Incidence of sacroiliac joint pain after lumbosacral spine fusion: A systematic review

OBJECTIVES

To determine the incidence of sacroiliac joint (SIJ) pain after lumbosacral spinal fusion.

BACKGROUND

Persistent low back pain is a potential source of disability and poor outcomes following lumbar spine fusion. The SIJ has been described as a potential source. However, there is a paucity of data concerning its importance.

METHODS

This is a PROSPERO registered systematic review. A systematic search of the English literature was performed in Medline, Embase and Cochrane Library databases. MeSH terms such as Lumbar vertebrae, Sacrum, Spinal Fusion, Pain, Sacrum, Ligaments, Sacroiliac Joint were utilized for the search. Key words such as "sacroiliac dysfunction.mp." and "sacroiliac complex.mp." were utilized for the search. Two independent reviewers reviewed articles to determine eligibility for final review and analysis. The Newcastle-Ottawa Scale was used to appraise the quality of all nonrandomized observational studies. Inverse variance weighting with random effects was used to pool data. The GRADE approach, PRISMA workflow and checklists was performed.

RESULTS

Twelve studies were included. All studies were observational and of moderate to low quality. The pooled incidence of sacroiliac joint pain was 15.8%. The pooled incidence of SIJ pain for patients without fusion extending to the sacrum was 15.8%. The pooled incidence of SIJ pain for patients with fusion extending to the sacrum was 32.9%. There was high heterogeneity.

CONCLUSION

SIJ pain is a potential cause of persistent pain after lumbar spine surgery. The current literature of poor quality. Patients presenting with pain after lumbosacral spine fusion should be evaluated for SIJ related pain.

Impact of Obesity on Complications and Surgical Outcomes of Adult Degenerative Scoliosis with Long- Segment Spinal Fusion

INTRODUCTION

The relationship between obesity and outcome of spine surgery has been controversial. The impact of obesity on surgical outcomes of patients undergoing long- segment (6 vertebrae or more) spinal fusion have not been studied. This study was designed to define the influence of obesity on the outcomes of patients undergoing long-segment spinal fusion.

METHODS AND MATERIALS

A retrospective study of patients undergoing long-segment (6 vertebrae or more) spinal fusion was realized. Patients were divided into non-obese group and obese group. Variables such as blood loss, operative time, length of stay, complications, reoperation rates, and clinical outcome were compared between the two groups.

RESULTS

Thirty-four non-obese patients (BMI: 26.43 ± 0.87) and 27 obese ones (BMI: 35.35 ± 1.81) were recruited. Number of fused levels in non-obese group was not significantly different from obese group (9.06±0.57 vertebrae vs 8.85±0.68 vertebrae, p=0.65). There was no significant difference between non-obese group and obese group in the blood loss during surgery (p= 0.12), the operating time (p=0.46) and the length of hospitalization (p=0.64). Similarly, no significant difference was found in surgical complications (p= 0.76) and medical complications (p=0.82) between the two groups. The rate of ambulatory improvement is similar between non-obese group and obese group (p=0.64).

CONCLUSION

Our study showed that there was no relationship between obesity and adverse surgical outcomes in ADS surgery with long-segment (6 vertebrae or more) spinal fusion.

C2-C3 vertebral disc angle: An analysis of patients with and without cervical spondylotic myelopathy

STUDY DESIGN

Retrospective analysis.

OBJECTIVE

To define C2-C3 vertebral disc angle (VDA) in patients with and without cervical spondylotic myelopathy.

SUMMARY OF BACKGROUND DATA

C2-C3 VDA is a new radiological index of cervical spine alignment. Recent studies have suggested that high postoperative values are associated with greater mechanical complications in patients with cervical spondylotic myelopathy. However, normative values for patients without myelopathy has yet to be defined.

METHODS

Patients with and without cervical myelopathy between 2017 and 2019 were included. Inclusion criteria were patients above 18 years of age with antero-posterior (AP) and lateral (LAT) cervical X-rays. In the non-myelopathic group, patients were excluded if they had neurological symptoms or deficits, presence of cervical axial pain, previous spinal surgery, or diagnosis of either spondylolisthesis or scoliosis. In the myelopathic group, patients were excluded if they had previous spinal surgery. Radiological indices evaluated include: C2-C3 disc angle, C2-C7 Cobb angle, C7 sagittal vertical axis, T1 slope.

RESULTS

In total, 99 patients without myelopathy and 22 patients with myelopathy were identified and analyzed. In patients without myelopathy, the mean for C2-C3 VDA was 25.9±7.9. For patients with myelopathy, preoperative values were 24.4±10.0 and 27.1±7.9 postoperatively. No statistically significant differences were found between patients with and without myelopathy. C2-C3 disc angle was not correlated with age (R=-0.173).

CONCLUSION

This study did not find statistically significant differences in C2-C3 VDA values between patients with and without cervical myelopathy. This study provides normative data for C2-C3 vertebral disc angle in patients with and without cervical spondylotic myelopathy. Furthermore, C2-C3 vertebral disc angle may be independent from age.

Spinal cord injuries without radiographic abnormality at two pediatric trauma centers in Ontario

BACKGROUND

Spinal cord injury without radiographic abnormality (SCIWORA) represents a traumatic myelopathy, either transient or permanent, that is not associated with visible vertebral fractures or ligamentous abnormalities on plain radiographs or CT. MRI has become essential in the diagnosis and evaluation of trauma patients and in predicting the long-term neurological outcome.

METHODS

The medical charts of 578 children with vertebral trauma at the Children's Hospital of Eastern Ontario and the Hospital for Sick Children were retrospectively reviewed.

RESULTS

Forty-five patients were identified as having traumatic myelopathy. Three of these patients had SCIWORA. Two sustained thoracic spinal cord injuries as a result of motor vehicle accidents and permanent neurological deficits. The third was involved in a sports-related injury and sustained a cervical spine injury that improved in 48 h.

CONCLUSIONS

SCIWORA is uncommon. The serious neurological sequelae that can result from a missed diagnosis merit more attention in identifying a spinal lesion in children with traumatic myelopathy. MRI has played a valuable role in this respect and may be even more predictive of outcome than the presenting neurological findings. The SCIWORA acronym can be modified to SCIWONA (spinal cord injury without neuroimaging abnormality) in order to highlight the importance of MRI in the prognosis.