{"paper_id":"f7a0d9f4-6806-4056-aa19-a8bbad1b3102","body_text":"Acta Medica Bulgarica, 2026, 53 (1) 1\nORIGINAL ARTICLE\nADVANCED SURGICAL AND THERAPEUTIC TRENDS \nIN THE TREATMENT OF CHRONIC SACROILIITIS \nIN NEUROSURGERY\nK. Bechev1,2, N. Yotova3, D. Markov2,4, V. Aleksiev5,6, G. Markov7, A. Fasova8\n1'HSDUWPHQW\u0003RI\u00031HXURVXUJHU\\\u000f\u00038QLYHUVLW\\\u0003+RVSLWDO\u0003³3XOPHG´\u0003±\u00033ORYGLY\u000f\u0003%XOJDULD\n2'HSDUWPHQW\u0003RI\u0003*HQHUDO\u0003DQG\u0003&OLQLFDO\u00033DWKRORJ\\\u000f\u0003)DFXOW\\\u0003RI\u00030HGLFLQH\u000f\u00030HGLFDO\u00038QLYHUVLW\\\u0003±\u00033ORYGLY\u000f\u0003%XOJDULD\n3'HSDUWPHQW\u0003RI\u0003$QDWRP\\\u000f\u0003+LVWRORJ\\\u0003DQG\u0003&\\WRORJ\\\u000f\u0003)DFXOW\\\u0003RI\u00030HGLFLQH\u000f\u00030HGLFDO\u00038QLYHUVLW\\\u0003±\u00033ORYGLY\u000f\u0003%XOJDULD \n4'HSDUWPHQW\u0003RI\u0003&OLQLFDO\u00033DWKRORJ\\\u000f\u000380+$7\u0003³3XOPHG\u0005\u0003±\u0003\u00033ORYGLY\u000f\u0003%XOJDULD\n5'HSDUWPHQW\u0003RI\u00037KRUDFLF\u00036XUJHU\\\u000f\u000380+$7\u0003³.DVSHOD´\u0003±\u00033ORYGLY\u000f\u0003%XOJDULD\n6'HSDUWPHQW\u0003RI\u0003&DUGLRYDVFXODU\u00036XUJHU\\\u000f\u00030HGLFDO\u00038QLYHUVLW\\\u0003±\u00033ORYGLY\u000f\u0003%XOJDULD\u0003\n70HGLFDO\u0003)DFXOW\\\u000f\u00030HGLFDO\u00038QLYHUVLW\\\u0003±\u00033ORYGLY\u000f\u0003%XOJDULD \n8'HSDUWPHQW\u0003RI\u0003$QDWRP\\\u000f\u0003+LVWRORJ\\\u0003DQG\u0003&\\WRORJ\\\u000f\u0003)DFXOW\\\u0003RI\u00030HGLFLQH\u000f\u00030HGLFDO\u00038QLYHUVLW\\\u0003±\u00033ORYGLY\u000f\u0003%XOJDULD\u0003\nAbstract. The sacroiliac joints are among the largest joints in the human body. They are \nsubjected to heavy loads on a daily basis. The pathology of the sacroiliac joints can be \neasi ly missed due to the many common and overlapping symptoms with other diseases \nin this area. The thin joint capsule, the high mechanical load, and the asymmetrical move-\nment of the pelvic girdle explain the frequent involvement of the sacroiliac joint. Chronic \ndegenerative processes in the joint may result from rheumatic, infectious, drug-dependent \nand oncological causes. Diseases such as ankylosing spondylitis, psoriatic arthropathy, \nBechet’s disease, hyperparathyroidism and various pyogenic causes also cause changes \nin the joint. Hormonal changes during pregnancy and being overweight are predisposing \nfactors for the development of chronic sacroiliac arthritis. According to the literature, 10-\n25% of the pain in the area is due to sacroiliac joint pain. Due to the often irradiating pain \nLQ\u0003 GL௺HUHQW\u0003 GLUHFWLRQV\u000f\u0003 D\u0003 FRUUHFW\u0003 GLDJQRVLV\u0003 LV\u0003 GL௻FXOW\u0011\u0003 7KH\u0003 WKHUDS\\\u0003 RI\u0003 FKURQLF\u0003 VDFURLOLWLV\u0003 LV\u0003\ncontinuously improving due to the high social im portance of this disease. Twenty-eight \npatients were treated in the Department of Neurosurgery of Pulmed University Hospital with \nhyaluronic acid injection and corticosteroid blockade, under X-ray control in both sacroiliac \njoints. Preoperatively, the patients were evaluated using neurological examination and the \nOswestry Disability Index, VAS, and “Facial Pain Rating Scale” scales. The results after \nthe minimally invasive methodology showed an excellent response to the pain syndrome. \nFollow-up of the patients continued up to nine months after the manipulation.\nKey words: sacroiliac joint anatomy and biomechanics, medical treatment, minimally invasive treatment\nCorresponding author: Kristian Bechev, MD, University Hospital Pulmed, Medical University – \nPlov div, Bulgaria, email: kristian_bechev@abv.bg \nORCID: 0009-0007-1460-3522 \nReceived: 10 June 2025; Accepted: 19 June 2025\n10.2478/AMB-2026-0036\n\n\n2 K. Bechev, N. Yotova, D. Markov et al.\nINTRODUCTION\nC\nKURQLF\u0003 VDFURLOLLWLV\u0003 LV\u0003 DQ\u0003 LQÀDPPDWLRQ\u0003 RI\u0003 WKH\u0003\nVDFURLOLDF\u0003 MRLQWV\u000f\u0003 ZKLFK\u0003 LV\u0003 RIWHQ\u0003 DVVRFLDWHG\u0003\nwith diseases of the group of seronegative \nVSRQG\\ORDUWKURSDWKLHV\u000f\u0003 VXFK\u0003 DV\u0003 DQN\\ORVLQJ\u0003 VSRQG\\-\nlitis and psoriatic arthritis. The disease is character-\nL]HG\u0003E\\\u0003SURORQJHG\u0003ORZ\u0003EDFN\u0003SDLQ\u000f\u0003VWLႇQHVV\u000f\u0003DQG\u0003IXQF-\nWLRQDO\u0003OLPLWDWLRQ\u0003WKDW\u0003FDQ\u0003VLJQL¿FDQWO\\\u0003LPSDLU\u0003SDWLHQWVµ\u0003\nTXDOLW\\\u0003RI\u0003OLIH\u0003>\u0014\u000f\u0003\u0016\u000f\u0003\u0017@\u0011\n7UDGLWLRQDOO\\\u000f\u0003 WUHDWPHQW\u0003 