Baria Dinah, Lindsey Ronald W, Milne Edward L, Kaimrajh David N, Latta Loren L
Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, Miami Beach, Florida.
Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas.
JB JS Open Access. 2020 Jan 13;5(1):e0034. doi: 10.2106/JBJS.OA.19.00034. eCollection 2020 Jan-Mar.
It is unclear whether the sacroiliac joint is vulnerable to adjacent segment disease. Clinical studies have suggested that many patients who have undergone lumbar arthrodesis will develop adjacent segment disease, which may contribute to sacroiliac joint degeneration. The purpose of the present study was to examine whether arthrodesis in the lumbar spine results in altered biomechanics at the sacroiliac joint that could contribute to adjacent segment disease within the joint.
With use of human cadavers in a biomechanical laboratory study, the effects of lower-lumbar arthrodesis and sacroiliac screws on the biomechanics of the sacroiliac joint were assessed. Human cadaveric pelves with lumbar spines were biomechanically tested in flexion-extension, rotation about the vertical axis, and compression along the vertical axis with single and double-leg support. Four conditions were compared: (1) intact, (2) L4-L5 arthrodesis, (3) L4-S1 arthrodesis, and (4) left sacroiliac screw. Construct vertical and horizontal motions at the anterior and posterior surfaces of the sacroiliac joint were measured.
Significant measurable increases in motion of the sacroiliac joint related to arthrodesis of the lumbar spine occurred with flexion-extension loading (p < 0.05). No significant changes were observed for rotation about the vertical axis or compression along the vertical axis with single and double-leg support.
After 360°, 1 or 2-level lumbosacral spine arthrodesis, the sacroiliac joint showed a significant increase in rotational motion with flexion-extension loading. Increases in horizontal translation with axial rotation loading and vertical translation with axial compression loading were not significant.
The risk of significant alteration of normal sacroiliac kinematics should be considered in all patients undergoing 360° lumbosacral arthrodesis.
骶髂关节是否易患相邻节段疾病尚不清楚。临床研究表明，许多接受腰椎融合术的患者会出现相邻节段疾病，这可能导致骶髂关节退变。本研究的目的是探讨腰椎融合术是否会导致骶髂关节生物力学改变，进而促成该关节内的相邻节段疾病。
在生物力学实验室研究中，使用人体尸体评估下腰椎融合术和骶髂螺钉对骶髂关节生物力学的影响。对带有腰椎的人体尸体骨盆进行生物力学测试，测试内容包括屈伸、绕垂直轴旋转以及单腿和双腿支撑时沿垂直轴的压缩。比较了四种情况：（1）完整状态；（2）L4-L5融合术；（3）L4-S1融合术；（4）左侧骶髂螺钉固定。测量骶髂关节前后表面的结构垂直和水平运动。
在屈伸加载时，与腰椎融合术相关的骶髂关节运动出现了显著的可测量增加（p < 0.05）。在单腿和双腿支撑下，绕垂直轴旋转或沿垂直轴压缩未观察到显著变化。
在360°、1或2节段腰骶椎融合术后，骶髂关节在屈伸加载时旋转运动显著增加。轴向旋转加载时水平平移增加以及轴向压缩加载时垂直平移增加均不显著。
所有接受360°腰骶融合术的患者都应考虑正常骶髂关节运动学发生显著改变的风险。
