The incidence of new onset sacroiliac joint pain following lumbar fusion

Lee, Yu Chao; Lee, Robert; Harman, Clare

doi:10.21037/jss.2019.09.05

Cited by 21 publications

(33 citation statements)

References 12 publications

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“…Previous studies proved lumbar diseases trigger abnormality of SIJ. For example, Lee et al (22) found 38 patients who developed new-onset SIJ pain in 317 individuals who underwent lumbar fusion. This operation also leads to the degradation of SIJ in CT assessments (23).…”

Section: Discussionmentioning

confidence: 99%

Lumbar Disc Herniation is a Nonnegligible Factor for the Degeneration of Sacroiliac Joints

et al. 2021

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Background: Sacroiliac joint (SIJ) abnormality is a potential source of low back pain (LBP), therefore numerous patients receive various treatments because of the degenerative changes of SIJ. However, the outcome is unfavorable for patients because these morphologic alterations are common but not the origins of LBP. Previous studies revealed lumbar fusion and transitional vertebra increased the prevalence of degeneration of SIJ. Lumbar disc herniation (LDH) is one of the most common lumbar diseases, but there is no study regarding the relationship between LDH and SIJ degradation. Objectives: The aim of this study was to investigate the severity of SIJ degeneration in patients with LBP with LDH. The relationship between degenerative changes of SIJ and LDH was also assessed. Study Design: Retrospective observational study. Setting: This study was conducted in 2 medical centers located in southeast and midwest China, respectively. Methods: Lumbar and pelvic computed tomography (CT) scans of patients with LDH (LDH group) from January 2016 to May 2020 were reviewed using a picture archiving and communication system. The control group was age, gender, and body mass index–matched patients with LBP without LDH. Patients underwent whole abdomen and pelvic CT examinations due to non-musculoskeletal disorders. Scores of SIJ degeneration were compared between patients with LDH and the control group. Differences in SIJ degeneration among patients with LDH with diverse characteristics, symptoms, and complications were also evaluated. Univariate and multivariate linear mixed model (LMM) was chosen to identify the factors associated with SIJ degeneration. Results: CT examinations of 782 patients with LDH were assessed, whereas 223 patients were in the control group. The SIJ degeneration score of the LDH group and control group were 6.00 (5.00) and 3.00 (4.00) (P < 0.05). Age and whether patients suffered from LDH were included in the LMM, which involved all reviewed patients (P < 0.05). Regarding the characteristics of LDH, the patients with more herniated discs had more severe SIJ degeneration. The score of SIJ degradation in patients with upper LDH was significantly higher than the other patients with LDH (12.00 [4.00] vs. 6.00 [4.00]; P < 0.05). Similarly, more significant SIJ degeneration was observed in patients with LDH who had secondary lumbar spinal stenosis (10.00 [4.00] vs. 5.00 [4.00]; P < 0.05). The scores of SIJ degradation were significantly greater in patients with LDH with sciatica, numbness, weakness, and/or cauda equina syndrome. Age and LDH were identified as associated factors for more serious degeneration of SIJ among patients with LDH. Limitations: The main limitation of this study was the retrospective observational nature. Hence our study described that SIJ degeneration was relevant to LDH, but the causal relationship was uncertain. Magnetic resonance imaging was not chosen in this study. Conclusions: The SIJ degeneration in patients with LDH was more serious than in individuals without LDH. SIJ degeneration was more significant in patients with LDH with more pathological alterations, symptoms, and complications. Age and LDH relate to SIJ degeneration. Therefore the diagnosis and selection of treatment for SIJ changes should comprehensively consider the coexistence of LDH. Key words: Lumbar disc herniation, low back pain, sacroiliac joint, degeneration, sciatica, numbness, weakness, cauda equina syndrome, computed tomography, linear mix model

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Section: Discussionmentioning

confidence: 99%

Lumbar Disc Herniation is a Nonnegligible Factor for the Degeneration of Sacroiliac Joints

et al. 2021

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“…This is similar to our findings, where 62% of the cases developed postoperative SIJ dysfunction. 13,14 Colò et al reviewed the literature and included 13 articles which showed an incidence of 37±28.5% of postoperative SIJ dysfunction out of a total of 1498 cases who did lumbar fusion surgeries. 4 In our study, the mean age of patients that had SIJ dysfunction after lumbar fixation surgeries was 48±8.4 years.…”

Section: Discussionmentioning

confidence: 99%

“…This was contradictory to the findings of Lee et al who reported that out of the 38 patients who developed SIJ dysfunction, 27 were females (71%) and only 11 were males (29%) which shows a significant higher prevalence in females. 14 It was found that BMI is an important risk factor that may lead to SIJ pain. In our study, 60% of the patients who developed SIJ dysfunction were obese (BMI 30-35), and this was similar to the study by De Palma et al who reported that when the BMI was 30 or 35 kg/m 2 , SIJ pain was most likely (46-64%).…”

