Paper of the month January 2023

Sacroiliac Joint Pain Should Be Suspected in Early Buttock and Groin Pain after Adult Spinal Deformity Surgery: An Observational Study.

Murata S, Iwasaki H, Takami M, Nagata K, Hashizume H, Tsutsui S, Taiji R, Kozaki T, Yamada H.

Spine Surg Relat Res. 2022 Feb 10;6(5):472-479. doi: 10.22603/ssrr.2021-0196. PMID: 36348687; PMCID: PMC9605755.

Free article. A paper from Wakayama Medical University in Japan

Dr. Murata and Dr. Iwasaki of the Department of Orthopaedic Surgery, Wakayama Medical University, reported that sacroiliac joint (SIJ) pain occurred in 11.7% of patients after adult spinal deformity surgery. They point out that SIJ pain appears postoperatively even after long fusion using a S2 alar-iliac screw (S2AIS).

Is this because of residual sacroiliac joint motion with only one S2AIS? Then there may be a way to use two S2AIS. When I perform a posterior SIJ fusion, I always use two S2AIS to hold the rotation of the ilium.

Spinal fusion could change the alignment and axis of movement of the SIJ, irritating the SIJ posterior ligament and causing transient pain. Or the screws stimulate the branches of the nerve endings to the SIJ. Alternatively, the S2AIS may have damaged the cartilage of the SIJ and caused inflammation within the SIJ, the authors stated.

The authors conclude that the effectiveness of ultrasound guided SIJ injections can be easily relieved the SIJ pain with an average of two repetitions. This is a very important clinical report. Surgeons are frustrated when there are complaints after major surgery, but SIJ pain could be easily identified and treated. It will improve the post-surgical course for both the surgeon and the patient.

I experienced the patient who was introduced to my hospital because of becoming painful SIJ after L4-S1 fusion, and I extended the fusion to the SIJ. Conversely, there was a patient who remained the L5-S facet pain after SIJ fusion, I speculated concomitant L5-S facet pain was mild and would not be problem after SIJ fusion. But L5-S facet pain affected her ADL and I needed to add the fixation to the L5 with connecting the instrument with those of SIJ fusion.

One of the SIJ scores in this article has been changed from the SIJ shear test to the Ganenslen’s test. I will ask the author directly about this and share it with everyone.

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Comment by Daisuke Kurosawa |

I asked the authors a question. The two main reasons for using the Gaenslen's test instead of the SIJ shear test in the scoring system were as follows.
(i) The Gaenslen's and Patrick's tests have been routinely confirmed in our clinical practice.
(ii) Postoperative patients complained of pain when lowering their legs from the bed, which is similar to the position of the Gaenslen's test, and this led us to use the test for diagnosis and to determine the efficacy of SIJ injections.

I got very interesting answers from a clinical point of view. Thank you, Dr. Murata.

What is the sum of 5 and 5?