The Sacroiliac Joint: A Potential Cause of Pain After Lumbar Fusion to the Sacrum

Abstract

The sacroiliac joint (SIJ) can cause pain after lumbosacral fusion. Diagnosis requires >75% relief after local anesthetic SIJ injection. This study is a retrospective review of patients with low back pain after lumbosacral fusion who had SIJ injections. Percentage and duration of pain relief were noted. Results are as follows: there were 34 patients; 8 fused at L5-S1, 14 fused at L4-S1, and 12 had multilevel fusions. Twenty had >75% relief within 45 minutes, and 11 had prolonged relief. Six had relief >20% but <75%, and one had prolonged relief. Eight never improved. Eight had posterior iliac crest bone harvested, and there was no correlation between donor side and pain side. In 34 patients with low back pain after lumbosacral fusion, SIJ was the cause of pain in 32% and possibly the cause in 29%. This is the first detailed description of this problem.

The percutaneous stabilisation of the sacroiliac joint with hollow modular anchorage screws: a prospective outcome study

“…In comparison to open sacroiliac joint fusion, the complication profile is acceptable [20]. The prevalence of sacroiliac joint involvement in post fusion low back pain ranges from 29 to 40 % [21,22]. This is likely to be due to transfer of motion from the fused segment to the next mobile intact segment, which in the case of lumbar-sacral fusion would be the sacroiliac joint.…”

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

“…Previous studies have revealed the facet and iliosacral joints to be a source of post-operative pain in a considerable number of patients [29,42,43]. Alterations of the segmental, sagittal and spinopelvic alignment as well as increased motion and stress adjacent to fused levels have been held responsible for post-fusion pain patterns [1,21,29,32,42,43,63].…”

“…1-1.5 ml for a facet joint infiltration and 2-3 ml for an infiltration of the iliosacral joint. All infiltrations were performed as direct joint infiltrations as described previously [18,19,29,31,42,43].…”

“…A reproducible, near total pain relief after controlled injections into the facet/ISJ joints or their nerve supply is a widely accepted standard reference technique for diagnosis of symptomatic lumbar zygoapophyseal-or sacroiliac-joint pain, with both techniques believed to produce equivalent diagnostic results [18,19,29,31,40,[42][43][44].…”

“…These post-operative pain patterns have been linked to increased stress distribution and motion adjacent to the fused segments as well as to pathologically altered lumbar segmental, sagittal and spinopelvic alignment [1,21,29,32,35,42,43,63]. The reported incidence of symptomatic ''fusion-related'' pain patterns from posterior joint structures ranges from 32 to 61%, and it's clinical relevance has been confirmed in a variety of studies using fluoroscopically guided spine infiltrations [29,42,43].…”