LQFOXGHV\u0003 FRQVHUYDWLYH\u0003 PH\u0010\nWKR\u0003GV\u0003VXFK\u0003DV\u0003QRQ\u0010VWHURLGDO\u0003DQWL\u0010LQÀDPPDWRU\\\u0003GUXJV\u0003\n\u000b16$,'V\f\u000f\u0003 SK\\VLRWKHUDS\\\u0003 DQG\u0003 LPPXQRVXSSUHVVLYH\u0003\nWKHUDS\\\u0003 >\u0014\u0013\u000f\u0003 \u0014\u0015@\u0011\u0003 +RZHYHU\u000f\u0003 LQ\u0003 VRPH\u0003 SDWLHQWV\u000f\u0003 V\\PS-\ntomatology remains persistent and more aggressive \nWKHUDSHXWLF\u0003DSSURDFKHV\u0003DUH\u0003UHTXLUHG\u000f\u0003LQFOXGLQJ\u0003LQWUD\u0010\narticular administration of hyaluronic acid and corti-\nFRVWHURLG\u0003 XQGHU\u0003 LPDJH\u0010JXLGHG\u000f\u0003 VXUJLFDO\u0003 LQWHUYHQWLRQ\u0003\n>\u0014\u0016\u0010\u0014\u0018@\u0011\u00032YHU\u0003WKH\u0003SDVW\u0003GHFDGH\u000f\u0003PHGLFDO\u0003VFLHQFH\u0003KDV\u0003\nmade advances in both the diagnosis and treatment \nRI\u0003VDFURLOLLWLV\u0011\u00037KH\u0003GHYHORSPHQW\u0003RI\u0003ELRORJLF\u0003DJHQWV\u000f\u0003DV\u0003\nZHOO\u0003 DV\u0003 PLQLPDOO\\\u0003 LQYDVLYH\u0003 VXUJLFDO\u0003 WHFKQLTXHV\u000f\u0003 KDV\u0003\nRSHQHG\u0003 QHZ\u0003 DYHQXHV\u0003 IRU\u0003 FRQWUROOLQJ\u0003 LQÀDPPDWLRQ\u0003\nDQG\u0003LPSURYLQJ\u0003IXQFWLRQDO\u0003FDSDFLW\\\u0003>\u0019\u000f\u0003\u0014\u0013\u000f\u0003\u0014\u001b\u000f\u0003\u0014\u001c\u000f\u0003\u0015\u0013@\u0011\u0003\nThe aim of the present study is to analyze current \ntrends in the therapeutic approach to chronic sacro-\nLOLLWLV\u000f\u0003IRFXVLQJ\u0003RQ\u0003WKH\u0003UROH\u0003RI\u0003VXUJLFDO\u0003WUHDWPHQW\u0003LQ\u0003WKH\u0003\ncomprehensive approach to the disease.\nMATERIALS AND METHODS\n'XULQJ\u0003 WKH\u0003 SHULRG\u0003 0DUFK\u0003 \u0015\u0013\u0015\u0016\u0003 ±\u0003 0DUFK\u0003 \u0015\u0013\u0015\u0017\u000f\u0003 \u0015\u001b\u0003\npatients with chronic sacroiliitis were diagnosed in \nthe Department of Neurosurgery at Pulmed Univer-\nsity Hospital by physical examination and diagnostic \nimaging. The latter were staged using the Oswestry \n'LVDELOLW\\\u0003,QGH[\u000f\u00039$6\u0003\u000b9LVXDO\u0003$QDORJXH\u00036FDOH\u0003RI\u00033DLQ\f\u0003\nand the „Facial Pain Rating Scale“. Only patients with \ninvolvement of both sacroiliac joints were included in \nthe study. The values of the VAS scale and „Facial \nPain Rating Scale“ were distributed in a scoring sys-\ntem as follows: \n\u0013\u0010\u0014\u0003±\u0003QR\u0003SDLQ\u000f\u0003QR\u0003SDLQ\u0003\u000bQR\u0003GLႈFXOW\\\u0003LQ\u0003GDLO\\\u0003OLIH\f\u001e\n\u0014\u0010\u0016\u0003±\u0003OLWWOH\u0003SDLQ\u0003\u000bGLႈFXOW\\\u0003LQ\u0003GDLO\\\u0003OLIH\f\u001e\n\u0016\u0010\u0018\u0003±\u0003PRGHUDWH\u0012PHGLXP\u0003SDLQ\u0003\u000bGLႈFXOWLHV\u0003DQG\u0012RU\u0003OLPL-\nWDWLRQV\u0003LQ\u0003GDLO\\\u0003OLIH\f\u001e\n\u0018\u0010\u001a\u0003±\u0003VHYHUH\u0003SDLQ\u0003\u000bOLPLWDWLRQV\u0003LQ\u0003GDLO\\\u0003OLIH\f\u001e\n7-9 – very severe pain (limitations and/or inability to \nIXQFWLRQ\u0003LQ\u0003GDLO\\\u0003OLIH\f\u001e\n9-10 – terrible/unbearable/unbearable pain (inability \nto function in daily life).\n7KH\u0003GLVWULEXWLRQ\u0003RI\u0003SDWLHQWV\u0003E\\\u0003VH[\u000f\u0003DJH\u000f\u0003DQG\u0003SDLQ\u0003VH-\nYHULW\\\u0003 DFFRUGLQJ\u0003 WR\u0003 WKH\u0003 GLႇHUHQW\u0003 VFDOHV\u0003 FDQ\u0003 EH\u0003 SUH-\nsented graphically in the following table: \nPreoperative imaging by computer-assisted tomo-\ngraphy (CAT) and magnetic resonance imaging \n(MRI) was also a consideration in the diagnosis of \nthe patients. Each patient underwent an MRI of the \nlumbar spine and sacroiliac region to exclude pathol-\nRJ\\\u0003LQ\u0003WKH\u0003OXPEDU\u0003VSLQH\u0011\u00037KH\u0003FKDUDFWHULVWLF\u0003LQÀDPPD-\ntory responses on the bone side in the presence of \nankylosing spondylitis are presented in Figure 1.\nMale/female \nsex Ages Oswestry Disability \nIndex pain score\nVAS pain \nassessment\nPain \nassessment on \na “Face scale”\nMen \n(12 patients)\n63+/- 2 \nyears old\n21% – 40% \nmoderate \ndisability\n5-7 \nsevere pain \n(limitations \nin daily life)\n3-5 \nmoderate/medium \nSDLQ\u0003\u000bGLႈFXOW\\\u0003RU\u0003 \nlimitations in daily life)\nWomen \n(16 patients)\n66+/- 2 \nyears old\n21% – 40% \nmoderate \ndisability\n5-7 \nsevere pain \n(limitations \nin daily life)\n5-7 \nsevere pain \n(limitations \nin daily life)\nTable 1. 6KRZV\u0003WKH\u0003GLVWULEXWLRQ\u0003RI\u0003SDWLHQWV\u0003E\\\u0003JHQGHU\u000f\u0003DJH\u0003DQG\u0003SDLQ\u0003VHYHULW\\\n\n3Advanced surgical and therapeutic trends...\nFig. 1.