Osteitis condensans ilii or osteopathia condensans ilii.pptx

Introduction to Osteitis condensans ilii, an uncommon cause of axial low back pain

1. Osteitis condensans ilii Dr. Mohammad Taqi Ehsani PGY2 of Orthopedics, FMIC September 2024

2. Introduction Osteitis condensans ilii , also known as  osteopathia condensans ilii  or hyperostosis triangularis ilii  in Germany, is characterized by benign sclerosis of the ilium adjacent to the  sacroiliac joint (SI), typically bilateral and triangular in shape.  non-progressive condition ,Benign cause of axial low back pain Non-inflammatory condition Primarily affects the auricular portion of the ilium Affects females <40y, often following pregnancy  incidence of 0.9-2.5%

3. Pathophysiology Idiopathic Pregnancy theory (not accepted widely) low blood circulation to the ilium in 3 rd trimester increased mechanical stress on Histopathology: In affected regions of sclerosis: focal bone marrow fibrosis. increased density in trabeculation increase in osteoblastic activity. a quantitative increase in lamellar bone

4. Signs and symptoms Often asymptomatic Axial low back pain (preg-3 rd trimester) Usually bilateral symptoms, may extend to the buttocks and posterior thighs in a non-radicular fashion Symptoms may or may not correlate with point tenderness at the sacroiliac joint Absence of sensory or motor loss Increased lumbar lordosis Muscle spasm

5. FABER test positive Test for sacro -iliac disease have also been found to be negative Fortin's Sign or Finger Test: A positive Fortin finger test is determined by when the patient twice identifies their most painful region within one centimeter of the area known as the posterior superior iliac spine

6. Differential diagnosis Unilateral Destructive neoplastic process SAPHO: a rare condition, present with the constellation of findings to include: synovitis, Acne, pustulosis, Hyperostosis Bilateral asymmetric: Gout Psoriatic arthritis (PA) Osteoarthritis Bilateral symmetric: Ankylosing spondylitis (AS) Rheumatoid arthritis (RA) Enteropathic arthritis (association with IBD) Major deferential is sacroiliitis Other differential considerations would include spondylosis of the lumbar spine, osteoarthritis of the femoroacetabular joints, piriformis syndrome, trochanteric or iliopsoas bursitis, muscle strain, or tendinosis

7. Differential diagnosis

8. Investigation often diagnosed incidentally Radiographic: well defined triangular sclerosis, with ossification affecting the iliac portion of the articulation triangular shape of sclerosis at the iliac border with preserved joint space Ossification is bilateral and symmetric No evidence of erosive arthritis/articular inflammatory findings Normal bone scan ESR variable Rheumatoid factor is also negative  HLA negative

9. Treatment Physical therapy NSAIDS Overweight has been found as poor outcome factor as it is supposed to be related with increased strain on both SI joints, Obesity reduction can thus be part of any treatment strategy Fluoroscopy guided steroid injections surgical core decompression in refractory cases (Percutaneous iliac core decompression through a cannulated drill bit) SI arthrodesis or open surgical resection of the sclerosed part of the affected ilium

10. Prognosis a self-limiting and non-progressive disease Most patients with OCI have an excellent outcome and symptoms regress in the majority of patients that's why OCI is rare in elderly patients