Exploring the link between Post-partum backache and Osteitis Condensans Ilii – A case report and literature review

Although relatively common, afflicting up to 2.5% of the general population, a paucity of recent publications elaborate on the disease known as Osteitis Condensans Ilii (OCI). The noted clustering of cases in females, in their 3rd trimester of pregnancy and post-partum period, underpins the various contributory etiological theories. The negative serology and specific radiological finding on an antero-posterior pelvic X-ray is of paramount importance to spinal surgeons to avoid fruitless over-investigation. Once the diagnosis is made the mainstay of treatment is reassurance that this is firstly a localized self-limiting condition devoid of the systemic complications that accompany several of the other common forms of sacroilitis. Despite additional conservative measures comprising anti-inflammatory medication and physiotherapy, there is a subset of patients with refractory pain who demand more. Here identifying the specific pain trigger is essential, and in those that demonstrate a significant response to sacroiliac joint injections there is sufficient evidence in the literature that they will respond to sacroiliac joint arthrodesis. There is also sufficient evidence in the literature that those that undergo a minimally invasive sacroiliac joint arthrodesis will incur a more favorable outcome than those who undergo an open approach. The alternative surgical intervention, namely resection of the area of osteitic iliac bone, is extremely controversial with little evidence in the literature that this will be of any benefit over the natural history of the disease. We present a case of a typical female patient who presented to our unit with the characteristic symptoms and signs of OCI. Her hematological and radiological investigations were furthermore classical. Despite her non-enduring response to conservative measures she fortunately did demonstrate a response to sacroiliac joint injections which opened the door for us to report a successful outcome post performing a minimally invasive sacroiliac joint arthrodesis.