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New Onset Sacroiliac Joint Pain After Transforaminal Interbody Fusion: What Are the Culprits? - PubMed

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New Onset Sacroiliac Joint Pain After Transforaminal Interbody Fusion: What Are the Culprits?

Kalyan Kumar Varma Kalidindi et al. Global Spine J. 2023 Apr.

Abstract

Study design: A retrospective case-control study.

Objective: Only a few studies have studied the incidence of new-onset SI joint pain following lumbar spine fusion surgery. We aimed to explore the association between new-onset SI joint pain following Transforaminal Lumbar Interbody Fusion (TLIF) for degenerative spine disorders and changes in spinopelvic parameters.

Methods: A retrospective review of hospital records and imaging database of a tertiary care institute was done for patients who underwent TLIF from October 2018 to October 2019. The 354 patients who satisfied the eligibility criteria were divided into 2 groups(Group A, new-onset SI joint pain group, n = 34 and Group B, normal controls, n = 320). Symptomatic relief (>70% reduction in the VAS [Visual Analogue Scale] score) after 15 minutes of SI joint injection was considered diagnostic of SI joint pain. Clinical and radiological spinopelvic parameters were compared between the 2 groups.

Results: Patients with postoperative SI joint pain (Group A) had significantly less preoperative and postoperative lumbar lordosis (p < 0.001) compared to the other group. Most of the patients in Group A had a cephalad migration of the apex postoperatively (30/34 patients) whereas majority of patients in group B had either predominant caudal migration (44/320 patients) or no migration of the lumbar apex (272/320 patients).

Conclusions: The preoperative and postoperative lumbar lordosis are significantly less and the postoperative pelvic tilt is significantly high in patients with new-onset SI joint pain compared to the control group. The cephalad migration of the lumbar apex is significantly associated with new-onset SI joint pain.

Keywords: TLIF; lumbar apex; sacroiliac joint pain; spinopelvic parameters.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.

A clinical image of a patient’s lower back with markings showing the border of the iliac crest and the PSIS (marked with ‘x’). The dimple also corresponds to the PSIS. The needle is directed laterally at an oblique angle of 45 degrees.

Figure 2.
Figure 2.

Illustrations depicting the pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), hip axis (HA) and location of lumbar apex (LLA). A vertical line drawn touching the most anterior part of the lumbar curve is used to identify the LLA. In figure 1a, the LLA was located at the body of L4. In figure 1b, after a 2 level TLIF, the LLA was shifted to the body of L3.

Figure 3.
Figure 3.

Flow chart followed for patient selection in the study.

Figure 4.
Figure 4.

Preoperative(3a) and postoperative(3b) X rays of a patient who underwent a single level TLIF. The LLA was maintained at L4 in both the images and the patient had no new onset SI joint pain. Preoperative(3c) and postoperative(3d) X rays of a patient who underwent a 2 level TLIF. The LLA was located at L5 preoperatively and shifted to L4 postoperatively. The patient had new onset SI joint pain postoperatively and underwent 3 SI joint infiltrations.

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