Is CT indicated in diagnosing sacroiliac joint degeneration?

To assess the value of computed tomography (CT) in the diagnosis of symptomatic sacroiliac (SI) joint degeneration.

CT images from 123 patients with clinically diagnosed SI joint pain were compared to age- and gender-matched controls without chronic back pain or previous back surgery. Degeneration was graded assessing joint space narrowing, osteophytes, subchondral sclerosis, cysts, and vacuum phenomena.

The mean total score for the patients was 9.6 and for the controls 9.7 (p=0.77). A subgroup analysis of the mean score for the SI joints that were subjected to surgery was 4.3, compared to 4.8 in the conservatively treated SI joints in the patient group (p=0.23) and 4.8 for all SI joints in the control group (p=0.25). For patients with unilateral left-sided pain (n=40), the mean score for the left side was 5.2 and for the right side 4.9 (p=0.49). For patients with right-sided pain (n=41), the mean score for the right side was 4.8 and the left side 4.7 (p=0.55).

The prevalence of SI joint degeneration on CT is equal in symptomatic and non-symptomatic individuals. This study indicates that the value of CT is limited, but further studies are needed to establish if CT has a place in diagnosing SI joint degeneration.