Incidence of de novo sacroiliac joint pain following adult spinal deformity surgery with pelvic fixation.

Abstract

ObjectiveThe aim of this study was to determine the rate of postoperative new-onset sacroiliac joint pain (SIJP) following adult spinal deformity (ASD) surgery with pelvic fixation.MethodsPatients undergoing ASD surgery with pelvic fixation, without baseline SIJP, and with a minimum 1-year follow-up were included. Patients were screened for SIJP by self-reported buttock/groin pain and/or posterior superior iliac spine (PSIS) pain scores ≥ 4. Patients with positive results on questionnaires were indicated for an SIJ examination consisting of 5 provocative maneuvers with ≥ 3 positive examination findings considered to be indicative of SIJP. Types of pelvic fixation were then compared for rates of postoperative SIJP.ResultsA total of 346 patients were identified, with mean age of 65 (SD 10) years and BMI of 28 (SD 5); 71% of patients were female. Thirteen patients (4%) underwent SIJ fusion at the index procedure. At the 1-year follow-up, 82 patients (24%) had positive screening responses for SIJP on the questionnaire; 63 underwent an SIJ examination and only 3 patients (1%) had a positive result. At the 2-year follow-up, 138 patients were administered the SIJP screening questionnaire; 31 (22%) had a positive questionnaire response for SIJP, 17 underwent an SIJ examination, and only 2 patients (1%) had a positive result. There was no difference in SIJP between patients with traditional iliac fixation (n = 162, 0% at 1 and 2 years) and S2-alar-iliac screws (n = 184), where 2% developed SIJP by 1 (p = 0.25) and 2 (p = 0.52) years, respectively. There was also no difference in SIJP between patients with 4 points of pelvic fixation (n = 85, 0% at 1 and 2 years) and patients with fewer than 4 points of pelvic fixation (n = 261), where 1% (p = 0.57) and 2% (p > 0.99) developed SIJP at 1 and 2 years, respectively. Of the 79 patients with iliac crest harvesting, none developed SIJP at the 1- or 2-year follow-up.ConclusionsBased on examination, the incidence of de novo SIJP following ASD surgery with pelvic fixation is low: only 1% at the 1- and 2-year follow-ups. The large discrepancy between at least moderate regional reported pain but a negative provocative examination warrants further investigation as to the source of substantial pain in nearly one-quarter of ASD patients postoperatively.