Radiologic Comparison of the Sacroiliac Joint Degeneration Following Lumbar or Lumbosacral Fusion

Jemin Yi; Woo Dong Nam

doi:10.4184/jkss.2019.26.4.141

Journal List > J Korean Soc Spine Surg > v.26(Suppl 1) > 1142095

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Yi and Nam: Radiologic Comparison of the Sacroiliac Joint Degeneration Following Lumbar or Lumbosacral Fusion

Original Article

Journal of Korean Spine Surg 2019;26(4):141-150.

Published online: 31 December 2019

DOI: https://doi.org/10.4184/jkss.2019.26.4.141

Radiologic Comparison of the Sacroiliac Joint Degeneration Following Lumbar or Lumbosacral Fusion

Jemin Yi, M.D., Woo Dong Nam, M.D.^∗,

Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Korea

^∗Department of Orthopaedic Surgery, School of Medicine Kangwon National University, Chuncheon, Korea

Corresponding author: Woo Dong Nam, M.D. ORCID ID: Woo Dong Nam: https://orcid.org/0000-0001-5117-2521 Jemin Yi: https://orcid.org/0000-0002-4688-5647 Department of Orthopaedic Surgery Kangwon National University Hospital 156, Baengnyeong-ro, Chuncheon, 24289, Korea TEL: +82-33-258-9209, FAX: +82-33-258-2149 E-mail: firekimdo@gmail.com

Received 4 October 201918 November 2019 Accepted 24 December 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study

Objectives

To compare the degeneration of sacroiliac joint (SIJ) following lumbar or lumbosacral fusion.

Summary of Literature Review

The SIJ is adjacent to lumbosacral junction and its degeneration can be the potential cause of pain.

However, the study addressing SIJ degeneration following lumbar or lumbosacral fusion is very limited.

Materials and Methods

From June 2002 to June 2012, 98 patients who underwent posterior decompression and posterolateral fusion were included in this study. The study group was divided into 2 groups according to the range of fusion. Group A had fusion to L5 and included 34 patients. Group B had fusion to S1 and included 64 patients. We evaluated the five years postoperative radiologic and clinical outcomes retrospectively.

Results

There was no statistically significant difference of bilateral preoperative subchondral sclerosis and osteophytes of the SIJ between group A and group B. However, group B revealed statistically significant subchondral sclerosis and osteophyte formation of the SIJ than group A on every radiographs after postoperative 1 year. In group B, the number of fusion segments and age were statistically positively correlated with the degeneration of the SIJ.

Conclusions

Degeneration of the SIJ revealed more rapid and more severe progression in lumbosacral fusion group than in lumbar fusion group. The number of fusion segments and age were positively correlated with the degeneration of the SIJ in lumbosacral fusion group. Therefore, these facts should be taken into account when performing spinal fusion.

Keywords: Lumbar degenerative disease, Posterolateral fusion, Sacroiliac joint, Adjacent segment disease

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Fig. 1.

Postoperative radiograph of 64 year-old woman who experienced lumbosacral fusion shows subchondral sclerosis of bilateral sacroiliac joint. Dotted lines show the total sacroiliac joint lines and solid lines note the range of subchondral sclerosis. Subchondral sclerosis of right and left sacroiliac joint was calculated as 74%, 82%, respectively.

Fig. 2.

Postoperative radiograph of 49 year-old woman who experienced lumbosacral fusion shows prominent osteophyte of bilateral sacroiliac joint. The right and left osteophytes measured 9.0 mm and 7.4 mm respectively.

Fig. 3.

A 69-year-old female patient who underwent L3-S1 posterolateral fusion. Sequential radiographs (A) preoperative, (B) postoperative 6 months, (C) postoperative 1 year, (D) Postoperative 3 years, (E) Postoperative 5 years) show the development of subchondral sclerosis and osteophytes of the sacroiliac joints.

Table 1.