\u00035DGLRJUDSK\u0003DQG\u000305,\u0003RI\u0003WKH\u0003OXPEDU\u0003VSLQH\u0003DQG\u0003VDFURLOLDF\u0003UHJLRQ\u000f\u0003SUHVHQWLQJ\u0003GHJHQHUDWLYH\u0003FKDQJHV\u0003LQ\u0003WKH\u0003MRLQW\nZRPHQ\u0011\u0003'XULQJ\u0003WKH\u0003WKLUG\u0003WULPHVWHU\u0003RI\u0003IROORZ\u0010XS\u000f\u0003\u001b\u0003PHQ\u0003\nand 10 women were reported to have fully responded \nto the treatment.\nInterpretation of the results indicates that the best \nHႇHFW\u0003 ZDV\u0003 DFKLHYHG\u0003 LQ\u0003 WKH\u0003 ¿UVW\u0003 \u0016\u0003 PRQWKV\u0003 DIWHU\u0003 WKH\u0003\nPDQLSXODWLRQ\u0003ZDV\u0003SHUIRUPHG\u0011\u0003$W\u0003WKH\u0003VL[WK\u0003PRQWK\u000f\u0003WKH\u0003\npercentage of patients who had no pain remained \nKLJK\u000f\u0003DOWKRXJK\u0003EHWZHHQ\u0003WKH\u0003\u0019WK\u0003DQG\u0003\u001cWK\u0003PRQWKV\u000f\u0003WKH\u0003\nstudy population that responded to the surgical treat-\nPHQW\u0003GURSSHG\u0003FRPSDUHG\u0003WR\u0003WKH\u0003¿UVW\u0003WULPHVWHU\u0011\u0003'HVSLWH\u0003\nWKHVH\u0003UHVXOWV\u000f\u0003RXU\u0003FRQFOXVLRQ\u0003LV\u0003WKDW\u0003WKH\u0003PHWKRG\u0003XVHG\u0003\nshows good results for the treatment of chronic sac-\nURLOLLWLV\u0003LQ\u0003ERWK\u0003VH[HV\u0011\u0003*UDSKLFDOO\\\u000f\u0003WKH\u0003UHVXOWV\u0003DUH\u0003SUH-\nsented in Figure 2.\nDISCUSSION\n$[LDO\u0003 VSRQG\\ORDUWKULWLV\u0003 LV\u0003 D\u0003 FKURQLF\u0003 V\\VWHPLF\u0003 LQÀDP-\nmatory disease. Sacroiliitis is a part of these diseas-\nHV\u0003WKDW\u0003FDQ\u0003KDYH\u0003GLႇHUHQW\u0003HWLRORJLHV\u0003DQG\u0003EH\u0003RI\u0003GLႇHU-\nHQW\u0003W\\SHV\u0003>\u0014\u000f\u0003\u0015@\u0011\u00037KH\u0003HPEU\\RQLF\u0003GHYHORSPHQW\u0003RI\u0003WKH\u0003\njoint occupies an important place. The sacroiliac joint \nThe treatment of the patients was performed using a \nPLQLPDOO\\\u0003LQYDVLYH\u0003PHWKRG\u0003LQ\u0003WKH\u0003RSHUDWLQJ\u0003URRP\u000f\u0003RE-\nserving the rules of asepsis and antisepsis. Patients \nZHUH\u0003DQHVWKHWL]HG\u0003E\\\u0003ORFDO\u0003LQ¿OWUDWLRQ\u0003ZLWK\u0003/LGRFDLQH\u0003\n20 mg/ml. The technique of the performed manipu-\nODWLRQ\u0003 FRQVLVWHG\u0003 RI\u0003 LQ¿OWUDWLRQ\u0003 RI\u0003 WKH\u0003 VDFURLOLDF\u0003 MRLQW\u0003\nXQGHU\u0003 UDGLRORJLFDO\u0003 FRQWURO\u0003 \u000bIRU\u0003 WKLV\u0003 SXUSRVH\u000f\u0003 SKDVH\u0003\nX-rays were used with a C-arm model „FYS3360A“ \nwith a radiation source of 0.002 mGy/h) with the \nSODFHPHQW\u0003 RI\u0003 \u0015\u0003 PO\u0003 RI\u0003 K\\DOXURQLF\u0003 DFLG\u0003 LQ\u0003 HDFK\u0003 MRLQW\u000f\u0003\nfollowed by 7 mg/ml. Flosterone. The manipulation \nends with a sterile dressing of the surgical wounds. \n,Q\u0003 WKH\u0003 WUHDWPHQW\u0003 SURWRFRO\u0003 ZH\u0003 HVWDEOLVKHG\u000f\u0003 SDWLHQWV\u0003\nhad to perform bed rest for 30 to 60 minutes after the \nPDQLSXODWLRQ\u0003 ZDV\u0003 SHUIRUPHG\u000f\u0003 DIWHU\u0003 ZKLFK\u0003 WKH\\\u0003 ZHUH\u0003\nverticalized and ambulated independently.\nRESULTS\n3RVWRSHUDWLYHO\\\u000f\u0003 SDWLHQWV\u0003 ZHUH\u0003 PRQLWRUHG\u0003 DQG\u0003 DV-\nsessed by applying the original pain rating scales. \nThe study continued for 9 months after the manipula-\ntion. Patient assessment on day seven showed the \nfollowing results: relative to the Oswestry Disability \n,QGH[\u000f\u0003ERWK\u0003VWXG\\\u0003JURXSV\u0003KDG\u0003DYHUDJH\u0003SDLQ\u0003VHYHULW\\\u0003\nVFRUHV\u0003 RI\u0003 \u0013\u0010\u0015\u0013\b\u0003 \u000bPLQLPDO\u0003 GLVDELOLW\\\f\u000f\u0003 LQGLFDWLQJ\u0003 WKH\u0003\npatients could manage activities of daily living. Simi-\nlar results were observed for the VAS and the „Facial \n3DLQ\u00035DWLQJ\u00036FDOH³\u000f\u0003ZKHUH\u0003SDWLHQWV\u0003UDWHG\u0003WKHLU\u0003SDLQ\u0003LQ\u0003\nWKH\u0003UDQJH\u001d\u0003\u0013\u0010\u0014\u0003±\u0003QR\u0003SDLQ\u000f\u0003QR\u0003SDLQ\u0003\u000bQR\u0003GLႈFXOW\\\u0003LQ\u0003GDLO\\\u0003\nactivities). Similar results were observed in the study \nFRKRUW\u0003LQ\u0003WKH\u0003¿UVW\u0003WULPHVWHU\u0011\u0003'XULQJ\u0003WKH\u0003VHFRQG\u0003WULPHV-\nWHU\u0003RI\u0003IROORZ\u0010XS\u000f\u0003\u0016\u0003RI\u0003WKH\u0003PHQ\u0003UHSRUWHG\u000f\u0003DQG\u0003ZHUH\u0003DV-\nVHVVHG\u0003DV\u0003KDYLQJ\u000f\u0003UHFXUUHQW\u0003SDLQ\u0003DQG\u0003YDOXHV\u0003VLPLODU\u0003\nto baseline. Similar complaints were recorded in 2 \nFig. 2. Graphical depiction of postoperative outcomes in treat-\nHG\u0003SDWLHQWV\u0003LQ\u0003DEVROXWH\u0003YDOXHV\u0003DႇHFWHG\u0003E\\\u0003WKH\u0003WUHDWPHQW\u0011\n\n4 K. Bechev, N. Yotova, D. Markov et al.