Osteitis Condensans Ilii

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Written by: Dr Jeremy Steinberg – created: 10 May 2022; last modified: 15 May 2022

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Osteitis condensans ilii (OCI) is a benign cause of chronic low back pain whereby there is sacroiliac joint sclerosis of unknown pathophysiology. It can also be asymptomatic. It almost exclusively affects females, often following pregnancy.

Pathophysiology

Unknown. Suspected to be mechanical.

Clinical Features

Chronic sacral spinal pain. Associated with tenderness over the sacroiliac joints.[1]

Imaging

On AP plain films there is a well defined triangular area of sclerosis on the iliac aspect of the bilateral sacroiliac joints. The joint space is relatively well preserved.

On MRI there is extensive sclerosis especially on the iliac side of the sacroiliac joints.

Differential Diagnosis

The most important differential is axial sponyloarthritis.

Similarities and differences between sacroiliitis of spondyloarthritis with osteitis condensans ilii.[2]
Sacroiliitis of spondyloarthritis Osteitis condensans ilii
Similarities Involvement of both sacroiliac joints and subchondral sclerosis
Differences
  • Young male
  • Low back pain and morning stiffness
  • Subchondral erosion and ankylosis in late phase
  • Subchondral reactive sclerosis in both sides of sacroiliac joints
  • Young female
  • Clinically silent or mild low back pain
  • No bone erosion or bony ankylosis
  • Well defined sclerotic lesion mainly in iliac side

Management

Unknown. Consider physiotherapy, NSAIDs, corticosteroid injection.

Further Reading

References

  1. Jenks, Katey; Meikle, Grant; Gray, Andrew; Stebbings, Simon (2009-04). "Osteitis condensans ilii: a significant association with sacroiliac joint tenderness in women". International Journal of Rheumatic Diseases. 12 (1): 39–43. doi:10.1111/j.1756-185X.2009.01378.x. ISSN 1756-185X. PMID 20374315. Check date values in: |date= (help)
  2. H Kang. Radiology Illustrated Spine. Springer. 2014

Literature Review