Assessment of Surgical Outcome of Sacroiliitis Injection in the Same Session of Lumber Surgeries

Background: Persistent low back pain (LBP) after lumbar spine surgery remains a significant source of patient dissatis-faction and healthcare burden. While various factors contrib-ute to postoperative LBP, the sacroiliac (SI) joint is increas-ingly recognized as a common and often underdiagnosed pain generator, particularly in patients with altered spinal biome-chanics following lumbar fusion. Sacroiliitis, or inflammation of the SI joint, may be overlooked in the preoperative workup, leading to persistent symptoms despite technically successful spinal procedures. Addressing SI joint pathology at the time of lumbar surgery may offer a more comprehensive and effective approach to pain management. Aim of Study: To evaluate the surgical results of SI joint injections carried out in the same session with lumbar sur-gery for patients who had lumber pathology with preopera-tive sacroilietis. Patients and Methods: Sixty patients with preoperative sacroiliitis who participated in this study underwent lumbar spine surgery. Intraoperative SI joint injection was adminis-tered with local anesthetic and corticosteroid to all patients. Visceral pain intensity was assessed with a Visual Analogue Scale (VAS) pre-, 3, and 6 months after the operation. The main endpoint measured was percentage improvement in VAS scores. Other outcomes included patient satisfaction and correlations of clinical and operative variables with pain im-provement. Results: Preoperatively, the mean VAS score was 6.47± 1.44, which significantly decreased (p<0.001) to 3.17±1.71 at 3 months and further to reach 3.70±2.23 at 6 months (p<0.001 when compared to baseline). At 3 months, it was 50.79%, and at 6 months, it was 36.67%. At 3 months, satisfaction or very satisfaction was reported in 63.3% of patients. Early (3-month) and final (6-month) pain improvement was observed to be strongly and positively correlated (r=0.730, p<0.001). It was found that there was a statistically significant negative corre-lation (r=–0.283; p=0.028) between the number of operated levels and improvement at 3 months. Sex, age, S1 fixation, or interbody fusion were not found to be associated with statisti-cally significant pain improvement. Conclusion: Intraoperative SI joint injections offer a promising, minimally invasive strategy for reducing postop-erative pain in patients with coexisting sacroiliitis undergoing lumbar fusion surgery. Pain relief was most pronounced at 3 months, with partial retention of benefit at 6 months. The early response appears predictive of long-term improvement.