\nYLF\u0003JLUGOH\u0003ORRVHQ\u0003XQGHU\u0003WKH\u0003LQÀXHQFH\u0003RI\u0003WKH\u0003KRUPRQH\u0003\nrelaxin. The range of motion in the joints increases \n>\u0018\u000f\u0003 \u001a\u000f\u0003 \u001b\u000f\u0003 \u0014\u0013\u000f\u0003 \u0014\u0014@\u0011\u0003 7KH\u0003 VDFURLOLDF\u0003 MRLQW\u0003 KDV\u0003 LPSRUWDQW\u0003\nrelationships with neighboring organs. The internal \nand external iliac veins connect to form the common \nLOLDF\u0003YHLQ\u0003LPPHGLDWHO\\\u0003DQWHULRU\u0003WR\u0003WKH\u0003MRLQW\u0011\u00037KXV\u000f\u0003WKH\\\u0003\nseparate the joint from the bifurcation of the common \nLOLDF\u0003DUWHU\\\u000f\u0003DQG\u0003PRUH\u0003DQWHULRUO\\\u0003IURP\u0003WKH\u0003XUHWHU\u0003>\u0014\u000f\u0003\u0015\u000f\u0003\n\u0016\u000f\u0003\u0018\u000f\u0003\u001a@\u0011\u00037KH\u0003OXPERVDFUDO\u0003WUXQN\u0003DQG\u0003Q\u0011REWXUDWRULXV\u0003DUH\u0003\nlocated along the anterior surface of the joint behind \nthe vessels. M. piriformis partially traps the anterior \nVXUIDFH\u0003RI\u0003WKH\u0003MRLQW\u0003FDSVXOH\u000f\u0003VHSDUDWLQJ\u0003WKH\u0003MRLQW\u0003IURP\u0003\nWKH\u0003XSSHU\u0003SDUW\u0003RI\u0003WKH\u0003SOH[XV\u0003VDFUDOLV\u0003>\u0014\u0010\u0018@\u0011\u00037KLV\u0003DQD-\nWRPLFDO\u0003 SUR[LPLW\\\u0003 LQÀXHQFHV\u0003 WKH\u0003 FOLQLFDO\u0003 SLFWXUH\u0003 DQG\u0003\ncreates conditions for the involvement of adjacent \nanatomical elements. The close relationship of the \njoint with the neural elements also explains the irra-\nGLDWLRQ\u0003RI\u0003SDLQ\u0003LQ\u0003GLႇHUHQW\u0003GLUHFWLRQV\u0003>\u0018\u000f\u0003\u0019@\u0011\n'HSHQGLQJ\u0003 RQ\u0003 WKH\u0003 HWLRORJ\\\u000f\u0003 VDFURLOLLWLV\u0003 FDQ\u0003 EH\u0003 UKHX-\nPDWLF\u000f\u0003 LQIHFWLRXV\u000f\u0003 GUXJ\u0010LQGXFHG\u000f\u0003 RU\u0003 RQFRORJLFDO\u0003 >\u001c\u0010\n\u0014\u0014@\u0011\u0003 $QN\\ORVLQJ\u0003 VSRQG\\OLWLV\u000f\u0003 SVRULDWLF\u0003 DUWKURSDWK\\\u000f\u0003\n%HFKHWµV\u0003 GLVHDVH\u000f\u0003 K\\SHUSDUDWK\\URLGLVP\u0003 DQG\u0003 YDULRXV\u0003\nS\\RJHQLF\u0003 FDXVHV\u0003 PD\\\u0003 DFFRPSDQ\\\u0003 LW\u0011\u0003 ,QÀDPPDWRU\\\u0003\nVDFURLOLLWLV\u0003PD\\\u0003EH\u0003VHFRQGDU\\\u0003WR\u0003RVWHRDUWKULWLV\u000f\u0003SUHJ-\nQDQF\\\u000f\u0003RU\u0003WUDXPD\u0011\u0003&OLQLFDO\u0003PDQLIHVWDWLRQV\u0003LQFOXGH\u0003ORZ\u0003\nEDFN\u0003SDLQ\u000f\u0003VWLႇQHVV\u000f\u0003DQG\u000f\u0003DW\u0003D\u0003ODWHU\u0003VWDJH\u000f\u0003UHVWULFWLRQ\u0003\nof movement. Benjamin Buchanan and Matthew Var-\nacallo report that only 10% to 25% of all low back \npain is due to sacroiliac pain. In up to 50% of these \nFDVHV\u000f\u0003WKH\u0003SDLQ\u0003UDGLDWHV\u0003WR\u0003WKH\u0003ORZHU\u0003H[WUHPLW\\\u000f\u0003LQ\u0003\u0019\b\u0003\nLW\u0003UDGLDWHV\u0003WR\u0003WKH\u0003OXPEDU\u0003UHJLRQ\u000f\u0003LQ\u0003\u0017\b\u0003WR\u0003WKH\u0003LQJXLQDO\u0003\nUHJLRQ\u000f\u0003DQG\u0003LQ\u0003\u0015\b\u0003WR\u0003WKH\u0003ORZHU\u0003DEGRPHQ\u0003>\u0014\u0013\u0010\u0014\u0016@\u0011\u00033DLQ\u0003\nPRVW\u0003 FRPPRQO\\\u0003 UDGLDWHV\u0003 WR\u0003 WKH\u0003 /\u0017\u0010/\u0018\u0003 GHUPDWRPHV\u000f\u0003\nEXW\u0003 LW\u0003 FDQ\u0003 DOVR\u0003 H[WHQG\u0003 RYHU\u0003 WKH\u0003 /\u0015\u0003 RU\u0003 EHORZ\u0003 WKH\u0003 6\u0016\u0003\nGHUPDWRPHV\u0011\u0003 2YHU\u0003 WKH\u0003 \\HDUV\u000f\u0003 YDULRXV\u0003 FULWHULD\u0003 KDYH\u0003\nEHHQ\u0003SXEOLVKHG\u0003IRU\u0003WKH\u0003GLDJQRVLV\u0011\u0003,Q\u0003WKH\u0003OLWHUDWXUH\u000f\u0003WKH\u0003\nRome criteria of 1961 and the New York criteria of \n1984 are known. The discovery in 1973 of the close \nDVVRFLDWLRQ\u0003 RI\u0003 WKH\u0003 +/$\u0010%\u0015\u001a\u0003 OHXNRF\\WH\u0003 DQWLJHQ\u0003 DQG\u0003\nVSRQG\\ORDUWKULWLV\u0003 ZDV\u0003 YHU\\\u0003 VLJQL¿FDQW\u0003 >\u001c\u000f\u0003 \u0014\u0015\u0010\u0014\u0017@\u0011\u0003 ,Q\u0003\n\u0014\u001c\u001c\u0013\u000f\u0003QHZ\u0003$PRU\u0003FULWHULD\u0003ZHUH\u0003SXEOLVKHG\u0003DQG\u0003DGRSWHG\u0003\nby the European Spondyloarthropathy Association. \n7KH\u0003PRUH\u0003LPSRUWDQW\u0003RQHV\u0003DUH\u0003>\u0019\u000f\u0003\u001b\u000f\u0003\u0014\u0013@\u001d\nA. Past or present clinical manifestations\n\u0014\u0011\u0003%DFN\u0003SDLQ\u0003DW\u0003QLJKW\u0003DQG\u0012RU\u0003PRUQLQJ\u0003VWLႇQHVV\n2. Asymmetric oligoarthritis\n3. Permanent or alternating gluteal pain\nB. Detection of changes on imaging\nC. Predisposing genetic factors\nD. Positive reaction after administration of appropri-\nate