Daisuke Kurosawa1, Eiichi Murakami1, Hiroshi Ozawa2, Hiroaki Koga3, Toyohiko Isu4, Yasuhiro Chiba4, Eiji Abe5, Eiki Unoki5, Yoshiro Musha6, Keisuke Ito6, Shinsuke Katoh7, Takuhiro Yamaguchi8. 1. Department of Orthopaedic Surgery/Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital, Sendai, Japan. 2. Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan. 3. Department of Orthopaedic Surgery, Kikuno Hospital, Kagoshima, Japan. 4. Department of Neurosurgery, Kushiro Rousai Hospital, Kushiro, Japan. 5. Spine and Spinal Cord Center, Toho University Ohashi Medical Center, Tokyo, Japan. 6. Department of Orthopaedic Surgery, Akita Kosei Medical Center, Akita, Japan. 7. Department of Rehabilitation, Tokushima University Hospital, Tokushima, Japan. 8. Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan.
Abstract
Objective: Sacroiliac joint (SIJ) pain originating from the posterior ligament manifests in not only the buttocks but also the groin and lower extremities and thus may be difficult to discern from pain secondary to other lumbar disorders. We aimed to develop a simple clinical diagnostic tool to help physicians distinguish between patients with SIJ pain originating from the posterior ligament and those with lumbar disc herniation (LDH) or lumbar spinal canal stenosis (LSS). Design: Prospective case-control study. Patients and Methods: We evaluated 62 patients with SIJ pain originating from the posterior ligament and 59 patients with LDH and LSS. Pain areas, pain increasing positions, provocation test, and tenderness points were investigated. A scoring system based on multivariate logistic regression equations using the investigated items was developed. Results: Two pain areas (the posterosuperior iliac spine (PSIS) detected by the one-finger test and groin), pain while sitting on a chair, provocation test, and two tenderness points (PSIS and the sacrotuberous ligament) had high odds ratios (range, 25.87–1.40) and were used as factors in the scoring system. An integer score derived from the regression coefficient and clinical experience was assigned to each identified risk factor. The sum of the risk score for each patient ranged from 0–9. This scoring system had a sensitivity of 90.3% and a specificity of 86.4% for a positivity cutoff point of 4. Conclusion: The scoring system can help distinguish between patients with SIJ pain originating from the posterior ligament and those with LDH and LSS.
Objective: Sacroiliac joint (SIJ) pain originating from the posterior ligament manifests in not only the buttocks but also the groin and lower extremities and thus may be difficult to discern from pain secondary to other lumbar disorders. We aimed to develop a simple clinical diagnostic tool to help physicians distinguish between patients with SIJ pain originating from the posterior ligament and those with lumbar disc herniation (LDH) or lumbar spinal canal stenosis (LSS). Design: Prospective case-control study. Patients and Methods: We evaluated 62 patients with SIJ pain originating from the posterior ligament and 59 patients with LDH and LSS. Pain areas, pain increasing positions, provocation test, and tenderness points were investigated. A scoring system based on multivariate logistic regression equations using the investigated items was developed. Results: Two pain areas (the posterosuperior iliac spine (PSIS) detected by the one-finger test and groin), pain while sitting on a chair, provocation test, and two tenderness points (PSIS and the sacrotuberous ligament) had high odds ratios (range, 25.87–1.40) and were used as factors in the scoring system. An integer score derived from the regression coefficient and clinical experience was assigned to each identified risk factor. The sum of the risk score for each patient ranged from 0–9. This scoring system had a sensitivity of 90.3% and a specificity of 86.4% for a positivity cutoff point of 4. Conclusion: The scoring system can help distinguish between patients with SIJ pain originating from the posterior ligament and those with LDH and LSS.