primary sacral ossification center resulting in synchondrosis in adulthood is rare and can confound diagnostic decision making during patient management. PURPOSE: To present a synchondrosis between the sacral ala and sacral body in a healthy 23-year-old US Marine who had low back pain. STUDY DESIGN/ SETTING: Case report. OUTCOME MEASURES: Self-report measures included a numerical pain scale and Roland Morris Disability questionnaire; physiological measures included plain film radiography, computed tomography scans, magnetic resonance imaging, and physical examination procedures; and functional measures included the patient's ability to run and sit without pain and to maintain US Marine Corps fitness standards. METHODS: The initial management of his low back pain included a course of nonsteroidal anti-inflammatory medication, chiropractic manipulation of the sacroiliac joints and adjacent tissues, and therapeutic exercise. When the patient's condition did not improve as quickly as anticipated, plain X-ray films were ordered; this revealed a vertical cleft in the sacrum at the site of the patient's pain. Further imaging showed the anomalous cleft to be a synchondrosis between the costal element and the centrum of the sacrum. Manual manipulation, physical training, and ergonomic advice were continued. RESULTS: Pain severity decreased from 7 to 0, and the Roland Morris score decreased from 14 to 1. He could sit for prolonged periods of time and exercise to Marine Corps standards. CONCLUSIONS: It is unlikely that the synchondrosis was the structure responsible for generating the patient's low back pain. However, such an anomaly is clinically relevant because it may mimic a fracture.
BACKGROUND CONTEXT: Persistence of a primary sacral ossification center resulting in synchondrosis in adulthood is rare and can confound diagnostic decision making during patient management. PURPOSE: To present a synchondrosis between the sacral ala and sacral body in a healthy 23-year-old US Marine who had low back pain. STUDY DESIGN/ SETTING: Case report. OUTCOME MEASURES: Self-report measures included a numerical pain scale and Roland Morris Disability questionnaire; physiological measures included plain film radiography, computed tomography scans, magnetic resonance imaging, and physical examination procedures; and functional measures included the patient's ability to run and sit without pain and to maintain US Marine Corps fitness standards. METHODS: The initial management of his low back pain included a course of nonsteroidal anti-inflammatory medication, chiropractic manipulation of the sacroiliac joints and adjacent tissues, and therapeutic exercise. When the patient's condition did not improve as quickly as anticipated, plain X-ray films were ordered; this revealed a vertical cleft in the sacrum at the site of the patient's pain. Further imaging showed the anomalous cleft to be a synchondrosis between the costal element and the centrum of the sacrum. Manual manipulation, physical training, and ergonomic advice were continued. RESULTS:Pain severity decreased from 7 to 0, and the Roland Morris score decreased from 14 to 1. He could sit for prolonged periods of time and exercise to Marine Corps standards. CONCLUSIONS: It is unlikely that the synchondrosis was the structure responsible for generating the patient's low back pain. However, such an anomaly is clinically relevant because it may mimic a fracture.
Authors: Silvano Mior; Deborah Sutton; Carolina Cancelliere; Simon French; Anne Taylor-Vaisey; Pierre Côté Journal: Chiropr Man Therap Date: 2019-07-15