Dysfunctional sacroiliac joint pain following lumbar discectomy/laminectomy

Overview of Literature: Pain arising at the sacroiliac joint is in most instances dysfunctional without concomitant radiographic findings. There have been some reports in the literature describing the occurrence of sacroiliac joint pain following lumbar spine surgery including laminectomy, discectomy and fusion. However, the issue hasn’t yet been widely evaluated in the literature.

Purpose: The aim of this study is to evaluate the incidence and laterality of dysfunctional sacroillac joint pain following lumbar spine surgery without fixation and to evaluate the efficacy of fluoroscopic or CT guided injection as a diagnostic and therapeutic tool.

Study Design: Forty-four patients suffering back pain and / or lower extremity pain with recent history of spinal operation are included having pain clinically suspicious of being of sacroiliac origin.

Methods: Clinically suspected patients were offered either fluoroscopy or CT guided sacroiliac joint injection using a 19-gauge spinal needle and injection of intraarticular 4 cc xylocain and 40 mg Triamcinolone acetonide (kenacort R) aiming at the S2 mid-sacral level.

Results: 18 patients were males and 26 patients were females. The age of patients ranged from 22 years to 65 years with a mean of 43 years. Previous operation done included 34 patients undergoing single level discectomy, and 10 patients had laminectomy for canal stenosis. Post injection response classified to negative responders (6) and positive responders (38) patients. The duration of improvement in positive responder group lasted from 14 days to 6 months with an average of 73 days.

Conclusion: A painful SIJ should be more considered as a differential diagnosis in patients with low back pain and leg pain in patients with prior lumbar surgery without fixation. The use of accurate diagnostic, therapeutic injections helps both diagnosis and pain relief.