Section: Discussionmentioning

confidence: 99%

“…15 Lee et al reported that 57% of the patients who developed SIJ degeneration post fusion had the S1 vertebra involved in the fusion. 14 The role of the number of fusion segments remains unclear. Some authors suggest that the higher number of vertebrae involved results in higher stress forces at the adjacent segment, leading to greater risk of joint degenerative changes.…”

Section: Discussionmentioning

confidence: 99%

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Predictors and Treatment Strategy of Sacroiliac Joint Pain after Lumbar-Fixation Surgery

Salah

Hasanain

Eldessouky

et al. 2021

Pan Arab Journal of Neurosurgery

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BACKGROUND: Sacroiliac joint (SIJ) pain is a commonly encountered problem following spine surgery. Therefore, its accurate diagnosis and proper management is mandatory for improving the quality of life following spine surgery. OBJECT:The aim of the study was to determine the incidence of SIJ dysfunction following lumbar fixation and to identify the possible risk factors and the treatment options. METHODS:A prospective study was conducted on 40 patients who were subjected to lumbar fixation by transpedicular screws. We included patients undergoing surgical lumbar fixation with no preoperative sacroiliac pain, while patients who had sacroiliac pain preoperatively or after surgeries other than fixation were excluded. All cases were operated upon in Cairo University Hospitals between March 2020 and October 2020. Sacroiliac joint pain was assessed post operatively using the Visual Analogue Scale (VAS). Estimated odds ratio (OR) with 95% confidence intervals (95% CI) and p values were used to evaluate the statistical significance of the associations and correlations between variables. A p value < 0.05 was considered statistically significant. RESULTS:Sacroiliac joint dysfunction occurred in 25 patients (62.5%). Increased body mass index (BMI), sacral fusion and multi-level fixation were regarded as important risk factors that lead to increased incidence of sacroiliac joint dysfunction post operatively (p value =0.034, 0.033 and 0.046, respectively). Eight patients were successfully managed conservatively, while 17 patients needed SIJ injection with 71% improvement. CONCLUSION:The lumbar fixation surgery disrupts the biomechanics of the lumbar spine increasing the incidence of sacroiliac joint dysfunction. Possible risk factors include increased body mass index, sacral fusion and multilevel fixation. Conservative treatment is the initial management of choice and it is effective in several cases. Sacroiliac joint injection with methylprednisolone and local anesthetics is an important line of treatment that gives excellent temporary relief of pain.

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“…Baber and Erdek (2016) augment our opinion that fusion of lumbar spine to sacrum as well as fusion of multiple segments may lead to SIJ disease. Lee et al (2019) described that the average time to new onset symptoms was 22 months.…”

Section: Sandén Et Al (2011)mentioning

confidence: 99%

Failed Back Surgery Syndrome

El-Sawy

Khodair

Alaghory

2021

Al-Azhar Medical Journal

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Background: Chronic low back pain is a serious health problem. Chronic pain affects negatively quality of life and should be treated as interest as personal handicapping issues.Objective: To discuss etiologies and risk factors of failed back surgery syndrome (FBSS) with evaluation of different management modalities to help lowering its incidence and upgrading patient's outcome.Patients and methods: This was a cross sectional retrospective study on randomized group of patients (50 patients) performed between May 2014 and May 2018 at El Sheikh Zayed specialized hospital. They complained from lower back pain with or without legs pain and had done one or more lumbar surgeries. All patients were subjected to history taking and neurological examination (motor power, stretch signs -strait leg raising, femoral stretch-and bladder control). Radiographic documentation was for all patients including magnetic resonance imaging (MRI) lumbar spinal stenosis (LSS).Results: Forty-four patients (88%) were managed by surgical re-intervention after clinical evaluation including complain analysis and neurological assessment and correlating it with pre-operative radiological findings. Six patients (12%) were found to have no radiological findings correlated to their complaints. Conclusion:Failed back surgery syndrome acts like a malignant disease that we are unable to completely treat it, but we can control it. In our study, we can catch many factors which will help. Patient selection to be fit candidate for lumbar surgery is a main matter.

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The incidence of new onset sacroiliac joint pain following lumbar fusion

Cited by 21 publications

References 12 publications

Lumbar Disc Herniation is a Nonnegligible Factor for the Degeneration of Sacroiliac Joints

Lumbar Disc Herniation is a Nonnegligible Factor for the Degeneration of Sacroiliac Joints

Predictors and Treatment Strategy of Sacroiliac Joint Pain after Lumbar-Fixation Surgery

Failed Back Surgery Syndrome

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