therapy\n:DOWHU\u00030DNV\\PRZ\\FK\u000f\u00035RHEHUW\u0003/DPEHUW\u0003HW\u0003DO\u0011\u0003UHSRUW-\nHG\u0003FDSVXOLWLV\u000f\u0003HQWKHVLWLV\u000f\u0003DQG\u0003OHVLRQV\u0003DQG\u0003HURVLRQV\u0003RI\u0003\nthe tissue surrounding the joint. They also introduced \nLV\u0003IRUPHG\u0003LQ\u0003WKH\u0003VHFRQG\u0003PRQWK\u0003RI\u0003JHVWDWLRQDO\u0003DJH\u000f\u0003D\u0003\nWKLQ\u0003¿EURXV\u0003FDSVXOH\u0003LV\u0003IRUPHG\u0003LQ\u0003WKH\u0003¿IWK\u0003PRQWK\u000f\u0003DQG\u0003\nLQ\u0003WKH\u0003\u0016\u001aWK\u0003JHVWDWLRQDO\u0003ZHHN\u000f\u0003WKH\u0003V\\QRYLDO\u0003PHPEUDQH\u0003\nFRYHUV\u0003WKH\u0003MRLQW\u0003FDSVXOH\u0011\u00037KH\u0003¿UVW\u0003GHFDGH\u0003RI\u0003DQ\u0003LQGL-\nYLGXDOµV\u0003GHYHORSPHQW\u0003LV\u0003DVVRFLDWHG\u0003ZLWK\u0003SURSRUWLRQDO\u0003\nJURZWK\u0003 RI\u0003 WKH\u0003 MRLQW\u0003 DQG\u0003 WKH\u0003 GHYHORSPHQW\u0003 RI\u0003 ¿EURXV\u0003\nFDUWLODJH\u000f\u0003ZKHUHDV\u0003LQ\u0003WKH\u0003VHFRQG\u0003DQG\u0003WKLUG\u0003GHFDGHV\u000f\u0003\nthe articular surfaces begin to become uneven and \nSURPLQHQW\u0003HGJHV\u0003DSSHDU\u0003RQ\u0003WKH\u0003LOLDF\u0003VXUIDFHV\u0003>\u0015@\u0011\nThe sacroiliac joint is a semi-mobile joint that con-\nnects the sacrum to the two pelvic bones. The facies \nauricularis of the os sacrum and the facies auricu-\nlaris of the os ilium serve as the articular surfaces. \nThey correspond in shape and relief and are covered \nwith hyaline cartilage. The cartilage of the os ilii is \ntwice as thin and more often shows degenerative \nFKDQJHV\u0003>\u0014\u000f\u0003\u0016\u000f\u0003\u0017@\u0011\u00037KH\u0003DUWLFXODU\u0003FDSVXOH\u0003LV\u0003VKRUW\u0003DQG\u0003\nattaches at the edges of the articular surfaces. The \nDUWLFXODU\u0003OLJDPHQWV\u0003DUH\u0003DQWHULRU\u000f\u0003SRVWHULRU\u0003DQG\u0003LQWHURV-\nseous. The anterior ones fuse with the superior and \ninferior regions of the joint. The posterior ones are \nPRUH\u0003QXPHURXV\u000f\u0003WKLFNHU\u0003DQG\u0003FRQVLVW\u0003RI\u0003VKRUW\u0003DQG\u0003ORQJ\u0003\nbundles. The short bundles lie deep and attach to the \nSRVWHULRU\u0003 VXUIDFH\u0003 RI\u0003 WKH\u0003 VDFUXP\u000f\u0003 SDUWLDOO\\\u0003 FRYHULQJ\u0003\nWKH\u0003IRUDPLQD\u0003VDFUDOLD\u0003SRVWHULRUD\u0003>\u0015\u0010\u0018@\u0011\u00037KH\u0003ORQJ\u0003OLJD-\nPHQWV\u0003DUH\u0003ORFDWHG\u0003PRUH\u0003VXSHU¿FLDOO\\\u0011\u00037KH\\\u0003GHVFHQG\u0003\nobliquely from the tuberositas iliaca to the middle part \nRI\u0003WKH\u0003FULVWD\u0003VDFUDOLV\u0003ODWHUDOLV\u000f\u0003EHFRPLQJ\u0003HQWZLQHG\u0003LQ\u0003\nWKH\u0003¿EHUV\u0003RI\u0003WKH\u0003OLJ\u0011\u0003VDFURWXEHUDOH\u0011\u0003$V\u0003OLJ\u0011\u0003LOLROXPEDOH\u0003\nDUH\u0003GHVLJQDWHG\u0003WKH\u0003¿EUHV\u0003ZKLFK\u0003VWDUW\u0003IURP\u0003WKH\u0003SURFHV-\nsus costalis of the 5th lumbar vertebra and end at the \ncrista iliaca. Deepest between the tuberositas sacra-\nlis and tuberositas iliaca are ligg. sacroiliaca interos-\nVHL\u0003>\u0014\u000f\u0003\u0016\u000f\u0003\u0017@\u0011\u00037KH\u0003FDSVXOH\u0003RI\u0003WKH\u0003VDFURLOLDF\u0003MRLQW\u0003LV\u0003UHOD-\nWLYHO\\\u0003WKLQ\u000f\u0003DQG\u0003GHIHFWV\u0003DUH\u0003RIWHQ\u0003VHHQ\u0003KHUH\u0003WKURXJK\u0003\nZKLFK\u0003V\\QRYLDO\u0003ÀXLG\u0003RU\u0003SXV\u0003OHDNV\u0003LQWR\u0003WKH\u0003VXUURXQGLQJ\u0003\nstructures. The sacroiliac joint is subjected to con-\ntinuous stress and strain. It consists of two parts: the \nV\\QGHVPRVLV\u0003DQG\u0003WKH\u0003V\\QRYLDO\u0003SDUW\u0003>\u0017\u000f\u0003\u0018\u000f\u0003\u0019@\u0011\nFibrous adhesions and mild obliteration are seen \nLQ\u0003 ERWK\u0003 VH[HV\u000f\u0003 HDUOLHU\u0003 LQ\u0003 PHQ\u0003 DQG\u0003 DIWHU\u0003 PHQRSDXVH\u0003\nLQ\u0003ZRPHQ\u0011\u0003,W\u0003XVXDOO\\\u0003RFFXUV\u0003DIWHU\u0003DJH\u0003\u0018\u0013\u0003>\u0014\u000f\u0003\u0015\u000f\u0003\u0018@\u0011\u0003,Q\u0003\nDGXOW\u0003LQGLYLGXDOV\u000f\u0003WKH\u0003MRLQW\u0003PD\\\u0003EH\u0003FRPSOHWHO\\\u0003¿EURVHG\u0003\nDQG\u0003 VRPHWLPHV\u0003 HYHQ\u0003 RVVL¿HG\u0011\u0003 &KDQJHV\u0003 LQ\u0003 WKH\u0003 VDF-\nURLOLDF\u0003 MRLQW\u0003 FDQ\u0003 FDXVH\u0003 ORZ\u0003 EDFN\u0003 DQG\u0003 VFLDWLF\u0003 SDLQ\u0003 >\u0015\u000f\u0003\n\u001a\u000f\u0003 \u001b\u000f\u0003 \u001c@\u0011\u0003 7KH\u0003 GLDJQRVLV\u0003 RI\u0003 SDLQ\u0003 RULJLQDWLQJ\u0003 IURP\u0003 WKLV\u0003\nMRLQW\u0003 LV\u0003 TXLWH\u0003 GLႈFXOW\u0003 EHFDXVH\u0003 WKH\u0003 VDPH\u0003 FRPSODLQWV\u0003\ncan be caused by disease of other anatomical struc-\nWXUHV\u0011\u00038VXDOO\\\u000f\u0003SDWLHQWV\u0003ZLWK\u0003SDWKRORJ\\\u0003LQ\u0003WKH\u0003MRLQW\u0003UH-\nSRUW\u0003SDLQ\u0003EHORZ\u0003WKH\u0003OHYHO\u0003RI\u0003WKH\u0003\u0018WK\u0003OXPEDU\u0003YHUWHEUD\u000f\u0003\nand most often it is localized around the position of \nthe spina iliaca posterior superior. Similar complaints \nwere reported by patients in our study group. Dur-\nLQJ\u0003 SUHJQDQF\\\u000f\u0003 WKH\u0003 MRLQWV\u0003 DQG\u0003 OLJDPHQWV\u0003 RI\u0003 WKH\u0003 SHO-\n\n5Advanced surgical and therapeutic trends...