Incidence and Risk Factors of Sacroiliac Joint Pain Following Lumbar Surgery with and without Fusion in Patients with Spinal Stenosis and Low-Grade Degenerative Spondylolisthesis: A Nonrandomized Clinical Trial

Toufigh Mohaddes Javadi; Navid Moghadam; Sadegh Bagherzadeh; Ramin Kordi; Dustin Kim; Faramarz Roohollahi; Mersad Moosavi; Morteza Faghih Jouibari; Milad Shafizadeh; Arash Jafarieh; Marzieh Rostami; Hosseinali Ataei; Mohammad Jafari; Mohsen Rostami

doi:10.1055/s-0045-1809390

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1809390

Original Article

Incidence and Risk Factors of Sacroiliac Joint Pain Following Lumbar Surgery with and without Fusion in Patients with Spinal Stenosis and Low-Grade Degenerative Spondylolisthesis: A Nonrandomized Clinical Trial

Toufigh Mohaddes Javadi

¹Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Navid Moghadam

²Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

³Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Sadegh Bagherzadeh

¹Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

²Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

,

Ramin Kordi

²Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

³Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Dustin Kim

⁴Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States

,

Faramarz Roohollahi

³Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Mersad Moosavi

³Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Morteza Faghih Jouibari

¹Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Milad Shafizadeh

¹Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Arash Jafarieh

⁵Department of Anesthesiology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Marzieh Rostami

⁵Department of Anesthesiology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Hosseinali Ataei

⁵Department of Anesthesiology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Mohammad Jafari

¹Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

³Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

,

Mohsen Rostami

⁴Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States

› Author Affiliations

Abstract

Background

Failed back surgery syndrome affects 10 to 46% of lumbar spine surgery patients, often resulting in persistent pain and functional impairment. Sacroiliac joint pain (SIJP) is a significant contributor, particularly following spinal fusion. This study aimed to assess SIJP incidence following lumbar surgery with and without fusion, and identify risk factors for sacroiliac joint syndrome (SIJS).

Materials and Methods

This prospective, nonrandomized clinical trial included 102 patients undergoing lumbar decompression alone (Dec group, n = 50) or decompression with fusion (DecPlus group, n = 52) at two university hospitals. Patients with persistent postoperative pain were assessed for SIJS using clinical provocative tests and fluoroscopy-guided sacroiliac joint blocks. Primary outcomes included SIJP incidence, visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) for disability, and Short-Form (SF)-36 Health Survey for quality of life. Patients were followed for 3 months postoperatively.

Results

SIJP was diagnosed in 36.3% of patients, with significantly higher incidence in the DecPlus group (50%) compared with the Dec group (22%) (p < 0.01). Pain scores (VAS) improved significantly in both groups, but ODI and SF-36 scores showed greater improvement in the Dec group (p < 0.01). SIJP has a significant relation with the upper instrumented vertebra (UIV) and length of fusion; however, extension of fusion to S1 does not significantly increase the SIJP. There was no significant association between SIJP and smoking, body mass index, or other comorbidities.

Conclusion

Based on our study, lumbar instrumented posterolateral fusion, compared with decompression without fusion, should be considered a risk factor for SIJP. In patients with instrumented fusion, the UIV and the length of fusion are related to SIJP; however, extending fusion to S1 does not significantly affect SIJP incidence.

Keywords

decompression - fusion - sacroiliac joint pain - failed back surgery syndrome

Full Text

References

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