Spinal fusion is a surgical procedure commonly used to treat various spinal conditions, such as degenerative disc disease, spinal stenosis, and spondylolisthesis. While it is generally considered an effective treatment option for relieving pain and improving spinal stability, there can be potential complications and side effects associated with the procedure. One such complication is the development of new onset sacroiliac joint (SIJ) pain following lumbar fusion.
The sacroiliac joint is located between the sacrum and the ilium, and it plays a crucial role in transferring loads between the upper body and the lower extremities. It is a synovial joint that allows for limited movement and is supported by ligaments and muscles. When the spine undergoes fusion, it can cause changes in the biomechanics and load distribution of the entire spinal region, including the SIJ.
Several studies have reported the incidence of new onset SIJ pain following lumbar fusion to be around 10-25%. The exact mechanism behind the development of SIJ pain after spinal fusion is not fully understood, but there are several factors that may contribute to its occurrence.
1. Altered biomechanics: Spinal fusion can alter the normal movement patterns and load distribution in the spine, which can lead to increased stress on the SIJ. This increased stress can cause inflammation and pain in the joint.
2. Adjacent segment degeneration: Fusion of one segment of the spine can lead to increased stress and degeneration of the adjacent segments. This degeneration can affect the SIJ, leading to pain.
3. Preexisting SIJ dysfunction: It is possible that patients who already have underlying SIJ dysfunction or instability may be more prone to developing SIJ pain following lumbar fusion. These patients may have preexisting SIJ problems that are exacerbated by the altered biomechanics after fusion.
4. Surgical technique: The surgical technique used during the fusion procedure can also play a role in the development of SIJ pain. Improper placement of hardware or excessive fusion can disrupt the normal biomechanics of the SIJ, leading to pain.
5. Patient factors: Certain patient factors, such as age, gender, and body mass index (BMI), may also influence the likelihood of developing SIJ pain after spinal fusion. For example, older patients and females have been found to be at a higher risk.
It is worth noting that not all patients who undergo lumbar fusion will develop SIJ pain. Many factors come into play, and it can be challenging to predict who will be affected. However, being aware of the potential risk and discussing it with your surgeon before undergoing fusion can help in making an informed decision.
In my personal experience as a healthcare provider, I have seen patients who developed SIJ pain following lumbar fusion. In some cases, the pain was mild and resolved with conservative treatment, such as physical therapy and medication. However, in other cases, the pain was more severe and required additional interventions, such as SIJ injections or even revision surgery.
While spinal fusion is generally an effective treatment for various spinal conditions, it can potentially lead to new onset SIJ pain in some patients. The exact incidence and predisposing factors for SIJ pain following lumbar fusion vary, and further research is needed to fully understand the underlying mechanisms. It is important for patients and healthcare providers to be aware of this potential complication and to consider it when discussing the risks and benefits of spinal fusion.