\nD\u0003 QHZ\u0003 GH¿QLWLRQ\u0003 LQFOXGLQJ\u001d\u0003 VXEFKRQGUDO\u0003 LQ¿OWUDWLRQ\u000f\u0003\nSUHVHQFH\u0003RI\u0003ÀXLG\u0003LQ\u0003WKH\u0003MRLQW\u000f\u0003HURVLRQ\u0003RI\u0003WKH\u0003MRLQW\u0003FDY-\nLW\\\u000f\u0003DQN\\ORVLV\u000f\u0003DQG\u0003ERQH\u0003EXGV\u0003>\u0019\u000f\u0003\u001b\u000f\u0003\u0014\u0014@\u0011\n7KH\u0003 PRVW\u0003 FRPPRQ\u0003 V\\PSWRP\u0003 LV\u0003 ORZ\u0003 EDFN\u0003 SDLQ\u000f\u0003 ZLWK\u0003\npain being strongest in the morning and diminishing \nDIWHU\u0003 PRYHPHQW\u000f\u0003 WKH\u0003 ODWWHU\u0003 LQFUHDVLQJ\u0003 DIWHU\u0003 VWDQGLQJ\u0003\nin a sitting position for a long time and when climb-\ning stairs or crossing the legs. Most patients report \nD\u0003VKDUS\u000f\u0003GXOO\u0003RU\u0003VWDEELQJ\u0003SDLQ\u0003WKDW\u0003VSUHDGV\u0003IURP\u0003WKH\u0003\nORZHU\u0003EDFN\u0003WR\u0003WKH\u0003EXWWRFN\u0003DUHD\u000f\u0003DQG\u0003WKHUH\u0003LV\u0003RIWHQ\u0003D\u0003\nIHHOLQJ\u0003RI\u0003VWLႇQHVV\u0003LQ\u0003WKH\u0003PRUQLQJ\u0003WKDW\u0003ODVWV\u0003IRU\u0003PRUH\u0003\nthan an hour each time after waking. One of the \nPRVW\u0003FRPPRQ\u0003V\\PSWRPV\u0003LV\u0003D\u0003FKDQJH\u0003LQ\u0003JDLW\u0003>\u001b\u000f\u0003\u0014\u0013\u000f\u0003\n\u0014\u0015@\u0011\u0003 6DFURLOLLWLV\u0003 LV\u0003 GLႈFXOW\u0003 WR\u0003 GLDJQRVH\u0003 DQG\u0003 WKHUHIRUH\u0003\nUHVHPEOHV\u0003 WKH\u0003 V\\PSWRPV\u0003 RI\u0003 OXPEDU\u0003 GLVF\u0003 KHUQLDWLRQ\u000f\u0003\nFR[DUWKURVLV\u000f\u0003DQG\u0003VFLDWLF\u0003QHUYH\u0003LQÀDPPDWLRQ\u0011\u0003$OO\u0003WKLV\u0003\nleads to incorrect treatment and delay in diagnosis \n>\u0018\u000f\u0003\u001a\u000f\u0003\u001b\u000f\u0003\u0014\u0017@\u0011\nDiagnosis is made by a thorough physical examina-\ntion of the patient and the use of diagnostic imag-\nLQJ\u0003PRGDOLWLHV\u000f\u0003WKH\u0003PRVW\u0003FRPPRQO\\\u0003XVHG\u0003EHLQJ\u001d\u0003SHO-\nYLF\u0003 UDGLRJUDSK\u000f\u0003 FRPSXWHG\u0003 D[LDO\u0003 WRPRJUDSK\\\u0003 \u000b&$7\f\u000f\u0003\nPDJQHWLF\u0003 UHVRQDQFH\u0003 LPDJLQJ\u0003 \u000b05,\f\u0003 >\u001b\u000f\u0003 \u001c@\u0011\u0003 7\\SLFDO\u0003\n¿QGLQJV\u0003 RQ\u0003 VDFURLOLDF\u0003 MRLQW\u0003 UDGLRJUDSKV\u0003 DUH\u001d\u0003 VFOHUR-\nVLV\u000f\u0003HURVLRQ\u000f\u0003SVHXGRGLODWDWLRQ\u000f\u0003DQG\u0003ERQH\u0003EULGJLQJ\u0011\u0003&7\u0003\nGLDJQRVLV\u0003VKRZV\u0003VLPLODU\u0003FKDQJHV\u0003DV\u0003UDGLRJUDSKV\u000f\u0003EXW\u0003\nwith much greater detail when illustrating bony struc-\nWXUHV\u0011\u00036FOHURVLV\u000f\u0003QDUURZLQJ\u0003RI\u0003WKH\u0003DUWLFXODU\u0003FOHIW\u000f\u0003HUR-\nsions and ankylosis are again seen. The greatest ad-\nvantage of the MRI scan is the clear visualization of \nGHWDLOHG\u0003DQDWRP\\\u000f\u0003SDWKRORJLF\u0003FKDQJHV\u000f\u0003DQG\u0003WKH\u0003IRFXV\u0003\nRI\u0003LQÀDPPDWLRQ\u0011\u00037KH\u0003LPDJH\u0003WKDW\u0003LV\u0003REWDLQHG\u0003LQFOXGHV\u0003\nthe abnormalities of the periarticular soft tissues that \nare only indirectly visible with other methods. Chronic \nstructural changes of the bone and joint are very well \nYLVXDOL]HG\u000f\u0003VXFK\u0003DV\u0003SHULDUWLFXODU\u0003IDWW\\\u0003WLVVXH\u0003DFFXPX-\nODWLRQ\u000f\u0003VXEFKRQGUDO\u0003HURVLRQV\u000f\u0003VFOHURVLV\u000f\u0003ERQH\u0003EULGJHV\u000f\u0003\nand ankylosis. Detection of periarticular fatty tissue \ndeposits is particularly important because other im-\naging modalities do not visualize these deposits. MRI \nLV\u0003QRW\u0003DVVRFLDWHG\u0003ZLWK\u0003UDGLDWLRQ\u0003H[SRVXUH\u000f\u0003VR\u0003LW\u0003LV\u0003DS-\nSURSULDWH\u0003 IRU\u0003 \\RXQJ\u0003 ZRPHQ\u000f\u0003 FKLOGUHQ\u000f\u0003 DQG\u0003 SDWLHQWV\u0003\nwith more previous exposure. Patients diagnosed \nwith sacroileitis are considered „MRI positive“ if more \nthan one lesion is visible on a single slide. If only one \nOHVLRQ\u0003LV\u0003SUHVHQW\u000f\u0003LW\u0003VKRXOG\u0003DOVR\u0003EH\u0003SUHVHQW\u0003LQ\u0003WKH\u0003QH[W\u0003\nWZR\u0003VOLGHV\u0003>\u001b\u000f\u0003\u001c\u000f\u0003\u0014\u0017\u0010\u0014\u001a@\u0011\nHyaluronic