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

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.

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.

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.

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.