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. 2022 Jul;12(6):1158-1164.
doi: 10.1177/2192568220978235. Epub 2020 Dec 30.

Sacroiliac Joint Degeneration After Lumbopelvic Fixation

Hiroaki Nakashima  1   2 , Tokumi Kanemura  1 , Kotaro Satake  1 , Kenyu Ito  1 , Satoshi Tanaka  1 , Naoki Segi  1   2 , Jun Ouchida  1   2 , Yujiro Kagami  1 , Kei Ando  2 , Kazuyoshi Kobayashi  2 , Shiro Imagama  2
Affiliations

Sacroiliac Joint Degeneration After Lumbopelvic Fixation

Hiroaki Nakashima et al. Global Spine J. 2022 Jul.

Abstract

Study design: Retrospective Study.

Objectives: Sacroiliac buttress screws (SBS) and S2 alar iliac screws (SAI) are used as distal screws in cases with long fusion to the pelvis. Distal fixation ends, whether exceeding the sacroiliac joint (SIJ), may affect postoperative degenerative changes in the SIJ. The aim of this study was to investigate SIJ degeneration after lumbosacral and lumbopelvic fixation, using SBS and SAI in degenerative spine diseases, respectively.

Methods: This study included 70 patients aged ≥50 years with lumbosacral fusion (>3 levels). They were divided into 2 groups (SBS 20 and SAI 50 cases) based on the type of distal screws. Radiographical and clinical data were reviewed with a minimum 2-year follow-up. Radiographical SIJ degeneration was analyzed using computed tomography; clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ).

Results: No significant differences were observed in patients' preoperative characteristics between the 2 groups. The incidence of SIJ degeneration, including osteophyte formation (30.0% and 8.0%, p = 0.03), intraarticular air (75.0% and 16.0%, p < 0.001), and subchondral cyst (20.0% and 2.0%. p = 0.02) in SBS and SAI groups, respectively, at the follow-up, was significantly higher in the SBS group. Although SIJ degenerative changes were significantly different between the SBS and SAI groups, there was no significant difference in VAS and JOABPEQ scores between the groups at 2 years post-surgery.

Conclusions: Lumbosacral fusion can cause SIJ degeneration, which is more frequent when SBS are used in fixation to the sacrum.

Keywords: S2 alar iliac screws; adjacent segment disease; lumbosacral fusion; sacroiliac buttress screws; sacroiliac joint.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Tokumi Kanemura is a consultant for Medtronic and NUVASIVE.

Figures

Figure 1.
Figure 1.
A representative case with postoperative sacroiliac joint (SIJ) degeneration after using sacroiliac buttress screws (SBS). Preoperative X-rays showing scoliosis (Cobb angle: 27°) (A), anterior-posterior combined fusion from T10 to sacrum was performed by using SBS (B), and postoperative CT at 2 years showing a subchondral cyst (white arrow) (C).
Figure 2.
Figure 2.
A representative case with postoperative sacroiliac joint (SIJ) degeneration after using S2 alar iliac screws (SAI). Preoperative X-rays showing scoliosis (Cobb angle: 31°) (A), anterior-posterior combined fusion from T10 to pelvis was performed by using SAI (B), and postoperative CT at 2 years showing a subchondral cyst (white arrow) (C).
See this image and copyright information in PMC

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