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  • Persistent Iliosacral Joint Syndrome Following Instrumentation to the Sacropelvis in Patients with Adult Spinal Deformity

    Final Number:

    Kai Michael Scheufler MD, PhD; Daniela Diesing MD; Rolf Schultheiss

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Persistent sacroiliac joint syndrome (PSIJS) may complicate surgical treatment of adult spinal deformity surgery (ASDS).

    Methods: Perioperative health-related quality of life (HRQOL) outcomes (ODI, SF12v2 scores) at 6, 12 and 24 months and radiographic studies were retrospectively analyzed in a cohort of 71 consecutive patients undergoing ASDS. PSIJS was confirmed in 9 individuals (12.7%) by placebo-controlled dual sacroiliac joint (SIJ) blocks. The relationships between global and regional spinopelvic morphometry, PSIJS and HRQOL outcomes were assessed by logistic regression and receiver-operating characteristics (ROC) analysis.

    Results: PSIJS, independently causing significantly reduced improvement in HRQOL scores (P<.001) 6 months postoperatively (fig. 1), warranted secondary ISF in nine patients (12.7%) within 12 months of index surgery, without evidence of progressive SIJ arthrosis, pseudarthrosis or hardware issues. Eight of nine patients undergoing secondary ISF reported at least 70% pain reduction at 24 months, rendering HRQOL scores equal to those of patients unaffected by PSIJS (fig. 1). Logistic regression/ROC analysis revealed close association between PSIJS and non-harmonious postoperative L4-S1 fractional lordosis (>10% deviation from target values; fig. 2), pelvic incidence (PI)>53°, hip arthrosis and preexistent advanced SIJ arthrosis (P<.01).

    Conclusions: PSIJS may negatively impact clinical outcome of ASDS. Recurrent preoperative SIJ-syndrome requiring interventional treatment, preexistent hip and SIJ arthrosis, insufficient restoration of L4-S1 fractional lordosis and high PI predispose to PSIJS. PSIJS may potentially be avoided by restoring physiological lumbosacral geometry and S2/sacral ala-iliac (SAI) screw fixation during index surgery. Secondary ISF appears to effectively reduce pain and physical impairment due to PSIJS.

    Patient Care: Findings described in this study may improve surgical strategy in sagittal plane correction in patients with adult kyphoscoliotic deformities

    Learning Objectives: To outline the relationship between clinical/morphometric parameters and PSIJS following ASDS including pelvic fixation and the therapeutic efficacy of secondary iliosacral fusion (ISF).


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