Maxwell Garrett, Lyon Kristopher A, Bhenderu Lokeshwar S, Schuchart Garret, Desai Ronak
Orthopedic Surgery, Baylor Scott & White Medical Center, Temple, USA.
Surgery, Texas A&M College of Medicine, Temple, USA.
Cureus. 2021 Nov 13;13(11):e19532. doi: 10.7759/cureus.19532. eCollection 2021 Nov.
Sacroiliac (SI) joint dysfunction is a significant contributor to low back pain. Percutaneous SI joint fusion is a minimally invasive procedure that can provide excellent pain relief for patients, but it is not without complications, especially in patients with abnormal lumbosacral anatomy. We report the case of a 71-year-old man with sacral dysmorphism who had a painful SI joint that was refractory to conservative therapy. After undergoing an elective percutaneous SI joint fusion, he was discharged in stable condition. He returned in a delayed fashion with a large subgluteal hematoma. Imaging revealed disruption of a branch of the superior gluteal artery (SGA). Surgical exploration and ligation of the SGA were undertaken. Sacral dysmorphism affects SI joint fusion procedures by altering sacral anatomy and the safe zones for SI joint implants. Variations in lumbosacral anatomy can also alter the course of the SGA and adjacent nerves. Due to the wide prevalence of sacral dysmorphism, especially in the setting of low back pain, pre-surgical planning to avoid iatrogenic injuries must be considered with advanced imaging studies such as a computed tomography angiogram of the pelvis or catheter-based angiogram, or alternative surgical approaches to the SI joint must be taken.
骶髂关节功能障碍是导致腰痛的重要原因。经皮骶髂关节融合术是一种微创手术，可为患者提供出色的疼痛缓解效果，但并非没有并发症，尤其是在腰骶部解剖结构异常的患者中。我们报告了一例71岁患有骶骨畸形的男性病例，其骶髂关节疼痛，对保守治疗无效。在接受择期经皮骶髂关节融合术后，他病情稳定出院。他后来因出现巨大的臀下血肿而再次就诊。影像学检查显示臀上动脉（SGA）的一个分支破裂。遂进行了手术探查并结扎了SGA。骶骨畸形通过改变骶骨解剖结构和骶髂关节植入物的安全区域来影响骶髂关节融合手术。腰骶部解剖结构的变异也会改变SGA和相邻神经的走行。由于骶骨畸形的广泛存在，尤其是在腰痛的情况下，必须通过骨盆计算机断层血管造影或基于导管的血管造影等先进影像学检查进行术前规划，以避免医源性损伤，或者必须采用骶髂关节的替代手术方法。
