European Spine Journal

, Volume 21, Issue 9, pp 1788–1796 | Cite as

Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge

Review Article

Abstract

Recently, the sacroiliac joint (SIJ) has gained increased attention as a source of persistent or new pain after lumbar/lumbosacral fusion. The underlying pathophysiology of SIJ pain may be increased mechanical load, iliac crest bone grafting, or a misdiagnosis of SIJ syndrome. Imaging studies show more frequent degeneration of the SIJ in patients with lumbar/lumbosacral fusion than in patients without such fusion. Using injection tests, it has been shown that SIJ pain is the cause of persistent symptoms in a considerable number of patients after fusion surgery. Recent articles reporting on surgical outcomes of SIJ fusion include a high percentage of patients who had lumbar/lumbosacral fusion or surgery before, although well-controlled clinical studies are necessary to assess the efficacy of surgical treatment. Taking these findings into consideration, the possibility that the SIJ is the source of pain should be considered in patients with failed back surgery syndrome after lumbar/lumbosacral fusion.

Keywords

Sacroiliac joint pain Lumbosacral fusion Lumbar fusion Pathophysiology 

Notes

Conflict of interest

None.

References

  1. 1.
    Deyo RA, Nachemson A, Mirza SK (2004) Spinal-fusion surgery: the case for restraint. N Engl J Med 350:722–726PubMedCrossRefGoogle Scholar
  2. 2.
    Fritzell P, Hägg O, Wessberg P, Nordwall A (2001) Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 26:2521–2532PubMedCrossRefGoogle Scholar
  3. 3.
    Bose B (2001) Outcomes after posterolateral lumbar fusion with instrumentation in patients treated with adjunctive pulsed electromagnetic field stimulation. Adv Ther 18:12–20PubMedCrossRefGoogle Scholar
  4. 4.
    Maigne JY, Planchon CA (2005) Sacroiliac joint pain after lumbar fusion. A study with anesthetic blocks. Eur Spine J pp 654–658Google Scholar
  5. 5.
    Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Herthoff KB (1981) Causes of failure of surgery on the lumbar spine. Clin Orthop 157:191–199PubMedGoogle Scholar
  6. 6.
    Burton CV (1991) Causes of failure of surgery on the lumbar spine: ten-year follow up. Mt Sinai J Med 58:183–187PubMedGoogle Scholar
  7. 7.
    Long DM (1991) Failed back surgery syndrome. Neurosurg Clin N Am 2:899–919PubMedGoogle Scholar
  8. 8.
    Long M, Filtzer DL, Bendebba M, Hendler NH (1988) Clinical features of failed back syndrome. J Neurosurg 69:61–71PubMedCrossRefGoogle Scholar
  9. 9.
    Bernard TN (1993) Repeat lumbar spine surgery. Spine 18:2196–2200PubMedCrossRefGoogle Scholar
  10. 10.
    Slipman CW, Shin CH, Patel RK, Isaac Z, Huston CW, Lipetz JS, Lenrow DA, Braverman DL (2002) Etiologies of failed back surgery syndrome. Pain Med 3:200–214PubMedCrossRefGoogle Scholar
  11. 11.
    Waguespack A, Schofferman J, Slosar P, Reynolds J (2002) Etiology of long-term failures of lumbar spine surgery. Pain Med 3:18–22PubMedCrossRefGoogle Scholar
  12. 12.
    Frymoyer J, Howe J, Kuhlmann D (1978) The long-term effects of spinal fusion on sacroiliac joints and ilium. Clin Orthop Relat Res. pp 196–201Google Scholar
  13. 13.
    Ebraheim NA, Elgafy H, Semaan HB (2000) Computed tomographic findings in patients with persistent sacroiliac pain after posterior iliac graft harvesting. Spine 25:2047–2051PubMedCrossRefGoogle Scholar
  14. 14.
    Dreyfuss P, Dreyer SJ, Cole A, Mayo K (2004) Sacroiliac joint pain. J Am Acad Orthop Surg 12:255–265PubMedGoogle Scholar
  15. 15.
    Lee CK, Langrana NA (1984) Lumbosacral spinal fusion. A biomechanical study. Spine 9:574–581PubMedCrossRefGoogle Scholar
  16. 16.
    Ha KY, Schendel MJ, Lewis JL, Ogilvie JW (1993) Effect of immobilization and configuration on lumbar adjacent-segment biomechanics. J Spinal Disord 6:99–105PubMedCrossRefGoogle Scholar
  17. 17.
