Sagittal Sacropelvic Morphology and Balance in Patients with Sacroiliac Joint Pain Following Lumbar Fusion Surgery

Abstract

ObjectiveTo investigate the sagittal sacropelvic morphology and balance of the patients with SIJ pain following lumbar fusion.MethodsAmong 452 patients who underwent posterior lumbar interbody fusion between June 2009 and January 2013, patients with postoperative SIJ pain, being responded to SIJ block were enrolled. For a control group, patients matched for sex, age group, the number of fused level and fusion to sacrum were randomly selected. Patients were assessed radiologic parameters including lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). To evaluate the sagittal sacropelvic morphology and balance, the ratio of PT/PI, SS/PI and PT/SS were analyzed.ResultsA total of 28 patients with SIJ pain and 56 patients without SIJ pain were assessed. Postoperatively, SIJ pain group showed significantly greater PT (p=0.02) than non-SIJ pain group. Postoperatively, PT/PI and SS/PI in SIJ pain group was significantly greater and smaller than those in non-SIJ pain group respectively (p=0.03, 0.02, respectively) except for PT/SS (p=0.05). SIJ pain group did not show significant postoperative changes of PT/PI and SS/PI (p=0.09 and 0.08, respectively) while non-SIJ pain group showed significantly decrease of PT/PI (p=0.00) and increase of SS/PI (p=0.00).ConclusionThis study presents different sagittal sacropelvic morphology and balance between the patients with/without SIJ pain following lumbar fusion surgery. The patients with SIJ pain showed retroversed pelvis and vertical sacrum while the patients without SIJ pain have similar morphologic features with asymptomatic populations in the literature.

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

“…Cho et al [3] analyzed the spinopelvic parameters in a consecutive group of 452 lumbar interbody fusions. This study evidenced an increased SIJ pain in patients with increased pelvic tilt.…”

“…These blocks, performed by an independent radiologist, consisted in an intra-articular SIJ injection of 20 mg (0.5 ml) of Methylprednisolone (Depo-Medrol Ò , Pfizer, Puurs, Belgium) and of 11.25 mg (4.5 ml) of Bupivacaine (Sintetica SA, SwissMedic, Mendrisio, Switzerland) [7]. After the procedure, the variation of the Visual Analog Score (VAS) was registered by the patient during the following week; a positive response was defined as a characteristic pain reduction of 75 % or greater for 1-4 h following the SIJ [3].…”

“…Despite a careful selection of cases, the failure rates after fusion has been reported to range from 5 to 30 % and SIJ has been suggested as a possible pain source by several authors [1,3]. Possible causes are an increased load transfer on the adjacent articulation associated to additional strains with translational motion that may lead to pain [4].…”

“…Possible causes are an increased load transfer on the adjacent articulation associated to additional strains with translational motion that may lead to pain [4]. Compensatory pelvic retroversion after lumbosacral fusion has been also considered as the mechanism of increased stress across SIJ with consequent development of regional pain [3].…”

Persistent Iliosacral Joint Syndrome following Instrumentation to the Sacropelvis in Patients with Adult Spinal Deformity

“…[26][27][28][29][30][31] Persistent sacroiliac joint syndrome (PSIJS) may result in undue loading of the SIJ due to cantilever effects by rigid instrumentation, [32][33][34] and it may be aggravated by impaired spinopelvic sagittal alignment. 35,36 Imaging studies revealed a higher incidence of SIJ degeneration in patients with instrumented lumbar fusion, 37 specifically following fusion to the sacrum. 38 However, PSIJS was also observed despite supplemental pelvic fixation.…”