SpringerLink
Log in

A systematic review and update on diagnosis and treatment of new onset sacroiliac joint dysfunction after lumbar fusion

  • Review Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Sacroiliac joint dysfunction (SIJD) after lumbar/lumbosacral fusion has become increasingly recognized as the utilization of lumbar fusion has grown. Despite the significant morbidity associated with this condition, uncertainty regarding its diagnosis and treatment remains. We aim to update the current knowledge of the etiology, diagnosis, and treatment of post-lumbar surgery SIJD.

Methods

PRISMA guidelines were used to search the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, and OVID databases for literature published in the last 10 years. The ROBIS tool was utilized for risk of bias assessment. Statistical analyses were performed using the R foundation. A Fisher’s exact test was performed to determine the risk of SIJD based on operative technique, gender, and symptom onset timeline. Odds ratios were reported with 95% confidence intervals. A p-value \(\le\) 0.05 was considered statistically significant.

Results

Seventeen publications were included. The incidence of new onset SIJD was 7.0%. The mean age was 56 years, and the follow-up length was 30 months. SIJD was more common with fixed lumbar fusion vs floating fusion (OR = 1.48 [0.92, 2.37], p = 0.083), fusion of \(\ge\) 3 segments (p < 0.05), and male gender increased incidence of SIJD (OR = 1.93 [1.27, 2.98], p = 0.001). Intra-articular injection decreased the Visual Analogue Scale (VAS) score by 75%, while radiofrequency ablation (RFA) reduced the score by 90%. An open approach resulted in a 13% reduction in VAS score versus 68 and 29% for SIJ fixation using the iFuse and DIANA approaches, respectively.

Conclusions

Lumbar fusion predisposes patients to SIJD, likely through manipulation of the SIJ’s biomechanics. Definitive diagnosis of SIJD remains multifaceted and a newer modality such as SPECT/CT may find a future role. When conservative measures are ineffective, RFA and SIJ fixation using the iFuse System yield the greatest improvement VAS and ODI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Thailand)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

This systematic review was not registered; however, a review protocol and data are available upon request.

Code availability

Not applicable.

Abbreviations

SIJ:

Sacroiliac joint pain

SIJD:

Sacroiliac joint dysfunction

SIJP:

Sacroiliac joint pain

VAS:

Visual Analogue Scale

ODI:

Oswestry Disability Index

SPECT/CT:

Single-photon emission computerized tomography

MIS:

Minimally invasive

RFA:

Radiofrequency ablation

LBP:

Low back pain

PT:

Pelvic tilt

LL:

Lumbar lordosis

SS:

Sacral slope

PI:

Pelvic incidence

References

  1. Ahlquist S, Park HY, Gatto J, Shamie AN, Park DY (2018) Does approach matter? A comparative radiographic analysis of spinopelvic parameters in single-level lumbar fusion. Spine J 18(11):1999–2008. https://doi.org/10.1016/j.spinee.2018.03.014

    Article  PubMed  Google Scholar 

  2. Al-Riyami K, Gnanasegaran G, Van den Wyngaert T, Bomanji J (2017) Bone SPECT/CT in the postoperative spine: a focus on spinal fusion. Eur J Nucl Med Mol Imaging 44(12):2094–2104. https://doi.org/10.1007/s00259-017-3765-6

    Article  PubMed  Google Scholar 

  3. Barros G, McGrath L, Gelfenbeyn M (2019) Sacroiliac joint dysfunction in patients with low back pain. Fed Pract 36(8):370–375

    PubMed  PubMed Central  Google Scholar 

  4. Buchanan P, Vodapally S, Lee DW, Hagedorn JM, Bovinet C, Strand N, Sayed D, Deer T (2021) Successful diagnosis of sacroiliac joint dysfunction. J Pain Res 14:3135–3143. https://doi.org/10.2147/JPR.S327351

    Article  PubMed  PubMed Central  Google Scholar 

  5. Büker N, Akkaya S, Gökalp O, Kıtış A, Savkın R, Kıter AE (2014) Middle-term therapeutic effect of the sacroiliac joint blockade in patients with lumbosacral fusion-related sacroiliac pain. Acta Orthop Traumatol Turc 48(1):61–66. https://doi.org/10.3944/AOTT.2014.3190

    Article  PubMed  Google Scholar 

  6. Cheung JPY (2020) The importance of sagittal balance in adult scoliosis surgery. Ann Transl Med 8(2):35–35. https://doi.org/10.21037/atm.2019.10.19

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cho D-Y, Shin M-H, Hur J-W, Ryu K-S, Park C-K (2013) Sagittal sacropelvic morphology and balance in patients with sacroiliac joint pain following lumbar fusion surgery. J Korean Neurosurg Soc 54(3):201–206. https://doi.org/10.3340/jkns.2013.54.3.201

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ciarpaglini R, Maestretti G (2014) Sacroiliac Joint Syndrome 10 Years after Lumbar Arthroplasty: The Importance of Spinopelvic Alignment. Glob Spine J 23(6):720–724. https://doi.org/10.1007/s00586-014-3547-9