    Bastian L, Lange U, Knop C, Tusch G, Blauth M (2001) Evaluation of the mobility of adjacent segments after posterior thoracolumbar fixation: a biomechanical study. Eur Spine J 10:295–300PubMedCrossRefGoogle Scholar
  18. 18.
    Chow DH, Luk KD, Evans JH, Leong JC (1996) Effects of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments. Spine 21:549–555PubMedCrossRefGoogle Scholar
  19. 19.
    Esses SI, Doherty BJ, Crawford MJ, Dreyzin V (1996) Kinematic evaluation of lumbar fusion techniques. Spine 21:676–684PubMedCrossRefGoogle Scholar
  20. 20.
    Nagata H, Schendel MJ, Transfeldt EE, Lewis JL (1993) The effects of immobilization of long segments of the spine on the adjacent and distal facet force and lumbosacral motion. Spine 18:2471–2479PubMedCrossRefGoogle Scholar
  21. 21.
    Quinnell RC, Stockdale HR (1981) Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Spine 6:263–267PubMedCrossRefGoogle Scholar
  22. 22.
    Dekutoski MB, Schendel MJ, Ogilvie JW, Olsewski JM, Wallace LJ, Lewis JL (1994) Comparison of in vivo and in vitro adjacent segment motion after lumbar fusion. Spine 19:1745–1751PubMedCrossRefGoogle Scholar
  23. 23.
    Chen CS, Cheng CK, Liu CL (2002) A biomechanical comparison of posterolateral fusion and posterior fusion in the lumbar spine. J Spinal Disord Tech 15:53–63PubMedCrossRefGoogle Scholar
  24. 24.
    Chen CS, Cheng CK, Liu CL, Lo WH (2001) Stress analysis of the disc adjacent to interbody fusion in lumbar spine. Med Eng Phys 23:483–491PubMedCrossRefGoogle Scholar
  25. 25.
    Weinhoffer SL, Guyer RD, Herbert M, Griffith SL (1995) Intradiscal pressure measurements above an instrumented fusion A cadaveric study. Spine 20:526–531PubMedCrossRefGoogle Scholar
  26. 26.
    Ivanov AA, Kiapour A, Ebraheim NA, Goel V (2009) Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint. Spine 34:162–169CrossRefGoogle Scholar
  27. 27.
    Ha K, Lee J, Kim K (2008) Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion. Spine 33:1192–1198PubMedCrossRefGoogle Scholar
  28. 28.
    Onsel C, Collier BD, Kir KM, Larson SJ, Meyer GA, Krasnow AZ, Isitman AT, Hellman RS, Carrera GF (1992) Increased sacroiliac joint uptake after lumbar fusion and/or laminectomy. Clin Nucl Med 17:283–287PubMedCrossRefGoogle Scholar
  29. 29.
    DePalma MJ, Ketchum JM, Saullo TR (2011) Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Med 12:732–739PubMedCrossRefGoogle Scholar
  30. 30.
    Chan K, Resnick D, Pathria M, Jacobson J (2001) Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients. Skelet Radiol 30:278–281CrossRefGoogle Scholar
  31. 31.
    Fowler BL, Dall BE, Rowe DE (1995) Complications associated with harvesting autogenous iliac bone graft. Am J Orthop 24:895–903PubMedGoogle Scholar
  32. 32.
    Kurz LT, Garfin SR, Booth RE Jr (1989) Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 14:1324–1331PubMedCrossRefGoogle Scholar
  33. 33.
    Katz V, Schofferman J, Reynolds J (2003) The SIJ: a potential cause of pain after lumbar fusion to the sacrum. J Spinal Disord Tech 16:96–99PubMedCrossRefGoogle Scholar
  34. 34.
    Howard JM, Glassman SD, Carreon LY (2011) Posterior iliac crest pain after posterolateral fusion with or without iliac crest graft harvest. Spine J 11:534–537PubMedCrossRefGoogle Scholar
  35. 35.
    Liliang PC, Lu K, Liang CL, Tsai YD, Wang KW, Chen HJ (2011) Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks. Pain Med 12:565–570PubMedCrossRefGoogle Scholar
  36. 36.
    Sembrano JN, Polly DW Jr (2009) How often is low back pain not coming from the back? Spine 34:E27–E32PubMedCrossRefGoogle Scholar
  37. 37.
    Weksler N, Velan GJ, Semionov M, Gurevitch B, Klein M, Rozentsveig V, Rudich T (2007) The role of sacroiliac joint dysfunction in the genesis of low back pain: the obvious is not always right. Arch Orthop Trauma Surg 127:885–888PubMedCrossRefGoogle Scholar
  38. 38.
    Ahn Y, Lee SH (2010) Iatrogenic sacroiliac joint syndrome after percutaneous pedicle screw fixation at the L5-S1 level: case report. Neurosurgery 67:E865–E866PubMedCrossRefGoogle Scholar
