Characteristics of the spinopelvic parameters of patients with sacroiliac joint pain

Incidence and risk factors of new-onset sacroiliac joint pain after spinal surgery: a systematic review and meta-analysis

Purpose

A systematic review and meta-analysis for incidence and risk factors of new-onset sacroiliac joint pain (SIJP) after spinal surgery aimed to provide evidence-based medical references for its early prevention, timely intervention, and appropriate treatment.

Methodology

The protocol of the systematic review and meta-analysis was registered in the International Prospective Register of Systematic Review (PROSPERO) with the PROSPERO ID (CRD42023463177). Relevant studies were searched to January 2024 from the databases of PubMed, Embase, Cochrane Library, and Web of Science, and the types of studies were cohort studies, case-control studies, and cross-sectional studies. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Cross-Sectional/Prevalence Study Quality recommended by the Agency for Healthcare Research and Quality (AHRQ). Two authors conducted studies search, data extraction, and quality assessment independently. Meta-analyses were done using Stata 14.0 software.

Results

Twelve observational studies with 3,570 spinal surgery patients were included. Ten were case-control studies, one was a cross-sectional study, and another was a cohort study, all of which were of moderate quality and above. The results of the meta-analysis showed that the incidence of new-onset SIJP after spinal surgery was 9.40%; females, no. of surgical segments, fusion to the sacrum, and postoperative pelvic tilt (PT) were significantly associated with the new-onset SIJP after spinal surgery. Meta-analyses for preoperative and postoperative controls of spondylopelvic parameters showed that postoperative lumbar lordosis (LL) in the SIJP group and postoperative LL and sacral slope (SS) of patients in the NoSIJP group had significant differences from preoperative.

Conclusion

Available evidence suggests that an increased risk of new-onset SIJP after spinal surgery is associated with sex, multi-segmental surgery, fusion to the sacrum, and greater postoperative PT.

Biomechanical Predictors of Sacroiliac Joint Uptake on Single-Photon Emission Computed Tomography/Computed Tomography

OBJECTIVE

Single-photon emission computed tomography/computed tomography (SPECT/CT) is an emerging imaging modality that identifies sites of heightened bone metabolism in response to increased stresses. The relationship between sacroiliac (SI) joint radiotracer uptake and anatomic biomechanical parameters is poorly understood.

METHODS

Adult patients with SPECT/CT scans performed at our institution between 2021 and 2023 for the workup of low back pain were included. Patient charts were reviewed for demographic factors including age, gender, and prior thoracolumbar fusion history. Biomechanical spinopelvic parameters were measured from standing scoliosis radiographs. SPECT/CT scans were reviewed for uptake at the SI joint. Patients were stratified into 2 cohorts; patients with SI uptake greater than iliac crest uptake were designated "hot," whereas those with less or equal uptake were labeled "cold."

RESULTS

One-hundred and sixty patients met inclusion criteria. Patients were slightly more male (55%) with average age 55 ± 14.9 years. Sixty-eight patients (43%) had evidence of increased SI activity. Interrater reliability showed substantial agreement (kappa = 0.62). The hot cohort demonstrated greater pelvic incidence (54.8 ± 14.0 degrees vs. 51.0 ± 11.0 degrees, P = 0.031) and pelvic tilt (20.8 ± 9.5 degrees vs. 18.4 ± 8.6 degrees, P =0.047) compared with the cold cohort. Patients were otherwise similar between cohorts (P > 0.05).

CONCLUSIONS

Increased pelvic incidence and pelvic tilt angles are associated with SPECT/CT uptake at the SI joint, which may reflect altered biomechanics at the spinopelvic junction. SPECT/CT may be a valuable tool to assess SI degeneration. Future studies are warranted to better characterize the clinical applications of these findings.

Effects of Sacral Slope Changes on the Intervertebral Disc and Hip Joint: A Finite Element Analysis

OBJECTIVE

Spinopelvic parameters are vital components that must be considered when treating patients with spinal disease. Several finite element (FE) studies have explored spinopelvic parameters such as sacral slope (SS) and the impact on the lumbar spine, although no study has examined the effect on the hip and sacroiliac joint (SIJ) on varying SS angles. Therefore, it is necessary to have a biomechanical understanding of the impact on the spinopelvic complex.

METHODS

An FE lumbar, pelvis, and femur model was created from computed tomography scans of a 55-year-old female patient with no abnormalities. Three models were created: a normal model (SS = 26°), a model with high SS (SS = 30°), and a model with low SS (SS = 20°). These models underwent loading for flexion, extension, lateral bending, and axial rotation. Range of motion (ROM), intradiscal pressures, hip joint, and SIJ contact stresses were analyzed.