    Article  Google Scholar 

  9. Colò G, Cavagnaro L, Alessio-Mazzola M, Zanirato A, Felli L, Formica M (2020) Incidence, diagnosis and management of sacroiliitis after spinal surgery: a systematic review of the literature. Musculoskelet Surg 104(2):111–123. https://doi.org/10.1007/s12306-019-00607-0

    Article  PubMed  Google Scholar 

  10. Crow WT, Willis DR (2009) Estimating cost of care for patients with acute low back pain: a retrospective review of patient records. J Am Osteopath Assoc 109(4):229–233. https://doi.org/10.7556/jaoa.2009.109.4.229

    Article  PubMed  Google Scholar 

  11. Cummings J, Capobianco RA (2013) Minimally invasive sacroiliac joint fusion: one-year outcomes in 18 patients. Ann Surg Innov Res 7(12):1–7. https://doi.org/10.1186/1750-1164-7-12

    Article  Google Scholar 

  12. Deng H, Yue JK, Ordaz A, Suen CG, Sing DC (2021) Elective lumbar fusion in the United States: national trends in inpatient complications and cost from 2002–2014. J Neurosurg Sci 65(5):503–512. https://doi.org/10.23736/S0390-5616.19.04647-2

    Article  PubMed  Google Scholar 

  13. Endres S, Ludwig E (2013) Outcome of distraction interference arthrodesis of the sacroiliac joint for sacroiliac arthritis. Indian J Orthop 47(5):437–442. https://doi.org/10.4103/0019-5413.118197

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gartenberg A, Nessim A, Cho W (2021) Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment. Eur Spine J 30(10):2936–2943. https://doi.org/10.1007/s00586-021-06927-9

    Article  PubMed  Google Scholar 

  15. Guan F, Sun Y, Zhu L, Guan G, Chen M, Chi Z, Tian D, Gu J, Yu Z (2018) Risk factors of postoperative sacroiliac joint pain for posterior lumbar surgery: ≥2-year follow-up retrospective study. World Neurosurg 110:546–551. https://doi.org/10.1016/j.wneu.2017.11.053

    Article  Google Scholar 

  16. Hudyana H, Maes A, Vandenberghe T, Fidlers L, Sathekge M, Nicolai D, Van de Wiele C (2016) Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws. Eur J Nucl Med Mol Imaging 43(2):349–354. https://doi.org/10.1007/s00259-015-3158-7

    Article  PubMed  Google Scholar 

  17. Jung MW, Schellhas K, Johnson B (2020) Use of diagnostic injections to evaluate sacroiliac joint pain. Int J Spine Surg 14(1):30–34. https://doi.org/10.14444/6081

    Article  PubMed  Google Scholar 

  18. Kalidindi KKV, Bansal K, Vishwakarma G, Chhabra HS (2021) New onset sacroiliac joint pain after transforaminal interbody fusion: what are the culprits? Glob Spine J 13(3):677–682. https://doi.org/10.1177/21925682211003852

  19. Kim HS, Kim SH, Ju CI, Kim SW, Lee SM, Shin H (2010) The role of bone cement augmentation in the treatment of chronic symptomatic osteoporotic compression fracture. J Korean Neurosurg Soc 48(6):490–495

    Article  PubMed  PubMed Central  Google Scholar 

  20. King W, Ahmed SU, Baisden J, Patel N, Kennedy DJ, MacVicar J, Duszynski B (2015) Diagnosis and treatment of posterior sacroiliac complex pain: a systematic review with comprehensive analysis of the published data. Pain Med 16(2):257–265

    Article  PubMed  Google Scholar 

  21. Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP (2021) Low back pain. Lancet Lond Engl 398(10294):78–92

    Article  Google Scholar 

  22. Le Huec JC, Tsoupras A, Leglise A, Heraudet P, Celarier G, Sturresson B (2019) The sacro-iliac joint: a potentially painful enigma. Update on the diagnosis and treatment of pain from micro-trauma. Orthop Traumatol Surg Res 105(1, Supplement):S31–S42

    Article  PubMed  Google Scholar 

  23. Lee YC, Lee R, Harman C (2019) The incidence of new onset sacroiliac joint pain following lumbar fusion. J Spine Surg Hong Kong 5(3):310–314

    Article  Google Scholar 

  24. Loh E, Agur AM, Burnham RS (2022) Ultrasound-guided radiofrequency ablation for SI joint pain: an observational study. Interv Pain Med 1(3):100118

    Google Scholar 

  25. Matsuki Y, Mizogami M, Shigemi K (2017) Successful treatment of failed back surgery syndrome with an ultrasound-guided sacroiliac joint block: a report of two cases. Anaesth. Pain Intensive Care 21(4):479–481

  26. Nessim A, Cho W, Yang XA, Applebaum A, Sekerak R, Brill S, Kim SY (2021) Infra-adjacent segment disease after lumbar fusion: an analysis of pelvic parameters. Spine 46(16):E888–E892

    Article  PubMed  Google Scholar 

  27. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan—a web and mobile app for systematic reviews. Syst Rev. https://doi.org/10.1186/s13643-016-0384-4

