Our Summary
This research paper is a review of existing studies on the pain and degeneration of the sacroiliac joint (SIJ), a joint in the lower back, that can occur after a surgical procedure called lumbosacral fixation. This surgery is done to stabilize the lower spine, but it has been suggested that it might lead to problems with the SIJ.
The researchers looked at 21 different studies, including a total of 2678 patients. They found that the amount of reported SIJ pain after having the surgery varied a lot, between 3% and 90% of patients.
When they looked at patients who had another type of surgery called spinal fusion, they found that those who had a fixed fusion (where the bones are permanently joined together) were more likely to have SIJ pain than those who had a floating fusion (where the bones are allowed to move slightly).
They also found that patients who had a particular type of scanning (CT scan) were more likely to show signs of SIJ degeneration if they had had the spinal fusion surgery than if they hadn’t.
The researchers concluded that patients who have lumbosacral fixation surgery are at risk of experiencing SIJ pain. They suggest that the number of levels fused, whether the pelvis or sacrum was involved in the surgery, the alignment of the spine after surgery, and where the bone graft was taken from could all be factors that might lead to SIJ degeneration and pain.
However, the researchers also noted that the studies they looked at were quite different from each other in terms of their design and the patients they included, so more research is needed to confirm these findings. The level of evidence provided by this review is classified as Level III, which means it provides a moderate level of evidence.
FAQs
- What is the prevalence of sacroiliac joint (SIJ) pain and degeneration after lumbosacral fixation?
- What are the potential risk factors leading to sacroiliac degeneration and pain after lumbar spine fixation?
- What is the difference in the prevalence of SIJ pain between patients who underwent spinal fusion with fixed and floating fusions?
Doctor’s Tip
A helpful tip that a doctor might tell a patient about spinal fusion is to be aware of the potential risk of developing sacroiliac joint (SIJ) pain and degeneration after the surgery. Patients who undergo lumbosacral fixation are at risk of experiencing SIJ pain, with the prevalence varying widely among individuals. Factors such as the number of fused levels, involvement of the pelvis or sacrum in the arthrodesis area, inadequate lumbosacral sagittal alignment, and the site of bone graft harvesting could be possible risk factors for SIJ degeneration and pain. It is important for patients to discuss these potential risks with their healthcare provider and to seek further evaluation if they experience any new or worsening symptoms after spinal fusion surgery.
Suitable For
Patients who have undergone lumbosacral fixation, particularly those who have had arthrodesis fixed, are at risk for developing sacroiliac joint (SIJ) pain and degeneration. Risk factors for SIJ pain after spinal fusion include the number of fused levels, involvement of the pelvis or sacrum in the arthrodesis area, inadequate lumbosacral sagittal alignment, and the site of bone graft harvesting. Patients who have undergone spinal arthrodesis have a higher prevalence of SIJ pain and degenerative changes compared to those who have not. Further prospective comparative studies are needed to better understand and address this issue.
Timeline
Before spinal fusion:
- Patient experiences chronic back pain and/or leg pain due to various spinal conditions such as degenerative disc disease, spinal stenosis, or spondylolisthesis.
- Patient undergoes diagnostic tests such as X-rays, MRI, and CT scans to determine the extent of the spinal condition.
- Patient undergoes conservative treatments such as physical therapy, medications, and injections to manage the pain.
- After failed conservative treatments, patient and their healthcare provider decide to proceed with spinal fusion surgery.
After spinal fusion:
- Patient undergoes spinal fusion surgery where the affected vertebrae are fused together using bone grafts, screws, and rods to stabilize the spine.
- Patient experiences post-operative pain and discomfort, which is managed with pain medications.
- Patient undergoes physical therapy to regain strength and mobility in the spine.
- Patient gradually resumes normal activities and experiences a decrease in pain and improvement in overall function.
- Patient may still experience some residual pain or discomfort, but overall, there is an improvement in their quality of life and ability to perform daily activities.
What to Ask Your Doctor
- What is the likelihood of experiencing SIJ pain after undergoing spinal fusion surgery?
- Are there any specific risk factors that may increase the chances of developing SIJ pain following lumbosacral fixation?
- How is SIJ pain typically diagnosed and treated after spinal fusion surgery?
- What are the potential long-term effects of SIJ degeneration following lumbosacral fixation?
- Are there any preventive measures or treatments that can help reduce the risk of developing SIJ pain after spinal fusion surgery?
- How common is SIJ degeneration among patients who have undergone spinal arthrodesis compared to those who have not?
- Are there any specific imaging tests or diagnostic procedures that can help identify SIJ degenerative changes in patients who have had lumbosacral fixation?
- What are the implications of having SIJ degeneration in terms of overall spinal health and function?
- Are there any specific lifestyle modifications or exercises that can help manage SIJ pain and degeneration after spinal fusion surgery?
- Are there any alternative treatment options available for patients experiencing SIJ pain following lumbosacral fixation?
Reference
Authors: Manzetti M, Ruffilli A, Barile F, Fiore M, Viroli G, Cappello L, Faldini C. Journal: Clin Spine Surg. 2023 May 1;36(4):169-182. doi: 10.1097/BSD.0000000000001341. Epub 2022 May 10. PMID: 35551147