  39. 39.
    Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N (1996) The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine 21:2594–2602PubMedCrossRefGoogle Scholar
  40. 40.
    Schwarzer AC, Aprill CN, Bogduk N (1995) The sacroiliac joint in chronic low back pain. Spine 20:31–37PubMedCrossRefGoogle Scholar
  41. 41.
    Slipman CW, Jackson HB, Lipetz JS, Chan KT, Lenrow D, Vresilovic EJ (2000) Sacroiliac joint pain referral zones. Arch Phys Med Rehabil 81:334–338PubMedCrossRefGoogle Scholar
  42. 42.
    Cohen SP, Rowlingson J, Abdi S (2004) Low back pain. In: Warfield XA, Bajwa ZA (eds) Principles and practice of pain medicine, 2nd edn. McGraw-Hill, New York, pp 273–284Google Scholar
  43. 43.
    Maigne JY, Aivaliklis A, Pfefer F (1996) Results of SIJ double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine 21:1889–1892PubMedCrossRefGoogle Scholar
  44. 44.
    Potter NA, Rothstein JM (1985) Intertester reliability for selected clinical tests of the SIJ. Phys Ther 65:1671–1675PubMedGoogle Scholar
  45. 45.
    Benzon HT, Katz JA, Benzon HA, Iqbal MS (2003) Piriformis syndrome: Anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology pp 1442–1448Google Scholar
  46. 46.
    Pool-Goudzwaard AL, Kleinrensink GJ, Snijders CJ, Entius C, Stoeckart R (2001) The sacroiliac part of the iliolumbar ligament. J Anat 199:457–463PubMedCrossRefGoogle Scholar
  47. 47.
    Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E (1998) The predictive value of provocative SIJ stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil 79:288–292PubMedCrossRefGoogle Scholar
  48. 48.
    Dreyfuss P, Dreyer S, Griffin J, Hoffman J, Walsh N (1994) Positive sacroiliac screening tests in asymptomatic adults. Spine 19:1138–1143PubMedCrossRefGoogle Scholar
  49. 49.
    Broadhurst NA, Bond MJ (1998) Pain provocation test used for assessment of SIJ dysfunction. J Spinal Disord 11:341–345PubMedCrossRefGoogle Scholar
  50. 50.
    Laslett M, Aprill CN, McDonald B, Young SB (2005) Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manip Ther 10:207–218CrossRefGoogle Scholar
  51. 51.
    Laslett M, Young SB, Aprill CN, McDonald B (2003) Diagnosing painful sacroiliac joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother 49:89–97PubMedGoogle Scholar
  52. 52.
    van der Wurff P, Buijs EJ, Groen GJ (2006) A multitest regimen of pain provocation tests as an aid to reduce unnecessary minimally invasive sacroiliac joint procedures. Arch Phys Med Rehabil 87:10–14PubMedCrossRefGoogle Scholar
  53. 53.
    Young S, Aprill C, Laslett M (2003) Correlation of clinical examination characteristics with three sources of chronic low back pain. Spin J 3:460–465CrossRefGoogle Scholar
  54. 54.
    Dreyfuss P, Cole AJ, Pauza K (1995) Sacroiliac joint injection techniques. Phys Med Rehabil Clin N Am 6:785–813Google Scholar
  55. 55.
    Elgafy H, Semaan HB, Ebraheim NA, Coombs RJ (2001) Computed tomography findings in patients with sacroiliac pain. Clin Orthop Relat Res 382:112–118PubMedCrossRefGoogle Scholar
  56. 56.
    Bredella MA, Steinbach LS, Morgan S, Ward M, Davis JC (2006) MRI of the sacroiliac joints in patients with moderate to severe ankylosing spondylitis. AJR Am J Roentgenol 187:1420–1426PubMedCrossRefGoogle Scholar
  57. 57.
    Puhakka KB, Jurik AG, Egund N, Schiottz-Christensen B, Stengaard-Pedersen K, van Overeem Hansen G, Christiansen JV (2003) Imaging of sacroiliitis in early seronegative spondylarthropathy. Assessment of abnormalities by MR in comparison with radiography and CT. Acta Radiol 44:218–229PubMedCrossRefGoogle Scholar
  58. 58.
    Tuite MJ (2004) Facet joint injection and sacroiliac joint injection. Semin Roentgenol 39:37–51PubMedCrossRefGoogle Scholar
  59. 59.
    Maigne JY, Boulahdour H, Chatellier G (1998) Value of quantitative radionuclide bone scanning in the diagnosis of sacroiliac joint syndrome in 32 patients with low back pain. Eur Spine J 7:328–331PubMedCrossRefGoogle Scholar
