Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge

Abstract

Recently, the sacroiliac joint (SIJ) has gained increased attention as a source of persistent or new pain after lumbar/lumbosacral fusion. The underlying pathophysiology of SIJ pain may be increased mechanical load, iliac crest bone grafting, or a misdiagnosis of SIJ syndrome. Imaging studies show more frequent degeneration of the SIJ in patients with lumbar/lumbosacral fusion than in patients without such fusion. Using injection tests, it has been shown that SIJ pain is the cause of persistent symptoms in a considerable number of patients after fusion surgery. Recent articles reporting on surgical outcomes of SIJ fusion include a high percentage of patients who had lumbar/lumbosacral fusion or surgery before, although well-controlled clinical studies are necessary to assess the efficacy of surgical treatment. Taking these findings into consideration, the possibility that the SIJ is the source of pain should be considered in patients with failed back surgery syndrome after lumbar/lumbosacral fusion.

Early Results of Sacro–Iliac Joint Fixation following Long Fusion to the Sacrum in Adult Spine Deformity

“…SIJ pain is a common source of pain; it presents as lower back pain and hip pain and is difficult to distinguish from other types of pelvic girdle pain [2,16]. The appropriate diagnosis of SIJ pain is by an injection of a local anesthetic to the SIJ alleviating the pain of the patient combined with radiological evidence of osteoarthritis of the joint [7,9].…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…Unfortunately the article does not made it clear whether exercise therapy during pregnancy would be of value. In the few patients I have seen post-partum, the pelvic pain is very much load related, and unilateral, and rather different from the low back pain described in the paper following the above by Yoshihara [62], which deals with sacroiliac pain after fusion. Here the presumed sacroiliac pain is very much low back pain.…”

Sacroiliac joint syndrome 10 years after lumbar arthroplasty: the importance of spinopelvic alignment

“…The alteration of the stress distribution, together with the alteration of the sagittal spinopelvic alignment, is considered to be responsible for an accelerated facet joint deterioration and disc degeneration on the adjacent segment of a fused level [9][10][11][12][13].…”