acid (HA) is one of the main components \nof the extracellular matrix that plays an important role \nLQ\u0003WKH\u0003SUHVHQFH\u0003RI\u0003DVHSWLF\u0003LQÀDPPDWLRQ\u0003LQ\u0003MRLQWV\u0003DV-\nsociated with the accumulation of HA polymers and \nFHOOV\u0003 RI\u0003 FKURQLF\u0003 QRQVSHFL¿F\u0003 LQÀDPPDWLRQ\u0011\u00037KH\u0003 ODWWHU\u0003\nFRQWUROV\u0003 WKH\u0003 H[SUHVVLRQ\u0003 RI\u0003 LQÀDPPDWRU\\\u0003 JHQHV\u0003 DQG\u0003\nWKH\u0003UHOHDVH\u0003RI\u0003F\\WRNLQHV\u0003LQ\u0003WKH\u0003SURFHVV\u0003RI\u0003LQÀDPPD-\ntion. It has been shown that upon local placement \nRI\u0003 H[RJHQRXV\u0003 +$\u0003 LQ\u0003 WKH\u0003 VDFURLOLDF\u0003 MRLQW\u000f\u0003 PHWDEROLF\u0003\nprocesses are initiated by synthesis and accumula-\ntion in the cartilaginous parts of the latter. In normal \nWLVVXHV\u000f\u0003+$\u0003LV\u0003LQ\u0003WKH\u0003IRUP\u0003RI\u0003D\u0003KLJK\u0003PROHFXODU\u0003ZHLJKW\u0003\ncompound (HMW-HA) that inhibits angiogenesis by \nreducing the proliferation and migration of endothelial \nFHOOV\u0003 DQG\u0003 WKH\u0003 H[SUHVVLRQ\u0003 RI\u0003 LQÀDPPDWRU\\\u0003 UHDFWLRQV\u0011\u0003\nResearch has shown that HMW-HA blocks T cell pre-\nFXUVRUV\u0003DQG\u0003SURGXFHV\u0003,/\u0010\u0014\u0013\u000f\u0003WKHUHE\\\u0003UHGXFLQJ\u0003WKH\u0003LQ-\nÀDPPDWRU\\\u0003UHVSRQVH\u0003>\u0014\u0018\u0010\u0015\u0013@\u0011\u0003\nCONCLUSIONS\nSurgical treatment of chronic sacroiliitis with intra-\narticular administration of corticosteroids and hyal-\nuronic acid has shown promising results in terms \nRI\u0003SDLQ\u0003UHGXFWLRQ\u000f\u0003LPSURYHG\u0003IXQFWLRQDO\u0003FDSDFLW\\\u0003DQG\u0003\nquality of life in patients. The combined approach \nDOORZV\u0003 ERWK\u0003 FRQWUROOLQJ\u0003 WKH\u0003 LQÀDPPDWRU\\\u0003 SURFHVV\u0003\nthrough corticosteroids and hyaluronic acid and pro-\nviding structural and metabolic support of the joint. \n'HVSLWH\u0003RXU\u0003FOLQLFDO\u0003REVHUYDWLRQV\u0003LQ\u0003WKH\u0003VWXG\\\u0003FRKRUW\u000f\u0003\nfurther randomized clinical trials with a larger num-\nber of patients and long-term follow-up are needed \nWR\u0003YDOLGDWH\u0003WKH\u0003HႈFDF\\\u0003DQG\u0003VDIHW\\\u0003RI\u0003WKLV\u0003WKHUDSHX-\nWLF\u0003 VWUDWHJ\\\u0011\u0003 6FLHQWL¿F\u0003 HYLGHQFH\u0003 VXJJHVWV\u0003 WKDW\u0003 WKH\u0003\nVDFURLOLDF\u0003MRLQW\u0003DQDWRP\\\u0003LV\u0003XQGHU\u0003VHYHUH\u0003VWUHVV\u000f\u0003UH-\nVXOWLQJ\u0003LQ\u0003SDLQ\u0003DQG\u0003VXEVHTXHQW\u0003GLVDELOLW\\\u000f\u0003ZKLFK\u0003KDV\u0003\nEHHQ\u0003VXFFHVVIXOO\\\u0003DGGUHVVHG\u0003E\\\u0003LQWUD\u0010DUWLFXODU\u0003ÀXR-\nURVFRSLF\u0003 QDYLJDWLRQ\u000f\u0003 K\\DOXURQLF\u0003 DFLG\u0003 DGPLQLVWUDWLRQ\u0003\nDQG\u0003ÀRVWHURQH\u0011\nAuthor Contributions: All authors have read and agreed \nto the published version of the manuscript.\nFunding: This research received no external funding.\nInstitutional Review Board Statement: The study was \nconducted in accordance with the Declaration of Helsinki \nand was approved by the Ethics Committee of Pulmed \nUniversity Hospital for studies involving human subjects. \nEach of the patients included in the observational study \ngave their verbal consent to the treating physician that they \nagreed to be treated in the manner described, having been \nLQIRUPHG\u0003 LQ\u0003 DGYDQFH\u0003 RI\u0003 WKH\u0003 EHQH¿WV\u0003 DQG\u0003 SRVVLEOH\u0003 ULVNV\u0003 RI\u0003\nthe procedure. No complications were observed during or \nafter the procedure.\nInformed consent statement: Verbal informed consent \nwas obtained in the presence of each of the authors of the \nVFLHQWL¿F\u0003DUWLFOH\u0003IURP\u0003DOO\u0003SDUWLFLSDQWV\u0003LQ\u0003WKH\u0003VWXG\\\u0011\n&RQÀLFWV\u0003RI\u0003,QWHUHVW\u001d\u00037KHUH\u0003LV\u0003QR\u0003FRQÀLFW\u0003RI\u0003LQWHUHVW\u0003LQ\u0003WKH\u0003\nVFLHQWL¿F\u0003DUWLFOH\u0003SUHVHQWHG\u0011\n\n6 K. Bechev, N. Yotova, D. Markov et al.\nREFERENCES\n1. .LDSRXU\u0003$\u000f\u0003-RXNDU\u0003$\u000f\u0003(OJDI\\\u0003+\u000f\u0003DO\u0011\u0003%LRPHFKDQLFV\u0003RI\u0003WKH\u00036DF-\nURLOLDF\u0003 -RLQW\u001d\u0003 $QDWRP\\\u000f\u0003 )XQFWLRQ\u000f\u0003 %LRPHFKDQLFV\u000f\u0003 6H[XDO\u0003 'L-\nPRUSKLVP\u000f\u0003DQG\u0003&DXVHV\u0003RI\u00033DLQ\u0011\u0003,QW\u0003-\u00036SLQH\u00036XUJ\u0011\u0003\u0015\u0013\u0015\u0013\u0003)HE\u0003\n\u0014\u0013\u001e\u0014\u0017\u000b6XSSO\u0003\u0014\f\u001d\u0016\u0010\u0014\u0016\u0011\u0003GRL\u001d\u0003\u0014\u0013\u0011\u0014\u0017\u0017\u0017\u0017\u0012\u0019\u0013\u001a\u001a\u0011\u0003\n2. :RQJ\u00030\u000f\u00036LQNOHU\u00030$\u000f\u0003.LHO\u0003-\u0011\u0003$QDWRP\\\u000f\u0003$EGRPHQ\u0003DQG\u00033HOYLV\u000f\u0003\n6DFURLOLDF\u0003 -RLQW\u0011\u0003 \u0015\u0013\u0015\u0016\u0003$XJ\u0003 \u001b\u0011\u0003 ,Q\u001d\u0003 6WDW3HDUOV\u0003 >,QWHUQHW@\u0011\u0003 7UHD-\nVXUH\u0003,VODQG\u0003\u000b)/\f\u001d\u00036WDW3HDUOV\u00033XEOLVKLQJ\u001e\u0003\u0015\u0013\u0015\u0018\u0003-DQ\u0011\n3. 