Demographic data of the patients in group A and B

	Group A (fusion to L5, n=34)	Group B (fusion to S1, n=64)	p-value
Age (year)	53.9±13.2^∗	53.4±14.9^∗	0.81
Gender (male: female)	14:20	28:36	0.83
Height (cm)	158.1±11.6^∗	158.5±9.5^∗	0.86
Weight (kg)	63.3±12.0^∗	61.2±11.3^∗	0.41
BMI (kg/m²)^∗	25.2±3.2^∗	24.4±3.9^∗	0.28
Mean BMD^∗ (T-score)	−0.5±2.1^∗	0.2±1.9^∗	0.19
Number of Fusion segment	2.5±0.9^∗	2.8±0.8^∗	0.08
1	5(15%)	2(3%)
2	12(35%)	21(33%)
3	12(35%)	28(44%)
4	5(15%)	13(20%)

^∗ Values in data cells represent mean±SD (standard deviation).

BMI: body mass index, BMD: bone mineral density, Rt:right, Lt: left.

Table 2.

Subchondral sclerosis of sacroiliac joint (%)

	Side of SIJ^∗	Group A (fusion to L5)	Group B (fusion to S1)	p-value
Preoperative	Rt^∗	8.8±12.6	9.6±12.4	0.301
	Lt^∗	8.6±13.5	9.1±12.6	0.880
6 months PO^∗	Rt	9.4±14.1	15.4 ±18.2	0.027
	Lt	9.5±14.5	16.4 ±18.4	0.067
1 year PO	Rt	9.9±15.0	20.7±21.1	0.002
	Lt	10.4±15.5	22.7±19.7	0.001
2 years PO	Rt	10.8±17.6	26.3±23.9	0.002
	Lt	11.1±16.3	28.7±22.0	<0.001
3 years PO	Rt	13.5±20.1	33.6±26.5	<0.001
	Lt	12.7±17.5	35.9±23.5	<0.001
4 years PO	Rt	15.7±22.6	41.2±29.2	<0.001
	Lt	16.4±18.9	44.1±26.2	<0.001
5 years PO	Rt	16.6±25.0	44.5±30.9	<0.001
	Lt	17.7±18.7	47.2±27.3	<0.001

^∗ Values in data cells represent mean±SD (standard deviation). SIJ: sacroiliac joint, PO: postoperative, Rt: right, Lt: left, PO: postoperative.

Table 3.

Osteophyte of sacroiliac joint (mm)

	Side of SIJ^∗	Group A (fusion to L5)	Group B (fusion to S1)	p-value
Preoperative	Rt^∗	1.4±1.9	2.1±2.7	0.120
	Lt^∗	1.5±2.0	2.2±2.4	0.218
6 months PO^∗	Rt	1.5±2.1	2.8 ±3.2	0.012
	Lt	1.5±2.0	2.7 ±2.7	0.018
1 year PO	Rt	1.7±2.3	3.4±3.4	0.004
	Lt	1.6±2.1	3.1±2.8	0.005
2 years PO	Rt	1.6±2.3	4.0±3.8	<0.001
	Lt	1.8±2.3	3.7±3.2	0.001
3 years PO	Rt	1.8±2.5	4.4±3.8	<0.001
	Lt	1.8±2.4	4.2±3.3	<0.001
4 years PO	Rt	1.9±2.6	4.8±3.9	<0.001
	Lt	1.8±2.3	4.5±3.4	<0.001
5 years PO	Rt	2.0±2.6	5.3±4.3	<0.001
	Lt	2.0±2.4	4.9±3.9	<0.001

^∗ Values in data cells represent mean±SD (standard deviation). SIJ: sacroiliac joint, PO: postoperative, Rt: right, Lt: left.

Table 4.

SIJ degeneration of group B (fusion to S1) according to the number of fusion segments.

	Subchondral sclerosis				Osteophyte
	Right SIJ		Left SIJ		Right SIJ		Left SIJ
	r^∗	p -value	r	p -value	r	p -value	r	p -value
6 months PO^∗	0.05	0.69	0.03	0.82	0.21	0.09	0.30	0.02^∗
1 year PO	0.17	0.17	0.17	0.18	0.24	0.06	0.29	0.02^∗
2 years PO	0.26	0.04^∗	0.17	0.18	0.31	0.01^∗	0.38	<0.01^∗
3 years PO	0.30	0.02^∗	0.26	0.04^∗	0.35	<0.01^∗	0.39	<0.01^∗
4 years PO	0.32	<0.01^∗	0.26	0.04^∗	0.35	<0.01^∗	0.39	<0.01^∗
5 years PO	0.33	0.01^∗	0.29	0.03^∗	0.35	<0.01^∗	0.38	<0.01^∗

r (Pearson's r, Pearson correlation coefficient), PO: postoperative.

