Influence of Lumbar Stenosis on Concomitant Sacroiliac Joint Pain: Short-Term and Preliminary Long-Term Results
Presented at SMISS Annual Forum 2018
By Thomas Freeman MD
With Konrad Bach MD,
Disclosures: Thomas Freeman MD None Konrad Bach MD None,
As many as 30% of chronic back pain sufferers complain of sacroiliac joint (SIJ) pain, and minimally invasive surgical techniques have made surgical treatment of the SIJ increasingly effective and attractive for surgeon and patient alike. Many patients have both claudication symptoms due to lumbar stenosis as well as concomitant SIJ pain.
We hypothesize that this SIJ pain is secondary to walking with a flexed posture to alleviate claudication symptoms. If true, we hypothesize that this “secondary SIJ pain” will spontaneously improve after successful lumbar laminectomy or laminectomy and fusion when patients resume walking upright, obviating the need for surgical treatment of the sacroiliac joint.
A retrospective review of charts from 01/01/2014 through the present was performed to identify sequential cases of adults 35 years of age or older with concomitant surgical spinal stenosis with neurogenic claudication as well as SIJ pain. SIJ pain was diagnoses clinically +/- confirmatory injection (≥ 50% improvement in SIJ pain). A 10-point VAS was used to assess SIJ pain preoperatively, at three months postoperatively, and at most recent follow up.
17 contiguous patients (8 female) met entry criteria. 10 were treated with decompression alone, 7 with decompression and fusion. Mean SIJ VAS score improved in the decompression alone group by 8.0±2.4 (8.9±1.7 - 0.9±2.2; p<0.0005). Mean SIJ VAS score improved in the decompression and fusion group by 8.9±2.0 (9.4±1.0 - 0.6±1.1; p<0.0005). There was no significant difference in VAS change when comparing those with SIJ pain diagnosed clinically and confirmed by injection (n=7) vs. those diagnosed clinically alone.
Sacroiliac joint pain shows rapid and dramatic improvement following lumbar laminectomy alone in patients with lumbar stenosis with claudication. The addition of a fusion also leads to a similar magnitude of improvement in SIJ pain. These results suggest that SIJ pain in patients with stenosis and claudication is secondary to walking in a flexed position, corrected rapidly after successful spinal decompression. While MIS techniques have improved SIJ surgery, in patients with concomitant stenosis with neurogenic claudication, it may not be necessary to operate on the SIJ altogether. Further research is needed to determine if other sagittal deformity corrections alleviate concomitant SIJ pain.