Sacroiliac Joint Degeneration and Pain After Spinal Arthrodesis

Abstract

Study Design: This was a systematic review. Objective: The present study aims to review the available literature concerning sacroiliac joint (SIJ) pain and degeneration after lumbosacral fixation to identify the prevalence and potential risk factors. Summary of Background Data: Although numerous factors can predispose patients to SIJ degeneration and pain various clinical studies indicate lumbosacral arthrodesis as a major cause. Materials and Methods: The PubMed-MEDLINE, Cochrane Central Registry of Controlled Trials, and Embase Biomedical database were searched. Peer-reviewed comparative studies, cohort studies, case series studies and case control studies, conducted either in a retrospective or prospective design, that registered data about SIJ pain and degeneration after lumbosacral fixation were included. Results: Twenty-one studies including 2678 patients met the inclusion criteria. The percentage of SIJ pain after lumbosacral fixation diagnosed with injections and physical examination varied widely, from 3% to 90%. Among patients who underwent spinal fusion, SIJ pain prevalence was higher when arthrodesis was fixed compared with floating fusions (59% vs. 10%, P-value >0.05). The prevalence of SIJ degenerative changes at computed tomography scan was more frequent in patients who underwent spinal arthrodesis than in those who did not (75% vs. 38.2%, P-value ≤0.05). Conclusion: According to current evidence, patients who received lumbosacral fixation are at risk of SIJ pain. Number of fused levels, involvement of pelvis or sacrum in the arthrodesis area, inadequate lumbosacral sagittal alignment, and site of bone graft harvesting could be possible risk factor leading to sacroiliac degeneration and pain after lumbar spine fixation that should be investigated by physicians. However, there is a lack of homogeneity of the studies that address the problem, therefore, further prospective comparative studies, with a homogeneous architecture and cohorts are needed. Level of Evidence: Level III.

Estimating the Cost of Spinopelvic Complications After Adult Spinal Deformity Surgery

“…The base case cumulative per-patient discounted 5-year costs of spinopelvic fixation failures was $34,177. Assuming ASD surgery incurs costs of $123,000, 14 the additional costs represent 28% of index surgery costs. Assuming approximately 27,580 patients undergoing ASD surgery annually in the US, the 5-year discounted costs represent $0.94 billion per year.…”

“… 8 , 9 A recent systematic review reported widely varying estimates (3–90%). 14 One study reported an increasing incidence of postoperative SI joint pain after lumbar fusion with increased number of lumbar vertebral segments fused. 12 The weighted average of the raw postoperative incidence of clinically diagnosed SI joint pain in Manzetti et al (24%) was assumed to represent a 2-year rate.…”

The Sacroiliac Joint

“…Among patients who have previously undergone fusion in the lower lumbar spine, pain may be related to degeneration as a form of adjacent segment degeneration or may have been present before the fusion but was somewhat masked by more severe pain from the lumbar spine. Lumbar/spinopelvic fixation results in degenerative changes at the SIJ in 40% to 75% of patients after 5 years 27,30 . Such degenerative changes may result from susceptibility to increased motion and stress at the articular surfaces after fixation.…”

A Biomechanical Comparison of 2 Different Topping-off Devices and Their Influence on the Sacroiliac Joint Following Lumbosacral Fusion Surgery

“…It has been suggested that SIJ may be responsible for chronic lower back pain in around 13% to 30% of patients who have undergone lumbar/lumbosacral fusion [ 15 ]. According to clinical research, fusion procedures have been found to expedite the process of SIJ degeneration, especially in the lumbosacral fusion group, where SIJ degeneration developed more often and revealed more rapid and more severe progression than in the lumbar group [ 16 , 17 ], potentially resulting in the SIJ-related pain [ 18 ]. From a biomechanics perspective, it is possible that SIJ degeneration may be caused by the increased motion and stress resulting from fusion [ 19 , 20 ], similar to how the ASD occurs in lumbar spine.…”