Yonsei Med J.  2012 Mar;53(2):416-421. 10.3349/ymj.2012.53.2.416.

Clinical Incidence of Sacroiliac Joint Arthritis and Pain after Sacropelvic Fixation for Spinal Deformity

• Ohtori S
• Sainoh T
• Takaso M
• Inoue G
• Orita S
• Eguchi Y
• Nakamura J
• Aoki Y
• Ishikawa T
• Miyagi M
• Arai G
• Kamoda H
• Suzuki M
• Kubota G
• Sakuma Y
• Oikawa Y
• Yamazaki M
• Toyone T
• Takahashi

• KMID: 1120211
• DOI: http://doi.org/10.3349/ymj.2012.53.2.416

Abstract

PURPOSE
Sacroiliac fixation using iliac screws for highly unstable lumbar spine has been reported with an improved fusion rate and clinical results. On the other hand, there is a potential for clinical problems related to iliac fixation, including late sacroiliac joint arthritis and pain.
MATERIALS AND METHODS
Twenty patients were evaluated. Degenerative scoliosis was diagnosed in 7 patients, failed back syndrome in 6 patients, destructive spondyloarthropathy in 4 patients, and Charcot spine in 3 patients. All patients underwent posterolateral fusion surgery incorporating lumbar, S1 and iliac screws. We evaluated the pain scores, bone union, and degeneration of sacroiliac joints by X-ray imaging and computed tomography before and 3 years after surgery. For evaluation of low back and buttock pain from sacroiliac joints 3 years after surgery, lidocaine was administered in order to examine pain relief thereafter.
RESULTS
Pain scores significantly improved after surgery. All patients showed bone union at final follow-up. Degeneration of sacroiliac joints was not seen in the 20 patients 3 years after surgery. Patients showed slight low back and buttock pain 3 years after surgery. However, not all patients showed relief of the low back and buttock pain after injection of lidocaine into the sacroiliac joint, indicating that their pain did not originate from sacroiliac joints.
CONCLUSION
The fusion rate and clinical results were excellent. Also, degeneration and pain from sacroiliac joints were not seen within 3 years after surgery. We recommend sacroiliac fixation using iliac screws for highly unstable lumbar spine.

Keyword

Sacroiliac; fixation; iliac screws; degeneration; pain

MeSH Terms

Aged
Arthritis/*surgery
Bone Screws
Female
Humans
Low Back Pain/diagnosis/epidemiology
Lumbar Vertebrae/*surgery
Male
Middle Aged
Pain/diagnosis/*epidemiology
Sacroiliac Joint/*immunology/*pathology

Figure

• 

  Fig. 1 The patient was a 67 year old woman with failed back syndrome and cerebral palsy. Before surgery, destructive change was seen in CT after myelography (A). The patient underwent posterolateral fusion (L2 to iliac) and anterior interbody fusion (L4-L5) and bone union was seen by X-ray imaging 12 months after surgery (B and C). Degenerative change was not seen in the sacroiliac joint before surgery (D). Degenerative change was not seen in sacroiliac joint 3 years after surgery (E). CT, computed tomography.

Reference

1. Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G. Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine (Phila Pa 1976). 2006. 31:2329–2336.

2. Tsuchiya K, Bridwell KH, Kuklo TR, Lenke LG, Baldus C. Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity. Spine (Phila Pa 1976). 2006. 31:303–308.

3. Kuklo TR, Bridwell KH, Lewis SJ, Baldus C, Blanke K, Iffrig TM, et al. Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws. Spine (Phila Pa 1976). 2001. 26:1976–1983.

4. Bernhardt M, Swartz DE, Clothiaux PL, Crowell RR, White AA 3rd. Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation. Clin Orthop Relat Res. 1992. 109–115.

5. Horowitch A, Peek RD, Thomas JC Jr, Widell EH Jr, DiMartino PP, Spencer CW 3rd, et al. The Wiltse pedicle screw fixation system. Early clinical results. Spine (Phila Pa 1976). 1989. 14:461–467.

6. Molinari RW, Bridwell KH, Lenke LG, Ungacta FF, Riew KD. Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches. Spine (Phila Pa 1976). 1999. 24:1701–1711.

7. Rechtine GR, Sutterlin CE, Wood GW, Boyd RJ, Mansfield FL. The efficacy of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusion in adult patients with degenerative spondylolisthesis. J Spinal Disord. 1996. 9:382–391.

8. Farcy JP, Rawlins BA, Glassman SD. Technique and results of fixation to the sacrum with iliosacral screws. Spine (Phila Pa 1976). 1992. 17:6 Suppl. S190–S195.

9. Louis R. Fusion of the lumbar and sacral spine by internal fixation with screw plates. Clin Orthop Relat Res. 1986. 18–33.

10. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res. 1986. 7–17.

11. Winter RB, Pinto WC. Pelvic obliquity. Its causes and its treatment. Spine (Phila Pa 1976). 1986. 11:225–234.

12. Wood EG III, Hanley EN Jr. Lumbar disc herniation and open limited discectomy: indications, techniques and results. Oper Tech Orthop. 1991. 1:23–28.

13. Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine (Phila Pa 1976). 1996. 21:2594–2602.

14. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine (Phila Pa 1976). 1996. 21:1889–1892.

15. Alderink GJ. The sacroiliac joint: review of anatomy, mechanics, and function. J Orthop Sports Phys Ther. 1991. 13:71–84.

16. Cassidy JD, Mierau DR. Haldeman Scott, editor. Pathophysiology of the sacroiliac joint. Principles and Practice of chiropractic. 1992. 2nd ed. San Mateo, CA: Appleton & Lange;211–224.

17. Murata Y, Takahashi K, Yamagata M, Takahashi Y, Shimada Y, Moriya H. Sensory innervation of the sacroiliac joint in rats. Spine (Phila Pa 1976). 2000. 25:2015–2019.