Sacroiliac joint tuberculosis is relatively uncommon and it is reported by case reports in the English-language literature. The previous study reports that SJB make up approximately 2–10% of spine tuberculosis, which tends to occur in adolescents and young adults. In the present series, the mean age of patients with SJT was 32 years which was consistent with the findings of Kim et al  and Ramlakan et al . More often than not, the blood supply to the sacroiliac joint decline after the third decade of life. It is inferred that the change of sacroiliac joint blood supply was the key mechanism . The mean interval from symptom onset to diagnosis is reported to be 16 to 19 months , but in our series, he mean interval between, but in our series was 5.7 ± 3.1months(2-12months). We hypothesized that the improvement of diagnostic technique maybe result from the clinical difference. Whereas, the diagnosis of sacroiliac joint tuberculosis is challenging and often misleading, either patients lack of specific symptoms in the early phase, or it easily to ignore sacroiliac joint because patients are examined in the supine position. Clinically, the most frequent symptoms is buttock or lumbar pain in SJT patients. The incidence of the fever is variable, in the present study, eight patients (30.7%) had fever. Our study show elevated ESR in all patients. Similarly, The result shown by Zhu et al . and Kim et al . The previous research showed that magnetic resonance imaging is high sensitive modality in the early diagnosis of SJT, associated capsular distention, cartilage and osseous erosions. In our series, MRI was done in all patients preoperatively. The diagnosis of SJT should be suspected in the presence of certain clinical and radiologic findings, laboratory data, and drug response in most patients, however, the histopathology is the gold standard for diagnosis of SJT.
The basic principles of treatment for SJT that we referred to the experience in treating spinal tuberculosis [14–16]. Treatment strategies for sacroiliac joint tuberculosis include both conservative and operative treatments. Surgery is frequently imperative, if patients suffer from failure of conservative treatment, or progression of joint instability or neurological dysfunction, or persistent pain. However, surgical treatment of the sacroiliac joint infection is quite challenging because of the complex anatomy of the sacroiliac joint junction. As a result of the advantages of 3D printing, the new technology has been extensively used in orthopaedics . As we know, 3D printing technology provide shorter, less invasive, more precise, and more reliable surgeries . It provides 3D models for surgical simulation and specific implant selection. Here we describe posterior surgical treatment of SJT assisted by three dimensional printing technology. The approach creates enough operating room allowing operation under direct visualisation for radical debridement without injuring lumbosacral plexus and blood vessel. Additionally, Broner et al.  and Weisz  have confirmed that spinal stability contribute to suppress spinal infection. The stable internal environment could decrease spinal tuberculosis relapse . In our series, spinal stability was unaffected, and all patients got bony fusion. And all patients recovered from tuberculosis. We compared the traditional surgery with 3D printing technology surgery in the treatment of SJT. It showed that the 3D printing group achieved much better results in time of operation, intra-operative blood loss, and number of intra-operative fluoroscopy than group A (P < 0.05). There were no significant differences between the two groups in fusion time and VAS score in the last follow-up.
From our experience, the treatment of SJT should focus on the following points. Firstly, the 3D printing technology were analyzed for a better preoperative planning. Secondly, the medical dispute between doctors and patients mainly manifests in the different cognition of diseases and the understanding of surgery program. The good communication between doctor and patient is benefical to improve the clinical outcome have reported by Cockburn et al  and Dyche et al . In our cohorts, 3D printing technology could help to better understand the anatomy and pathology, improve patient’s understanding and reduce the medical dispute. Thirdly, we applied a simulated virtual surgery on a 3D-printed model not only to choose ideal screw length and the direction but also to design the range of debridement prior to the actual surgery. Fourthly, pre-operative immobilization and nutrition support need to be emphasized. Finally, but not insignificantly, despite advances in surgical techniques, chemotherapy remains the cornerstone of SJTB treatment.