Prevalence and Management of Postoperative Lumbar Fixation Sacro-Iliitis

Background: Sacroiliac joint (SIJ) pain is a common mor-bidity which occurs post lumbar fixation surgery. In our study, 90 patients were studied to determine the incidence and man-agement of sacroiliac pain post lumbar fixation. Age, sex, body mass index (BMI) was found to be factors affecting the inci-dence of pain, BMI was found to be the main factor affecting the incidence of pain. We concluded that most cases developed sacroiliac pain post-operative. Conservative management is the first line of treatment which included bed rest, analgesics and physiotherapy. Patients who did not improve by conservative management required sacroiliac injection with analgesics and corticosteroids, and for those who didn’t improve by injection radiofrequency ablation was used. This study was done to determine the prevalence of the SIJ degenerative changes after lumbar spinal fusion surgery and to identify the potential risk factors contributing to it and to assess efficacy of conservative management and SIJ injection with steroids and anesthetics, and radiofrequency. Aim of Study: 1- Detection of the incidence of SIJ degeneration post lumbar fixation and determining the risk factors for development of this condition 2- Diagnosis of post-operative SIJ pain. 3- Proposing a protocol to manage cases of sacroiliac joint dys-function after lumbar spine fixation. Patients and Methods: The study involved 90 patients who were operated upon by lumbar and lumbosacral fixation regardless cause of operation in Kasr El-Aini Hospitals, Cairo University. Sacroiliac joint dysfunction was assessed by pain provocation tests, VAS and radiological assessment by plain X-ray post-operative. Results: The study involved 90 patients. We detected sac-roiliac joint dysfunction in 53 cases (85.9%) with mean age 47 years old. 66% of patients developed sacroiliac joint dys-function were obese, 73.5% of them were operated upon by multi-level fixation, 75.5% of the patients operated upon by s1 fixation developed sacroiliac joint dysfunction. As regard the management 35.14% were improved on conservative treatment according to VAS, while 64.86% of patients underwent Sacro-iliac joint injection of them 92.5% improved and 7.5% failed to improve. Those who didn’t improve after injection underwent radiofrequency which showed satisfactory improvement. Conclusion: The SIJ is a possible source of persistent pain or new pain with failed back surgery syndrome after fixation of lower lumbar vertebrae. Conservative treatment is the first choice then sacroiliac joint injection with corticosteroid and lo-cal anesthetics provides temporary line of treatment, then radi-ofrequency techniques could be tried with satisfactory results. Surgical treatment may be an option for retractable cases.