Sacroiliac tuberculosis – A neglected differential in refractory low back pain – Our series of 35 patients

IntroductionOsteo-articular tuberculosis accounts for 1–3% of which 5–8% involves sacro-illiac joint. Isolated sacroiliac involvement is very rare. It usually presents as vague back pain. Plain radiographs are often inconclusive. Due to rarity of lesion, vague symptoms and non-conclusive X-rays the diagnosis is further delayed. We present a series of 35 patients presented with sacroiliac tuberculosis.Methods35 patients were diagnosed of sacroiliac tuberculosis from January 2008 to December 2011. After a thorough history and clinical examination, patients were taken up for X-rays and MRI scans. Ultrasound guided needle aspiration was done from suspected area. After histological confirmation of the diagnosis, patients were treated with anti tubercular therapy.ResultsPersistent low back pain and difficulty with walking were noted in all patients. There were 21 males (60%) and 14 females and the age ranged from 22 to 55 years (mean: 27 years). Most of the patients (91.4%) had unilateral disease (32 patients). Results of conservative management were good. 21 (60%) of our patients achieved bony ankylosis at the end of study. 9 patients did not respond to conservative management where surgical debridement was done. 4 of these cases had MDR tuberculosis.ConclusionSacroiliac tuberculosis must be kept as a differential in all refractory low back pain particularly in endemic areas. MRI is very helpful in early diagnosis of disease. In the early stages of the infection aspiration using a closed needle biopsy is recommended. An open biopsy is essential when the aspirate yields no growth. Open debridement should be done in those not responding to conservative management.