Elsevier

World Neurosurgery

Volume 110, February 2018, Pages e546-e551
World Neurosurgery

Original Article
Risk Factors of Postoperative Sacroiliac Joint Pain for Posterior Lumbar Surgery: ≥2-Year Follow-up Retrospective Study

https://doi.org/10.1016/j.wneu.2017.11.053Get rights and content

Purpose

A retrospective study was conducted to clarify the risk factors of postoperative sacroiliac joint pain (SIJP) for posterior open lumbar surgery.

Patients and Methods

A total of 472 patients who underwent posterior lumbar surgery between January 2011 and December 2014 were included in this analysis. We recorded basic characteristics, surgical characteristics, and SIJP information for each patient.

Results

The incidence of postoperative SIJP is 13.8% in our study. Comparison of the incidence of SIJP between diskectomy and posterior lumbar interbody fusion indicated that SIJP incidence tended to be higher in posterior lumbar interbody fusion patients (P = 0.029). Compared with the single-segment group, SIJP occurred more frequently in the multiple operative segments group (P = 0.025). Comparing the incidence of SIJP among different types of lumbar diseases, SIJP incidence is significantly higher in the lumbar stenosis group (P = 0035).

Conclusion

Lumbar fusion surgery and multiple operative segments are interdependent risk factors for the postoperative SIJP. The incidence of postoperative SIJP also increases in patients with lumbar stenosis compared with lumbar disk herniation and lumbar spondylolisthesis.

Introduction

With the aging population increasing gradually, the incidence of lumbar spinal disease increases simultaneously. Traditional conservative management such as physical therapy, epidural steroid injections, and daily life activities modification is effective to some extent. For some lumbar diseases such as lumbar stenosis, surgery seems to be a better choice.1 Alleviation of pain is one goal of lumbar surgery, but postoperative sacroiliac joint pain (SIJP) can occur after the operation in some cases. The incidence of SIJP ranged from 40.4%–10% according to previous studies.2, 3 Several causes such as iliac graft harvesting, adjacent segment disease, and fusion hardware-related low back pain might contribute to the postoperative SIJP of posterior lumbar surgery.4, 5, 6

Several researchers have tried to investigate the postoperative SIJP after posterior lumbar surgery, but lack of consensus of SIJP diagnostic criteria limited the study.2, 3, 7, 8, 9 Previous studies had reported that there was no single specific physical examination that could accurately identify a painful sacroiliac joint (SIJ).10, 11 By now, the SIJ block is considered as the gold standard for SIJP diagnosis.12, 13 A systematic review concluded that 3 positive provocation tests (Patrick test, Gaenslen test, and SIJ shear test) had significant discriminative power (diagnostic odds ratio: 17.16) for diagnosing SIJP using the reference standard of 2 positive blocks.14

SIJP is considered as one cause of postoperative low back pain,6, 15, 16 and the research aimed to investigate the risk factors of SIJP after lumbar surgery is rare. In this study, we aimed to investigate the risk factors of postoperative SIJP after the posterior lumbar operation.

Section snippets

Study Design

This study was approved by the Institutional Review Broad of Harbin Medical University, Heilongjiang, China. A total of 599 lumbar disk herniation, lumbar stenosis, or lumbar spondylolisthesis patients were enrolled in our study. All these patients underwent primary lumbar open diskectomy or posterior lumbar interbody fusion (PLIF) between January 2011 and December 2014 by 2 senior surgeons in our department. The surgical techniques and surgical procedure were determined by the 2 surgeons. The

Patient Characteristics

Among the 599 patients, 472 completed the follow-up for 28–75 months (mean 45.7 months) at April 2017. There were 191 males and 281 females with the mean age of 44.21 years (range: 17–76 years). The follow-up rate was 78.8% (472/599) (Table 1).

All the patients whose neurologic symptoms were not relieved well or even deteriorated received MRI scan after the operation to confirm the decompression completely. Three of the patients who required revision surgery for inadequate decompression were

Discussion

In this study, the incidence of postoperative SIJP is 13.8%, which is similar to previous studies, which ranged from 40.4%–10%.2, 3, 4, 20 That number could be varied upon the diagnostic criteria of the sacroiliac joint. The incidence is lower than incidence of transient sacroiliac joint–related pain according to the previous reporting.8 It might be because some SIJP can be alleviated in a short time spontaneously. It is not easy to diagnose SIJP because there are no established clinical,

Conclusion

On the basis of a mean 45.7 months' follow-up for the patients who underwent posterior lumbar surgery, the incidence of postoperative SIJP is 13.8%. Statistical analysis shows that lumbar fusion surgery and multiple operative segments are risk factors for the postoperative SIJP. The incidence rate of postoperative SIJP also increases in patients with lumbar stenosis compared with lumbar disk herniation and lumbar spondylolisthesis.

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    Conflict of interest statement: This study was supported by National Science Foundation of Heilongjiang Province, China (QC2015091).

    Fulin Guan and Yang Sun are co–first authors.

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