Clinical incidence of sacroiliac joint arthritis and pain after sacropelvic fixation for spinal deformity.
OBJECTIVE
Sacroiliac fixation using iliac screws for highly unstable lumbar spine has been reported with an improved fusion rate and clinical results. On the other hand, there is a potential for clinical problems related to iliac fixation, including late sacroiliac joint arthritis and pain.


METHODS
Twenty patients were evaluated. Degenerative scoliosis was diagnosed in 7 patients, failed back syndrome in 6 patients, destructive spondyloarthropathy in 4 patients, and Charcot spine in 3 patients. All patients underwent posterolateral fusion surgery incorporating lumbar, S1 and iliac screws. We evaluated the pain scores, bone union, and degeneration of sacroiliac joints by X-ray imaging and computed tomography before and 3 years after surgery. For evaluation of low back and buttock pain from sacroiliac joints 3 years after surgery, lidocaine was administered in order to examine pain relief thereafter.


RESULTS
Pain scores significantly improved after surgery. All patients showed bone union at final follow-up. Degeneration of sacroiliac joints was not seen in the 20 patients 3 years after surgery. Patients showed slight low back and buttock pain 3 years after surgery. However, not all patients showed relief of the low back and buttock pain after injection of lidocaine into the sacroiliac joint, indicating that their pain did not originate from sacroiliac joints.


CONCLUSIONS
The fusion rate and clinical results were excellent. Also, degeneration and pain from sacroiliac joints were not seen within 3 years after surgery. We recommend sacroiliac fixation using iliac screws for highly unstable lumbar spine.
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. sohtori@faculty.chiba-u.jp
Seiji
S
Ohtori
Takeshi
T
Sainoh
Masashi
M
Takaso
Gen
G
Inoue
Sumihisa
S
Orita
Yawara
Y
Eguchi
Junichi
J
Nakamura
Yasuchika
Y
Aoki
Tetsuhiro
T
Ishikawa
Masayuki
M
Miyagi
Gen
G
Arai
Hiroto
H
Kamoda
Miyako
M
Suzuki
Gou
G
Kubota
Yoshihiro
Y
Sakuma
Yasuhiro
Y
Oikawa
Masashi
M
Yamazaki
Tomoaki
T
Toyone
Kazuhisa
K
Takahashi
D000368:Aged; D001168:Arthritis / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology*; D012446:Sacroiliac Joint / Q000276:immunology* / Q000473:pathology*