RESULTS

The high SS model (SS = 30°) indicated the highest ROM in the L5-S1 (slip angle) level and the highest intradiscal pressures. The highest average hip and SIJ contact stresses were present in this model, although the low SS model (SS = 20°) in extension had the largest stresses for the hip and SIJ.

CONCLUSIONS

The results provide evidence that patients with higher SS may be more prone to increased ROM at the slip angle (L5-S1). In addition, patients with higher SS were shown to have higher contact stresses on the hip joint and SIJ, potentially leading to SIJ dysfunction. Clinically, correcting lumbar lordosis including SS is important; however, a high SS may have a negative impact on the intervertebral disc, SIJ, and hip joint.

Sacroiliac joint degeneration in degenerative lumbar spondylolisthesis and related risk factors: a retrospective study

OBJECTIVE

This study was performed to evaluate the degree of radiological sacroiliac joint (SIJ) degeneration in patients with degenerative lumbar spondylolisthesis (DLS). The related risk factors for SIJ degeneration were also investigated.

METHODS

We retrospectively analyzed the lumbar and pelvic computed tomography (CT) scans of 303 patients with DLS admitted from January 2018 to December 2021. One hundred and fifty-six age-, gender-, and body mass index-matched patients without lumbar anomality who underwent lower abdominal or pelvic computed tomography scans were included in the control group. Sagittal parameters were measured on full-length lateral radiographs. Two protocols (Backlund's grade and Eno's classification) were used to assess SIJ degeneration. Univariate analysis and bivariate and multivariate regression analysis were performed to identify the factors affecting SIJ degeneration in patients with DLS.

RESULTS

According to Backlund's grade and Eno's classification, SIJ degeneration was more severe in the DLS group than in the control group (P < 0.001). Multi-segment degenerative changes (P = 0.032), two-level DLS (P = 0.033), a history of hysterectomy (P < 0.001), lower extremity pain (P = 0.016), and pelvic pain (P = 0.013) were associated with more significant SIJ degeneration as assessed by Backlund's grade. The results of Pearson's correlation analysis showed positive correlation between the sagittal vertical axis and SIJ degeneration (r = 0.232, P = 0.009). The multivariate linear regression analysis showed that a history of hysterectomy was significantly correlated with SIJ degeneration in patients with DLS (r = 1.951, P = 0.008).

CONCLUSIONS

SIJ degeneration was more severe in patients with than without DLS. We should take SIJ degeneration into consideration when diagnosing and treating DLS especially those who had undergone previous hysterectomy or showed sagittal malalignment.

Relationship Between Sacroiliac Joint-related Pain and Spinopelvic Mobility

STUDY DESIGN

A case-control study.

OBJECTIVE

To evaluate the relationship between sacroiliac joint-related pain (SIJ-RP) and spinopelvic mobility.

SUMMARY OF BACKGROUND DATA

No specific radiological findings are available for the diagnosis of SIJ-RP. A previous study reported that a higher pelvic incidence and sacral slope (SS) values were significantly associated with sacroiliac joint pain. The concept of spinopelvic mobility, which is evaluated by the differences between SS in the standing and sitting positions, has been the focus of hip and spine surgeries in recent years.

MATERIALS AND METHODS

The SIJ-RP group comprised patients diagnosed with SIJ-RP based on physical findings and their response to analgesic injections. No other lumbar or hip joint diseases were observed. The non-SIJ-RP group comprised patients with lower back pain for reasons other than SIJ-RP. Radiographs of the lateral view of the pelvis in the standing and sitting positions were evaluated for all patients. We compared and analyzed the backgrounds, SS in the two positions, and difference in SS between the two positions in both groups.

RESULTS

In total, 245 patients were included in the study, with 49 and 196 patients in the SIJ-RP and non-SIJ-RP groups, respectively. More female patients experienced SIJ-RP than male patients ( P =0.0361). There were significant differences between the groups for SS in standing ( P =0.0076), sitting ( P =0.0005), and those with a difference between sitting and standing of <5° ( P =0.0278) in the univariate analyses. Logistic regression analyses, after adjustment for age and sex, revealed significant differences between the groups with an SS difference <5° ( P =0.0088; 95% confidence interval, 1.280-5.519), with an odds ratio of 2.7.

CONCLUSION

On evaluating spinopelvic mobility, we found that SIJ-RP was related to hypomobility of the sacrum, which could indicate the hypermobility of the sacroiliac joint.