Eiki Unoki1, Naohisa Miyakoshi2, Eiji Abe3, Takashi Kobayashi3, Toshiki Abe3, Daisuke Kudo2, Yoichi Shimada2. 1. Department of Orthopedic Surgery, Koto Kousei Hospital, Hachirogata-machi, Minamiakita-gun, Akita, Japan. 2. Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan. 3. Department of Orthopedic Surgery, Akita Kousei Medical Center, Akita, Japan.
Abstract
STUDY DESIGN: A retrospective study. OBJECTIVE: To examine the postoperative incidence of sacroiliac joint pain (SIJP) at the lower fusion level following multisegment fusion. SUMMARY OF BACKGROUND DATA: Recently, multisegment fusion is being increasingly performed. While proximal junctional kyphosis (PJK) commonly develops following multisegment fusion, SIJP also commonly occurs following this surgery. In surgery for adult spinal deformity, fixation is often extended to the pelvis to include the sacroiliac joint. Therefore, the question of whether SIJP occurs in such cases is interesting. Here, we examined postoperative incidence of SIJP at the lower fusion level, including the incidence of PJK, and postoperative lumbopelvic alignment. METHODS: Participants included 77 patients who underwent corrective fusion (≥3 segments). Patients were divided into three groups based on the lower fixation end: L5 (L5), S (sacrum), and P (pelvis). In the P group, an S2 alar iliac screw was used. Postoperative incidence of SIJP and PJK in each group was examined along with lumbopelvic parameters. RESULTS: SIJP incidence was 16.7%, 26.1%, and 4.2% in the L5, S, and P groups, respectively, indicating the highest value in the S group and a significantly lower value in the P group. PJK incidence was 23.3%, 30.4%, and 29.2% in the L5, P, and S groups, respectively, with no significant differences. Regarding postoperative lumbopelvic parameters, there was no significant difference between the groups; however, lumbar lordosis tended to be better in the P group. CONCLUSION: SIJP incidence was extremely high with fixation to the sacrum, and in the group with fixation to the pelvis, there was hardly any SIJP. Sacropelvic fixation using S2 alar iliac screws could prevent SIJP onset following multisegment fusion. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: A retrospective study. OBJECTIVE: To examine the postoperative incidence of sacroiliac joint pain (SIJP) at the lower fusion level following multisegment fusion. SUMMARY OF BACKGROUND DATA: Recently, multisegment fusion is being increasingly performed. While proximal junctional kyphosis (PJK) commonly develops following multisegment fusion, SIJP also commonly occurs following this surgery. In surgery for adult spinal deformity, fixation is often extended to the pelvis to include the sacroiliac joint. Therefore, the question of whether SIJP occurs in such cases is interesting. Here, we examined postoperative incidence of SIJP at the lower fusion level, including the incidence of PJK, and postoperative lumbopelvic alignment. METHODS:Participants included 77 patients who underwent corrective fusion (≥3 segments). Patients were divided into three groups based on the lower fixation end: L5 (L5), S (sacrum), and P (pelvis). In the P group, an S2 alar iliac screw was used. Postoperative incidence of SIJP and PJK in each group was examined along with lumbopelvic parameters. RESULTS: SIJP incidence was 16.7%, 26.1%, and 4.2% in the L5, S, and P groups, respectively, indicating the highest value in the S group and a significantly lower value in the P group. PJK incidence was 23.3%, 30.4%, and 29.2% in the L5, P, and S groups, respectively, with no significant differences. Regarding postoperative lumbopelvic parameters, there was no significant difference between the groups; however, lumbar lordosis tended to be better in the P group. CONCLUSION: SIJP incidence was extremely high with fixation to the sacrum, and in the group with fixation to the pelvis, there was hardly any SIJP. Sacropelvic fixation using S2 alar iliac screws could prevent SIJP onset following multisegment fusion. LEVEL OF EVIDENCE: 3.
Authors: Jianxiong Zheng; Xiaoreng Feng; Jie Xiang; Fei Liu; Frankie K L Leung; Bin Chen Journal: J Orthop Surg Res Date: 2021-10-30 Impact factor: 2.359