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Case Reports
. 2021 Sep 20;2(12):CASE21102.
doi: 10.3171/CASE21102.

Radiculopathy with concomitant sacroiliac dysfunction and lumbosacral degenerative disease: illustrative case

Jeffrey D Oliver  1 , Noah L Lessing  2 , Harry M Mushlin  3 , Joshua R Olexa  1 , Kenneth M Crandall  1 , Charles A Sansur  1
Affiliations
Case Reports

Radiculopathy with concomitant sacroiliac dysfunction and lumbosacral degenerative disease: illustrative case

Jeffrey D Oliver et al. J Neurosurg Case Lessons. .

Abstract

Background: The sacroiliac joint (SIJ) is an important cause of low back pain and referred leg pain (RLP). Pain from SIJ dysfunction may occur in isolation or may result from a combination with lumbosacral area-mediated pain. SIJ fusion is one treatment modality for medically refractory symptoms and may also have a role in the treatment of RLP.

Observations: The authors present a challenging case of concomitant lumbosacral degenerative disease and SIJ dysfunction in a patient with radiculopathy. They provide clinical characteristics and imaging findings and discuss difficulties in dealing with the intersection of these two distinct diagnoses. In addition, the authors offer a review of the relevant literature, elucidating the role of SIJ dysfunction in causing radicular lower extremity pain, the relationship to concomitant lumbosacral degenerative disease, and outcome data for SIJ fusion as it relates to RLP.

Lessons: With increasing numbers of patients undergoing spinal instrumentation in the setting of degenerative lumbosacral arthritis, as well as randomized controlled trial data demonstrating the efficacy of SIJ fusion for medically refractory SIJ dysfunction, it is important to recognize the challenges in understanding how both of these patient groups may present with radiculopathy. Failure to do so may result in incorrect patient selection, poor outcomes, and increased morbidity for at-risk patients.

Keywords: CT = computed tomography; QOL = quality of life; RCT = randomized controlled trial; RLP = referred leg pain; SIJ = sacroiliac joint; fusion; iMIA = iFuse Implant System Minimally Invasive Arthrodesis; radiculopathy; sacroiliac joint; sciatica.

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Conflict of interest statement

Disclosures Dr. Crandall reported nonfinancial support from Stryker outside the submitted work. Dr. Sansur reported “other” from Stryker Spine and “other” from Nuvasive outside the submitted work. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
Preoperative T2 sagittal magnetic resonance imaging showing L5–S1 disc herniation and loss of disc height.
FIG. 2.
FIG. 2.
Postoperative lateral radiographs after anterior lumbar interbody fusion and posterior lumbar decompression and fusion.
FIG. 3.
FIG. 3.
Coronal lumbar CT showing increased right greater than left cortical bone formation, osteophyte development, and intraarticular sacroiliac joint air.
See this image and copyright information in PMC

References

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