^∗ Asterisks denote statistical significance(p<0.05).

Table 5.

SIJ degeneration of group B (fusion to S1) according to the age.

	Subchondral sclerosis				Osteophyte
	Right SIJ		Left SIJ		Right SIJ		Left SIJ
	r∗	p -value	r	p -value	r	p -value	r	p -value
6 months PO∗	0.34	0.01	0.27	0.03	0.41	<0.01	0.37	<0.01
1 year PO	0.43	<0.01	0.36	<0.01	0.39	<0.01	0.39	<0.01
2 years PO	0.41	<0.01	0.32	0.01	0.34	0.01	0.39	<0.01
3 years PO	0.45	<0.01	0.37	<0.01	0.37	<0.01	0.40	<0.01
4 years PO	0.48	<0.01	0.41	<0.01	0.37	<0.01	0.41	<0.01
5 years PO	0.47	<0.01	0.40	<0.01	0.33	0.01	0.36	<0.01

r (Pearson's r, Pearson correlation coefficient), PO: postoperative.

Table 6.

SIJ degeneration of group B (fusion to S1) according to the body weight.

	Subchondral sclerosis				Osteophyte
	Right SIJ		Left SIJ		Right SIJ		Left SIJ
	r∗	p -value	r	p -value	r	p -value	r	p -value
6 months PO∗	−0.24	0.04	−0.31	0.01	−0.28	0.02	−0.30	0.02
1 year PO	−0.33	0.01	−0.38	0.01	−0.36	<0.01	−0.39	<0.01
2 years PO	−0.36	<0.01	−0.43	<0.01	−0.34	0.01	−0.37	<0.01
3 years PO	−0.39	<0.01	−0.46	<0.01	−0.35	0.01	−0.40	<0.01
4 years PO	−0.34	0.01	−0.43	<0.01	−0.35	<001	−0.38	<0.01
5 years PO	−0.38	<0.01	−0.43	<0.01	−0.35	0.01	−0.32	0.01

r (Pearson's r, Pearson correlation coefficient), PO: postoperative.

Table 7.

Pain intensity

Clinical Parameters	Group A (fusion to L5)	Group B (fusion to S1)	p-value
VAS^∗ for back pain
Pre-operative	5.8±2.9	5.6±2.2	0.56
6 months PO^∗	3.4±1.9	3.2±2.4	0.58
1 year PO	2.9±2.4	3.1±1.3	0.31
2 year PO	3.2±2.1	2.9±1.8	0.85
3 year PO	2.6±1.9	2.5±2.4	0.60
4 year PO	2.5±2.2	2.2±1.9	0.32
5 years PO	2.6±2.5	2.2±2.2	0.45
VAS for radiating pain on the lower extremity
Pre-operative	7.3±2.1	7.6±2.3	0.55
6 months PO	2.5±2.2	2.7±2.1	0.42
1 year PO	2.2±1.8	2.3±2.1	0.44
2 year PO	2.1±2.3	2.1±2.2	0.52
3 year PO	2.2±1.6	2.4±2.2	0.60
4 year PO	2.4±2.2	2.3±1.9	0.38
5 years PO	2.4±2.3	2.5±2.4	0.61

^∗ Values in data cells represent mean±SD (standard deviation). VAS: visual analogue scale, PO: postoperative.

Table 8.

Oswestry disability index (ODI) score

Clinical Parameters	Group A (fusion to L5)	Group B (fusion to S1)	p-value
Pre-operative	62±15	58±14	0.69
6 months PO^∗	36±15	32±13	0.24
1 year PO	31±13	28±13	0.36
2 year PO	26±13	16±13	0.67
3 year PO	22±14	21±14	0.75
4 year PO	23±13	22±14	0.56
5 years PO	21±17	19±15	0.77

^∗ Values in data cells represent mean±SD (standard deviation). PO: postoperative.

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