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

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This article aims to provide an update on the etiology, diagnosis, and treatment of sacroiliac joint dysfunction (SIJD) after lumbar or lumbosacral fusion surgeries. The study utilized PRISMA guidelines to search various databases for relevant literature published in the last 10 years. The results showed that the incidence of new onset SIJD was 7.0%. Factors such as the operative technique, gender, and symptom onset timeline were found to affect the risk of SIJD. Conservative measures were not always effective, and radiofrequency ablation (RFA) and SIJ fixation using the iFuse system were found to be the most effective treatment options. The study concludes that lumbar fusion increases the risk of SIJD, and further research on diagnosis and treatment modalities is needed. PMID: 38280117 | DOI: 10.1007/s00701-024-05918-1

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established sugical centre on Harley Street UK

Published article

S: Lumbar fusion predisposes patients to SIJD, likely through manipulation of the SIJ’s biomechanics. Definitive diagnosis of SIJD remains multifaceted and a newer modality such as SPECT/CT may find a future role. When conservative measures are ineffective, RFA and SIJ fixation using the iFuse System yield the greatest improvement VAS and ODI.

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Acta Neurochir (Wien). 2024 Jan 27;166(1):43. doi: 10.1007/s00701-024-05918-1.ABSTRACTBACKGROUND: Sacroiliac joint dysfunction (SIJD) after lumbar/lumbosacral fusion has become increasingly recognized as the utilization of lumbar fusion has grown. Despite the significant morbidity associated with this condition, uncertainty regarding its diagnosis and treatment remains. We aim to update the current knowledge of the etiology, diagnosis, and treatment,

Acta Neurochir (Wien). 2024 Jan 27;166(1):43. doi: 10.1007/s00701-024-05918-1.

ABSTRACT

BACKGROUND: Sacroiliac joint dysfunction (SIJD) after lumbar/lumbosacral fusion has become increasingly recognized as the utilization of lumbar fusion has grown. Despite the significant morbidity associated with this condition, uncertainty regarding its diagnosis and treatment remains. We aim to update the current knowledge of the etiology, diagnosis, and treatment of post-lumbar surgery SIJD.

METHODS: PRISMA guidelines were used to search the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, and OVID databases for literature published in the last 10 years. The ROBIS tool was utilized for risk of bias assessment. Statistical analyses were performed using the R foundation. A Fisher’s exact test was performed to determine the risk of SIJD based on operative technique, gender, and symptom onset timeline. Odds ratios were reported with 95% confidence intervals. A p-value [Formula: see text] 0.05 was considered statistically significant.

RESULTS: Seventeen publications were included. The incidence of new onset SIJD was 7.0%. The mean age was 56 years, and the follow-up length was 30 months. SIJD was more common with fixed lumbar fusion vs floating fusion (OR = 1.48 [0.92, 2.37]p = 0.083), fusion of [Formula: see text] 3 segments (p < 0.05), and male gender increased incidence of SIJD (OR = 1.93 [1.27, 2.98]p = 0.001). Intra-articular injection decreased the Visual Analogue Scale (VAS) score by 75%, while radiofrequency ablation (RFA) reduced the score by 90%. An open approach resulted in a 13% reduction in VAS score versus 68 and 29% for SIJ fixation using the iFuse and DIANA approaches, respectively.

S: Lumbar fusion predisposes patients to SIJD, likely through manipulation of the SIJ’s biomechanics. Definitive diagnosis of SIJD remains multifaceted and a newer modality such as SPECT/CT may find a future role. When conservative measures are ineffective, RFA and SIJ fixation using the iFuse System yield the greatest improvement VAS and ODI.

PMID:38280117 | DOI:10.1007/s00701-024-05918-1

The London Spine Unit : most established sugical centre on Harley Street UK

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

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Acta Neurochir (Wien). 2024 Jan 27;166(1):43. doi: 10.1007/s00701-024-05918-1.ABSTRACTBACKGROUND: Sacroiliac joint dysfunction (SIJD) after lumbar/lumbosacral fusion has become increasingly recognized as the utilization of lumbar fusion has grown. Despite the significant morbidity associated with this condition, uncertainty regarding its diagnosis and treatment remains. We aim to update the current knowledge of the etiology, diagnosis, and treatment

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