  60. 60.
    Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic EJ (1996) The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine 21:2251–2254PubMedCrossRefGoogle Scholar
  61. 61.
    Lusins JO, Danielski EF, Goldsmith SJ (1989) Bone SPECT in patients with persistent back pain after lumbar spine surgery. J Nucl Med 30:490–496PubMedGoogle Scholar
  62. 62.
    Gates GF, McDonald RJ (1999) Bone SPECT of the back after lumbar surgery. Clin Nucl Med 24:395–403PubMedCrossRefGoogle Scholar
  63. 63.
    Vleeming A, Buyruk HM, Stoeckart R, Karamursel S, Snijders CJ (1992) An integrated therapy for peripartum pelvic instability: a study of the biomechanical effects of pelvic belts. Am J Obstet Gynecol 166:1243–1247PubMedGoogle Scholar
  64. 64.
    DonTigney RL (1985) Function and pathomechanics of the sacroiliac joint. A review. Phys Ther 65:35–44Google Scholar
  65. 65.
    Greeman PE (1990) Clinical aspects of sacroiliac function in walking. J Man Med 5:125–129Google Scholar
  66. 66.
    Slipman CW, Whyte WS 2nd, Chow DW, Chou L, Lenrow D, Ellen M (2001) Sacroiliac joint syndrome. Pain Physician 4:143–152PubMedGoogle Scholar
  67. 67.
    Janda V (1986) Muscle weakness and inhibition (pseudoparesis) in back pain syndromes. In: Grieve GP (ed) Modern manual therapy of the vertebral column. Churchill Livingstone, EdinburghGoogle Scholar
  68. 68.
    Mooney V, Pozos R, Vleeming A, Gulick J, Swenski D (2001) Exercise treatment for sacroiliac pain. Orthopedics 24:29–32PubMedGoogle Scholar
  69. 69.
    Liliang PC, Lu K, Weng HC, Liang CL, Tsai YD, Chen HJ (2009) The therapeutic efficacy of sacroiliac joint blocks with triamcinolone acetonide in the treatment of sacroiliac joint dysfunction without spondyloarthropathy. Spine 34:896–900PubMedCrossRefGoogle Scholar
  70. 70.
    Cusi M, Saunders J, Hungerford B, Wisbey-Roth T, Lucas P, Wilson S (2010) The use of prolotherapy in the sacroiliac joint. Br J Sports Med 44:100–104PubMedCrossRefGoogle Scholar
  71. 71.
    Aydin SM, Gharibo CG, Mehnert M, Stitik TP (2010) The role of radiofrequency ablation for sacroiliac joint pain: a meta-analysis. PMR 2:842–851Google Scholar
  72. 72.
    Speldewinde GC (2011) Outcomes of percutaneous zygapophysial and sacroiliac joint neurotomy in a community setting. Pain Med 12:209–218PubMedCrossRefGoogle Scholar
  73. 73.
    Calvillo O, Esses SI, Ponder C, D’Agostino C, Tanhui E (1998) Neuroaugmentation in the management of sacroiliac joint pain. Report of two cases. Spine 23:1069–1072PubMedCrossRefGoogle Scholar
  74. 74.
    Buchowski JM, Kebaish KM, Sinkov V, Cohen DB, Sieber AN, Kostuik JP (2005) Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint. Spine J 5:520–528PubMedCrossRefGoogle Scholar
  75. 75.
    Schutz U, Grob D (2006) Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Acta Orthop Belg 72:296–308PubMedGoogle Scholar
  76. 76.
    Wise CL, Dall BE (2008) Minimally invasive sacroiliac arthrodesis. J Spinal Disord Tech 21:579–584PubMedCrossRefGoogle Scholar
  77. 77.
    Khurana A, Guha AR, Mohanty K, Ahuja S (2009) Percutaneous fusion of the sacroiliac joint with hollow modular anchorage screws: clinical and radiological outcome. J Bone Joint Surg (Br) 91:627–631CrossRefGoogle Scholar
  78. 78.
    Simpson LA, Waddell JP, Leighton RK, Kellam JF, Tile M (1987) Anterior approach and stabilization of the disrupted sacroiliac joint. J Trauma 27:1332–1339PubMedCrossRefGoogle Scholar
  79. 79.
    Dabezies EJ, Millet CW, Murphy CP, Acker JH, Robicheaux RE, D’Ambrosia RD (1989) Stabilization of sacroiliac joint disruption with threaded compression rods. Clin Orthop Relat Res 246:165–171PubMedGoogle Scholar
  80. 80.
    Waisbrod H, Krainick JU, Gerbershagen HU (1987) Sacroiliac joint arthrodesis for chronic lower back pain. Arch Orthop Trauma Surg 106:238–240PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryNYU Hospital for Joint DiseasesNew YorkUSA

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