Incidence, diagnosis and management of sacroiliitis after spinal surgery: a systematic review of the literature

Colò, Gabriele; Cavagnaro, Luca; Alessio-Mazzola, Mattia; Zanirato, Andrea; Felli, Lamberto; Formica, Matteo

doi:10.1007/s12306-019-00607-0

Cited by 18 publications

(11 citation statements)

References 52 publications

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“… 6 Other studies place the post-op incidence of sacroiliitis from 5% to 75% stating it is directly proportional to the number of fused segments. 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

“…6 Other studies place the post-op incidence of sacroiliitis from 5% to 75% stating it is directly proportional to the number of fused segments. 7,8 Given the concomitant nature of pain associated with the SIJ and other related conditions, pain physicians can expect to treat patients with overlapping symptoms. Unfortunately, the treatment of one pathology may not relieve the pain associated with the other.…”

Section: Introductionmentioning

confidence: 99%

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Pain Relief Salvage with a Novel Minimally Invasive Posterior Sacroiliac Joint Fusion Device in Patients with Previously Implanted Pain Devices and Therapies

Deer¹,

Rupp²,

Budwany³

et al. 2021

JPR

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Background Sacroiliac joint (SIJ) pain is a common cause of low back pain, a problem experienced by two-thirds of adults in the United States population. Traditionally, the management of persistent SIJ-related pain has involved conservative therapies (physical therapy, topical medications, oral anti-inflammatory medications), interventional therapies (SIJ steroid injections or ablation), and surgery (SIJ fusion; open and lateral approach). Recent advancements in technology have paved the way for SIJ fusion via a posterior approach, which aims to minimize complications and enhance recovery. Objective The purpose of this study is to introduce the concept of the posterior approach to SIJ fusion as a feasible adjunct and salvage technique for patients with inadequate pain relief from other minimally invasive surgical procedures, and to validate its efficacy through a retrospective multicenter data analysis. Design Multicenter retrospective observational study. Methods Patients with refractory SIJ pain were treated by interventional pain physicians at one of the eight different pain management centers. All patients underwent posterior SIJ fusion via the LinQ TM sacroiliac fusion procedure. Demographical data were collected, in addition to patient-reported pain relief. Results A total of 111 patients were included in the study and underwent posterior SIJ fusion for refractory SIJ-related pain following the use of spinal cord stimulation (SCS), interspinous spacer (ISS), intrathecal drug delivery (IDDS), and/or minimally invasive lumbar decompression (MILD). Overall, the mean patient reported pain relief following posterior SIJ fusion was 67.6%. In patients with a history of failed back surgery syndrome, the mean patient reported pain relief was 76.5%. Conclusion In this retrospective case series of patients with continued intolerable pain following SCS, ISS, IDDS, or MILD, a novel posterior SIJ fusion device provided significant pain relief in a salvage manner. These early results suggest that this intervention may be a therapeutic option to consider in these patients.

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“… 6 Other studies place the post-op incidence of sacroiliitis from 5% to 75% stating it is directly proportional to the number of fused segments. 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pain Relief Salvage with a Novel Minimally Invasive Posterior Sacroiliac Joint Fusion Device in Patients with Previously Implanted Pain Devices and Therapies

Deer¹,

Rupp²,

Budwany³

et al. 2021

JPR

View full text Add to dashboard Cite

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“…Medical treatment includes non-steroidal antiinflammatory drugs (NSAIDs), muscle relaxants, topical anti-inflammatory gels and sometimes, in chronic cases, anti-depressants can be added. 12 Adding a well-planned physiotherapy program to medical treatment can be helpful. Physiotherapy programs usually include strengthening of back muscles and pelvic mobilization exercises.…”