    Article  PubMed  PubMed Central  Google Scholar 

  28. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71

    Article  PubMed  PubMed Central  Google Scholar 

  29. Park J, Ham D-W, Kwon B-T, Park S-M, Kim H-J, Yeom JS (2020) Minimally invasive spine surgery: techniques, technologies, and indications. Asian Spine J 14(5):694–701

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pizones J, García-Rey E (2020) Pelvic motion the key to understanding spine–hip interaction. EFORT Open Rev 5(9):522–533

    Article  PubMed  PubMed Central  Google Scholar 

  31. Rainov NG, Schneiderhan R, Heidecke V (2019) Triangular titanium implants for sacroiliac joint fusion. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 28(4):727–734

    Article  Google Scholar 

  32. Savarese LG, Menezes-Reis R, Bonugli GP, da Herrero CFPS, Defino HLA, Nogueira-Barbosa MH (2020) Spinopelvic sagittal balance: what does the radiologist need to know? Radiol Bras 53(3):175–184

    Article  PubMed  PubMed Central  Google Scholar 

  33. Slinkard N, Agel J, Swiontkowski MF (2013) Documentation of outcomes for sacroiliac joint fusion: does prior spinal fusion influence the outcome? Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22(10):2318–2324

    Article  Google Scholar 

  34. Smith AG, Capobianco R, Cher D, Rudolf L, Sachs D, Gundanna M, Kleiner J, Mody MG, Shamie AN (2013) Open versus minimally invasive sacroiliac joint fusion: a multi-center comparison of perioperative measures and clinical outcomes. Ann Surg Innov Res 7(1):14

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tonosu J, Kurosawa D, Nishi T, Ito K, Morimoto D, Musha Y, Ozawa H, Murakami E (2019) The association between sacroiliac joint-related pain following lumbar spine surgery and spinopelvic parameters: a prospective multicenter study. Eur Spine J 28(7):1603–1609

    Article  PubMed  Google Scholar 

  36. Tseng C, Chen K-T, Fong Y-C, Lin C-W, Sun L-W, Chen C-M, Wang G-C (2023) Biportal endoscopic radiofrequency ablation of the sacroiliac joint complex in the treatment of chronic low back pain: a technical note with 1-year follow-up. Diagn Basel Switz 13(2):229

    Google Scholar 

  37. Unoki E, Abe E, Murai H, Kobayashi T, Abe T (2016) Fusion of multiple segments can increase the incidence of sacroiliac joint pain after lumbar or lumbosacral fusion. Spine 41(12):999–1005

    Article  PubMed  Google Scholar 

  38. Unoki E, Miyakoshi N, Abe E, Kobayashi T, Abe T, Shimada Y (2017) Sacroiliac joint pain after multiple-segment lumbar fusion: a long-term observational study-non-fused sacrum vs. fused sacrum. Spine Surg Relat Res 1(2):90–95

    Article  PubMed  PubMed Central  Google Scholar 

  39. Urits I, Burshtein A, Sharma M et al (2019) Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep 23(3):23

    Article  PubMed  Google Scholar 

  40. Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH (2012) The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 221(6):537–567

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Wang J, Zhang Q, Liu F, Yuan H, Zhang Y, Wang X, Li J (2022) Predicting the ideal apex of lumbar lordosis based on individual pelvic incidence and inflection point in asymptomatic adults. Front Surg 9:912357

    Article  PubMed  PubMed Central  Google Scholar 

  42. Whiting P, Savović J, Higgins JPT, Caldwell DM, Reeves BC, Shea B, Davies P, Kleijnen J, Churchill R (2016) ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol 69:225–234

    Article  PubMed  PubMed Central  Google Scholar 

  43. Yao Z, Li L, Zhang P, Yang L, Bai X, Peng S, Lai Y (2022) Biomechanics evaluation of sacroiliac joint pain after lumbosacral fusion: a finite element analysis. J Orthop Res Off Publ Orthop Res Soc. https://doi.org/10.1002/jor.25411

    Article  Google Scholar 

  44. Yoshihara H (2012) Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge. Eur Spine J 21(9):1788–1796

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA

    Helen Karimi, Rahul Rodrigues, Shrey Patel, Jainith Patel, Jacob Kosarchuk & James Kryzanski

Authors
  1. Helen Karimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rahul Rodrigues
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shrey Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jainith Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacob Kosarchuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James Kryzanski
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed to the study conception and design. HK and RR performed an independent blinded review of publications for inclusion. SP resolved any discrepancies as a third blinded reviewer. All the authors participated in the construction and revision of the manuscript, and all provided the final approval for submission.

Corresponding author

Correspondence to Helen Karimi.

Ethics declarations

Ethics approval

The manuscript does not contain clinical studies or patient data.

Consent to participate

The manuscript does not contain clinical studies or patient data.

Consent for publication

The manuscript does not contain clinical studies or patient data.

Conflicts of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karimi, H., Rodrigues, R., Patel, S. et al. A systematic review and update on diagnosis and treatment of new onset sacroiliac joint dysfunction after lumbar fusion. Acta Neurochir 166, 43 (2024). https://doi.org/10.1007/s00701-024-05918-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00701-024-05918-1

Keywords

Search

Navigation