Original ArticleRisk Factors of Postoperative Sacroiliac Joint Pain for Posterior Lumbar Surgery: ≥2-Year Follow-up Retrospective Study
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.
References (27)
- et al.
Transient sacroiliac joint-related pain is a common problem following lumbar decompressive surgery without instrumentation
Clin Neurol Neurosurg
(2015) - et al.
Diagnostic validity of criteria for sacroiliac joint pain: a systematic review
J Pain
(2009) - et al.
Impact of sacropelvic fixation on the development of postoperative sacroiliac joint pain following multilevel stabilization for degenerative spine disease
Clin Neurol Neurosurg
(2016) - et al.
Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study
J Orthop Sci
(2007) - et al.
Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests
Man Ther
(2005) - et al.
Risk Factors of postoperative low back pain for lumbar spine disease
World Neurosurg
(2016) - et al.
Surgical versus nonsurgical therapy for lumbar spinal stenosis
N Engl J Med
(2008) - et al.
Fusion of multiple segments can increase the incidence of sacroiliac joint pain after lumbar or lumbosacral fusion
Spine (Phila Pa 1976)
(2016) - et al.
Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks
Pain Med
(2011) - et al.
Computed tomographic findings in patients with persistent sacroiliac pain after posterior iliac graft harvesting
Spine (Phila Pa 1976)
(2000)
Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature
Spine (Phila Pa 1976)
Etiology of chronic low back pain in patients having undergone lumbar fusion
Pain Med
Sacroiliac joint pain after lumbar fusion to the sacrum
J Spinal Disord Tech
Cited by (12)
Sacroiliac joint injection for management sacroiliac joint pain after lumbosacral spinal fusion surgery: A prospective study at the single center in Vietnam
2023, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementSacroiliac Joint Degeneration and Pain After Spinal Arthrodesis: A Systematic Review
2023, Clinical Spine Surgery
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.