A systematic review and update on diagnosis and treatment of new onset sacroiliac joint dysfunction after lumbar fusion.

Karimi H, Rodrigues R, Patel S, Patel J, Kosarchuk J, Kryzanski J.
Acta Neurochir (Wien). 2024 Jan 27;166(1):43.

As described in this review paper, the study by Unoki and colleagues in Japan, which was presented at the ICSJS 2016, shows that the risk of sacroiliac joint dysfunction (SIJD) increases with fusion of >3 vertebral bodies and with fusion to the sacrum.

I believe that the authors of this paper are routinely focusing on the sacroiliac joint because they have reviewed SIJD after lumbar fusion surgery.

I would like to ask the following questions to the author and his team leader.

1. Do you have any experience including the sacroiliac joint in the fusion range when performing lumbar fusion to anticipate the risk of SIJD after lumbar fusion surgery?
2. What are the specific physical and image findings of a new onset SIJD after lumbar fusion surgery that would lead you to decide to fuse the sacroiliac joint as well?
3. What device do you use when connecting from lumbar fusion to sacroiliac fusion?

I look forward to comments on this from Dr. Bruce Dall as well, because he has a lot of experience in this matter.

My comments on SIJD after lumbar fusion are as follows;

・Tonosu et al. reported that patients with higher pelvic incidence (PI) may be at higher risk of developing SIJD after lumbar spine surgery. This result would mean that the development of SIJD is predestined.

Tonosu J, Kurosawa D, Nishi T, Ito K, Morimoto D, Musha Y, Ozawa H, Murakami E. The association between sacroiliac joint-related pain following lumbar spine surgery and spinopelvic parameters: a prospective multicenter study. Eur Spine J. 2019 Jul;28(7):1603-1609.

PI value, however, can change, and preoperative PI value before lumbar surgery might not be an indicator used to make a definitive decision for adding sacroiliac joint fusion.

Ohya J, Kawamura N, Takasawa E, Onishi Y, Ohtomo N, Miyahara J, Hayakawa C, Kunogi J. Pelvic incidence change on the operating table. Eur Spine J. 2021 Sep;30(9):2473-2479.

・Changes in spinal alignment appear to play a role in the development of SIJD after lumbar fusion surgery, but interpretation on a static image is difficult. Other factors besides spinal alignment, such as the degree of hip range of motion, the nature of daily activities, and whether the patient has sufficient abdominal trunk muscle strength, seem to have a greater influence.

・The availability of implant options that can link SIJ and spinal fusion is important, and I am hopeful that ProFuse, developed by Dr. Volker Fuchs, may be an answer.

Fuchs V, Rieger B. A New Approach to the Treatment of Sacroiliac Joint Pain and First Patient-Reported Outcomes Using a Novel Arthrodesis Technique for Sacroiliac Joint Fusion. Orthop Res Rev. 2024 Feb 1;16:43-57.

・Lumbar fusion procedures are being performed in large numbers. SIJD after lumbar fusion will continue to be a serious problem in the future. We need to investigate whether SIJ fusion with a lateral approach after spinal fusion to the sacrum or SIJ fusion with an extended posterior linkage from spinal fusion has a better postoperative course and biomechanical benefit.

I sincerely welcome any comments from SIMEG members.

Daisuke Kurosawa