The Sacroiliac Joint and Long Lumbosacral Fusions



Fig. 13.1
AP X-ray of previous lumbosacral instrumented fusions



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Fig. 13.2
Lateral X-ray of previous instrumented lumbosacral fusions


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Fig. 13.3
Image guided diagnostic injection verified diagnosis


The patient noted significant pain relief after his SI joint fusions; however, he had persisting symptoms consistent with flat back syndrome, also known as positive sagittal imbalance (Figs. 13.4, 13.5, and 13.6).

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Fig. 13.4
Postoperative AP X-ray showing bilateral SIJ instrumentation


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Fig. 13.5
PA scoliosis film


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Fig. 13.6
Lateral scoliosis film showing “flat back” syndrome

The patient then underwent spinal reconstruction with a lumbar pedicle subtraction osteotomy. Distal fixation was challenging with the SI joint implants in place. The patient is quite satisfied with his clinical improvement (Figs. 13.7, 13.8, 13.9, and 13.10).

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Fig. 13.7
Postoperative lateral scoliosis film after subtraction osteotomy


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Fig. 13.8
Postoperative PA scoliosis film after subtraction osteotomy


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Fig. 13.9
AP X-ray after subtraction osteotomy


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Fig. 13.10
Lateral X-ray after subtraction osteotomy



Conclusion


It is now recognized that adjacent segment degenerative disease does affect the SIJ when a long lumbosacral fusion is performed. If the SIJ is fixated when performing a long lumbosacral fusion, certain pitfalls such as over abundant iliac bone graft harvesting, with its associated potential effects on the SIJ and the ramifications of positive sagittal balance, especially in the elderly, must be considered by the spine surgeon proactively to avoid potential long-term complications. When both positive sagittal balance and the SIJs are symptomatic and require surgery, the spine surgeon must be cognizant of the best methods to use and in what sequence to use them in order to achieve the best overall result for the patient.


References



1.

Ghiselli G, Wang JC, Bhatia NN, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am. 2004;86-A(7):1497–503.PubMed

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Oct 22, 2016 | Posted by in ORTHOPEDIC | Comments Off on The Sacroiliac Joint and Long Lumbosacral Fusions
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