8ODV\u000367 \u000f\u0003'LHNKRႇ\u00037 \u000f\u0003=LHJHOHU\u0003.\u0011\u00036H[\u0003'LVSDULWLHV\u0003RI\u0003WKH\u00036DFUR-\nLOLDF\u0003-RLQW\u001d\u0003)RFXV\u0003RQ\u0003-RLQW\u0003$QDWRP\\\u0003DQG\u0003,PDJLQJ\u0003$SSHDUDQFH\u0011\u0003\n'LDJQRVWLFV\u0003 \u000b%DVHO\f\u0011\u0003 \u0015\u0013\u0015\u0016\u0003 )HE\u0003 \u001c\u001e\u0014\u0016\u000b\u0017\f\u001d\u0019\u0017\u0015\u0011\u0003 GRL\u001d\u0003 \u0014\u0013\u0011\u0016\u0016\u001c\u0013\u0012GL-\nagnostics13040642. \n4. ;LRQJ\u0003< \u000f\u0003&DL\u00030\u000f\u0003;X\u0003< \u000f\u0003HW\u0003DO\u0011\u0003-RLQW\u0003WRJHWKHU\u001d\u00037KH\u0003HWLRORJ\\\u0003DQG\u0003\npathogenesis of ankylosing spondylitis. Front Immunol. 2022 \n2FW\u0003\u0014\u001a\u001e\u0014\u0016\u001d\u001c\u001c\u0019\u0014\u0013\u0016\u0011\u0003GRL\u001d\u0003\u0014\u0013\u0011\u0016\u0016\u001b\u001c\u0012¿PPX\u0011\u0015\u0013\u0015\u0015\u0011\u001c\u001c\u0019\u0014\u0013\u0016\u0011\u0003\n5. 3RLOOLRW\u0003 $-\u000f\u0003 =ZLUQHU\u0003 -\u000f\u0003 'R\\OH\u0003 7 \u000f\u0003 +DPPHU\u0003 1\u0011\u0003 $\u0003 6\\VWHPDWLF\u0003\n5HYLHZ\u0003 RI\u0003 WKH\u0003 1RUPDO\u0003 6DFURLOLDF\u0003 -RLQW\u0003 $QDWRP\\\u0003 DQG\u0003 $G-\njacent Tissues for Pain Physicians. Pain Physician. 2019 \n-XO\u001e\u0015\u0015\u000b\u0017\f\u001d(\u0015\u0017\u001a\u0010(\u0015\u001a\u0017\u0011\u0003\n6. 3UDWL\u0003&\u000f\u0003/HTXHUUH\u00037 \u000f\u0003/H\u0003*Rႇ\u0003%\u000f\u0003HW\u0003DO\u0011\u00031RYHO\u0003LQVLJKWV\u0003LQWR\u0003WKH\u0003\nanatomy and histopathology of the sacroiliac joint and corre-\nlations with imaging signs of sacroiliitis in case of axial spon-\nG\\ORDUWKULWLV\u0011\u0003 )URQW\u0003 3K\\VLRO\u0011\u0003 \u0015\u0013\u0015\u0016\u0003 0D\\\u0003 \u0014\u0014\u001e\u0014\u0017\u001d\u0014\u0014\u001b\u0015\u001c\u0013\u0015\u0011\u0003 GRL\u001d\u0003\n10.3389/fphys.2023.1182902. \n7. 7 RQRVX\u0003 -\u000f\u0003 2ND\u0003 +\u000f\u0003 :DWDQDEH\u0003 .\u000f\u0003 HW\u0003 DO\u0011\u0003 &KDUDFWHULVWLFV\u0003 RI\u0003 WKH\u0003\nspinopelvic parameters of patients with sacroiliac joint pain. \n6FL\u0003 5HS\u0011\u0003 \u0015\u0013\u0015\u0014\u0003 0DU\u0003 \u0017\u001e\u0014\u0014\u000b\u0014\f\u001d\u0018\u0014\u001b\u001c\u0011\u0003 GRL\u001d\u0003 \u0014\u0013\u0011\u0014\u0013\u0016\u001b\u0012V\u0017\u0014\u0018\u001c\u001b\u0010\u0013\u0015\u0014\u0010\n84737-1. \n8. 'LHNKRႇ\u00037 \u000f\u0003/DPEHUW\u00035\u000f\u0003+HUPDQQ\u0003.*\u0011\u000305,\u0003LQ\u0003D[LDO\u0003VSRQG\\OR-\nDUWKULWLV\u001d\u0003XQGHUVWDQGLQJ\u0003DQ\u0003Ã$6$6\u0010SRVLWLYH\u000305,µ\u0003DQG\u0003WKH\u0003 $6$6\u0003\nFODVVL¿FDWLRQ\u0003 FULWHULD\u0011\u00036NHOHWDO\u00035DGLRO\u0011\u0003 \u0015\u0013\u0015\u0015\u00036HS\u001e\u0018\u0014\u000b\u001c\f\u001d\u0014\u001a\u0015\u0014\u0010\n1730. doi: 10.1007/s00256-022-04018-4. \n9. -XULN\u0003 $*\u0011\u0003 'LDJQRVWLFV\u0003 RI\u0003 6DFURLOLDF\u0003 -RLQW\u0003 'LႇHUHQWLDOV\u0003 WR\u0003\nAxial Spondyloarthritis Changes by Magnetic Resonance \n,PDJLQJ\u0011\u0003-\u0003&OLQ\u00030HG\u0011\u0003\u0015\u0013\u0015\u0016\u0003-DQ\u0003\u0015\u001c\u001e\u0014\u0015\u000b\u0016\f\u001d\u0014\u0013\u0016\u001c\u0011\u0003GRL\u001d\u0003\u0014\u0013\u0011\u0016\u0016\u001c\u0013\u0012\njcm12031039. \n10. =KDQJ\u0003.\u000f\u0003/LX\u0003&\u000f\u0003=KX\u0003< \u000f\u0003HW\u0003DO\u0011\u00036\\QWKHWLF\u000305,\u0003LQ\u0003WKH\u0003GHWHFWLRQ\u0003\nand quantitative evaluation of sacroiliac joint lesions in axial \nVSRQG\\ORDUWKULWLV\u0011\u0003 )URQW\u0003 ,PPXQRO\u0011\u0003 \u0015\u0013\u0015\u0015\u0003 6HS\u0003 \u0015\u0019\u001e\u0014\u0016\u001d\u0014\u0013\u0013\u0013\u0016\u0014\u0017\u0011\u0003\nGRL\u001d\u0003\u0014\u0013\u0011\u0016\u0016\u001b\u001c\u0012¿PPX\u0011\u0015\u0013\u0015\u0015\u0011\u0014\u0013\u0013\u0013\u0016\u0014\u0017\u0011\u0003\n11. &LKDQ\u0003g) \u000f\u0003.DUDEXOXW\u00030\u000f\u0003.ÕOÕQoR÷OX\u00039\u000f\u0003