Section: Introductionmentioning

confidence: 99%

Sacroiliitis Following Lumbosacral Fixation: Prevalence and Management

Koheil

Dorgham

Shaban

2021

Pan Arab Journal of Neurosurgery

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BACKGROUND: Sacroiliitis following lumbosacral fixation is an important cause of postoperative low back pain and should be properly diagnosed and managed to improve the short-and long-term postoperative outcomes. OBJECT:We aimed to assess the prevalence of sacroiliitis following lumbar fusion procedures and the possible options of treatment available for such complication. METHODS:In this retrospective cross-sectional study, 100 patients who underwent spinal fusion surgery were included and observed for the next 3 months following surgery to detect postoperative sacroiliitis. RESULTS:One hundred patients aged 23-65 years were included in the current study, with a mean age of 43.1±5.7 years. Fifty seven percent were females and 43% were males. Forty-seven patients (47%), 22 females (46.8%) and 25 males (53.2%), experienced sacroiliitis after a duration of 23.7 to 71 days post-operative with a mean of 33.8±1.7 days post-operative. Muscle relaxants and non-steroidal anti-inflammatory drugs (NSAID) were prescribed to all patients; 26 out of 47 patients (55%) responded well to medical treatment for 28 days with reduction of pain visual analogue scale (PVAS) from 7.3±2.1 to 3.3±1.4. In 21 patients (45%), medical treatment failed and physiotherapy sessions were added to medical treatment for 28 days with improvement of PVAS from 6.5±1 after 28 days medical treatment to 2.9±1.9 after medical treatment plus physiotherapy sessions. Five patients needed intra-articular steroid injection with further improvement of PVAS to <1. CONCLUSION:Sacroiliitis is an important cause of low back pain post lumbar fixation. Sacroiliitis is a frequent complication after lumbar fusion surgery detected in 47% of our study group. It was successfully managed with NSAIDs and physiotherapy in most of the cases.

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“…However, although iliac screws were proven to be superior to the Galveston technique in terms of construct strength, iliac screws were shown to cause pain due their prominence, ending in revision surgery in about 22% of cases [5,6]. Moreover, instrumentation down to the sacrum puts a long cranial cantilever on the SIJ, not only reducing the durability of the construct but also causing a biomechanical overload and therefore Ethics committee registration number: 159/16S severe pain of the SIJ, which was reported in a systematic review to occur in 37 ± 28.48% (range 6-75%) of patients [7].…”

Section: Introductionmentioning

confidence: 99%

Revision by S2-alar-iliac instrumentation reduces caudal screw loosening while improving sacroiliac joint pain—a group comparison study

et al. 2020

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Lumbosacral instrumentation continues to be challenging due to complex biomechanical force distributions and poor sacral bone quality. Various techniques have therefore been established. The aim of this study was to investigate the outcome of patients treated with S2-alar-iliac (S2AI), S2-alar (S2A), and iliac (I) instrumentation as the most caudal level. Sixty patients underwent one of the 3 techniques between January 2012 and June 2017 (S2AI 18 patients, S2A 20 patients, I 22 patients). Mean age was 70.4 ± 8.5 years. Screw loosening (SL) and sacroiliac joint (SIJ) pain were evaluated during the course at 3-month and maximum follow-up (FU). All patients completed 3-month FU, the mean FU period was 2.5 ± 1.5 years (p = 0.38), and a median of 5 segments was operated on (p = 0.26), respectively. Bone mineral density (BMD), derived opportunistically from computed tomography (CT), did not significantly differ between the groups (p = 0.66), but cages were more frequently implanted in patients of the S2A group (p = 0.04). SL of sacral or iliac screws was more common in patients of the S2A and I groups compared with the S2AI group (S2AI 16.7%, S2A 55.0%, I 27.3% of patients; p = 0.03). SIJ pain was more often improved in the S2AI group not only after 3 months but also at maximum FU (S2AI 61.1%, S2A 25.0%, I 22.7% of patients showing improvement; p = 0.02). Even in shorter or mid-length lumbar or thoracolumbar constructs, S2AI might be considered superior to S2A and I instrumentation due to showing lower incidences of caudal SL and SIJ pain.

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Incidence, diagnosis and management of sacroiliitis after spinal surgery: a systematic review of the literature

Cited by 18 publications

References 52 publications

Pain Relief Salvage with a Novel Minimally Invasive Posterior Sacroiliac Joint Fusion Device in Patients with Previously Implanted Pain Devices and Therapies

Pain Relief Salvage with a Novel Minimally Invasive Posterior Sacroiliac Joint Fusion Device in Patients with Previously Implanted Pain Devices and Therapies

Sacroiliitis Following Lumbosacral Fixation: Prevalence and Management

Revision by S2-alar-iliac instrumentation reduces caudal screw loosening while improving sacroiliac joint pain—a group comparison study

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