Oliver Jeffrey D, Lessing Noah L, Mushlin Harry M, Olexa Joshua R, Crandall Kenneth M, Sansur Charles A
Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland.
University of Maryland School of Medicine, Baltimore, Maryland; and.
J Neurosurg Case Lessons. 2021 Sep 20;2(12):CASE21102. doi: 10.3171/CASE21102.
The sacroiliac joint (SIJ) is an important cause of low back pain and referred leg pain (RLP). Pain from SIJ dysfunction may occur in isolation or may result from a combination with lumbosacral area-mediated pain. SIJ fusion is one treatment modality for medically refractory symptoms and may also have a role in the treatment of RLP.
The authors present a challenging case of concomitant lumbosacral degenerative disease and SIJ dysfunction in a patient with radiculopathy. They provide clinical characteristics and imaging findings and discuss difficulties in dealing with the intersection of these two distinct diagnoses. In addition, the authors offer a review of the relevant literature, elucidating the role of SIJ dysfunction in causing radicular lower extremity pain, the relationship to concomitant lumbosacral degenerative disease, and outcome data for SIJ fusion as it relates to RLP.
With increasing numbers of patients undergoing spinal instrumentation in the setting of degenerative lumbosacral arthritis, as well as randomized controlled trial data demonstrating the efficacy of SIJ fusion for medically refractory SIJ dysfunction, it is important to recognize the challenges in understanding how both of these patient groups may present with radiculopathy. Failure to do so may result in incorrect patient selection, poor outcomes, and increased morbidity for at-risk patients.
骶髂关节（SIJ）是下腰痛和牵涉性腿痛（RLP）的重要病因。骶髂关节功能障碍引起的疼痛可能单独出现，也可能与腰骶部介导的疼痛共同出现。骶髂关节融合术是治疗药物难治性症状的一种治疗方式，在牵涉性腿痛的治疗中也可能发挥作用。
作者介绍了一例患有神经根病的患者，同时存在腰骶部退行性疾病和骶髂关节功能障碍的具有挑战性的病例。他们提供了临床特征和影像学表现，并讨论了处理这两种不同诊断交叉情况时的困难。此外，作者对相关文献进行了综述，阐明了骶髂关节功能障碍在引起下肢神经根性疼痛中的作用、与同时存在的腰骶部退行性疾病的关系，以及骶髂关节融合术与牵涉性腿痛相关的疗效数据。
随着越来越多的患者在退行性腰骶关节炎的情况下接受脊柱内固定，以及随机对照试验数据表明骶髂关节融合术对药物难治性骶髂关节功能障碍有效，认识到理解这两组患者如何都可能出现神经根病所面临的挑战很重要。如果做不到这一点，可能会导致患者选择错误、预后不良以及高危患者的发病率增加。
