Abstract
Low back pain persisting or appearing after a technically successful lumbar fusion challenges clinicians. In this context, the sacroiliac joint could be a possible source of pain, but the frequency of its responsibility is not really known. We used sacroiliac anesthetic blocks, the gold standard for diagnosis, to determine this frequency. Our second goal was to search predictive factors for a positive block. Our prospective series consisted of 40 patients with persistent low back pain after a technically successful fusion who received a sacroiliac anesthetic block under fluoroscopic control. The diagnostic criterion was a relief of more than 75% of the pain on a visual analog scale. We found a 35% rate of positive blocks. The only criterion that characterized these patients was a postoperative pain different from the preoperative pain in its distribution ( p =0.017). A free interval of more than 3 months between surgery and appearance of the pain had an indicative value ( p =0.17). An increased uptake in the sacroiliac on bone scintigraphy or a past history of posterior iliac bone-graft harvesting had no significant value ( p =0.74 and p =1.0, respectively). The sacroiliac joint is a possible source of pain after lumbar fusion. The anesthetic block under fluoroscopic control remains the gold standard.
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Axelsson P, Johnsson R, Stromqvist B (1997) The spondylolytic vertebra and its adjacent segment. Mobility measured before and after posterolateral fusion. Spine 22:414–417
Balderston RA, Albert TJ, McIntosh T, Wong L, Dolinskas C (1998) Magnetic resonance imaging analysis of lumbar disc changes below scoliosis fusions. A prospective study. Spine 23:54–58
Coventry MB, Tapper EM (1972) Pelvic instability. A consequence of removing iliac bone graft for grafting. J Bone Joint Surg Am 54:83–101
Ebraheim NA, Elgafy H, Semaan HB (2000) Computed tomographic findings in patients with persistent sacroiliac pain after posterior iliac graft harvesting. Spine 25:2047–2051
Fortin JD, Aprill CN, Ponthieux B, Pier J (1994) Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part II: Clinical evaluation. Spine 19:1483–1489
Fritzell P, Hagg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study Group (2001) Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 26:2521–2532
Frymoyer JW, Howe J, Kuhlman D (1978) The long-term effects of spinal fusion on the sacroiliac joints and ilium. Clin Orthop 134:196–201
Gates GF, McDonald RJ (1999) Bone SPECT of the back after lumbar surgery. Clin Nucl Med 24:395–403
Heary RF, Schlenk RP, Sacchieri TA, Barone D, Brotea C (2002) Persistent iliac crest donor site pain: independent outcome assessment. Neurosurgery 50:510–516
Kostuik JP, Esses SI (1991) Sacral destabilization and restabilization. Causes and treatment. In: Frymoyer JW (ed) The adult spine. Principles and practice. Raven, New York, pp 2159–2178
Lichtblau S (1962) Dislocation of the sacroiliac joint. A complication of bone grafting. J Bone Joint Surg Am 44:193–198
Maigne JY, Doursounian L, Boulahdour H, Aivaliklis A (1995) Lombalgies post-arthrodèses : rôle possible de l’articulation sacro-iliaque. Post-fusion low back pain: a possible role of the sacroiliac joint. Rachis 7:324–326
Maigne JY, Aivaliklis A, Pfeffer F (1996) Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low-back pain. Spine 21:1889–1892
Maigne JY, Boulahdour H, Chatellier G (1998) Value of quantitative radionuclide bone scanning in the diagnosis of sacroiliac joint syndrome in 32 patients with low back pain. Eur Spine J 7:328–331
Onsel C, Collier BD, Metin K et al (1992) Increased sacroiliac joint uptake after lumbar fusion and/or laminectomy. Clin Nucl Med 17:283–287
Schwarzer AC, Aprill CN, Bogduk N (1995) The sacroiliac joint in chronic low back pain. Spine 20:31–37
Shono Y, Kaneda K, Abumi K, McAfee PC, Cunningham BW (1998) Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. Spine 23:1550–1558
Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E (1996) The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine 21:2251–2254
Xu R, Ebraheim NA, Yeasting RA, Jackson WT (1996) Anatomic considerations for posterior iliac bone harvesting. Spine 2:1017–1020
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Maigne, J.Y., Planchon, C.A. Sacroiliac joint pain after lumbar fusion. A study with anesthetic blocks. Eur Spine J 14, 654–658 (2005). https://doi.org/10.1007/s00586-004-0692-6
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DOI: https://doi.org/10.1007/s00586-004-0692-6