Department of Neurosurgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA.
Acta Neurochir (Wien). 2024 Jan 27;166(1):43. doi: 10.1007/s00701-024-05918-1.
Sacroiliac joint dysfunction (SIJD) after lumbar/lumbosacral fusion has become increasingly recognized as the utilization of lumbar fusion has grown. Despite the significant morbidity associated with this condition, uncertainty regarding its diagnosis and treatment remains. We aim to update the current knowledge of the etiology, diagnosis, and treatment of post-lumbar surgery SIJD.
PRISMA guidelines were used to search the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, and OVID databases for literature published in the last 10 years. The ROBIS tool was utilized for risk of bias assessment. Statistical analyses were performed using the R foundation. A Fisher's exact test was performed to determine the risk of SIJD based on operative technique, gender, and symptom onset timeline. Odds ratios were reported with 95% confidence intervals. A p-value [Formula: see text] 0.05 was considered statistically significant.
Seventeen publications were included. The incidence of new onset SIJD was 7.0%. The mean age was 56 years, and the follow-up length was 30 months. SIJD was more common with fixed lumbar fusion vs floating fusion (OR = 1.48 [0.92, 2.37], p = 0.083), fusion of [Formula: see text] 3 segments (p < 0.05), and male gender increased incidence of SIJD (OR = 1.93 [1.27, 2.98], p = 0.001). Intra-articular injection decreased the Visual Analogue Scale (VAS) score by 75%, while radiofrequency ablation (RFA) reduced the score by 90%. An open approach resulted in a 13% reduction in VAS score versus 68 and 29% for SIJ fixation using the iFuse and DIANA approaches, respectively.
Lumbar fusion predisposes patients to SIJD, likely through manipulation of the SIJ's biomechanics. Definitive diagnosis of SIJD remains multifaceted and a newer modality such as SPECT/CT may find a future role. When conservative measures are ineffective, RFA and SIJ fixation using the iFuse System yield the greatest improvement VAS and ODI.
随着腰椎/腰骶融合术的应用越来越广泛，人们越来越认识到骶髂关节功能障碍（SIJD）的存在。尽管这种情况会带来严重的发病率，但对于其诊断和治疗仍存在不确定性。我们旨在更新目前对腰椎手术后 SIJD 的病因、诊断和治疗的认识。
使用 PRISMA 指南在过去 10 年中搜索 PubMed/Medline、Web of Science、Cochrane Reviews、Embase 和 OVID 数据库中的文献。使用 ROBIS 工具评估偏倚风险。使用 R 基础进行统计分析。Fisher 精确检验用于根据手术技术、性别和症状发作时间线确定 SIJD 的风险。报告了优势比及其 95%置信区间。p 值[公式：见正文]0.05 被认为具有统计学意义。
纳入了 17 篇文献。新发 SIJD 的发生率为 7.0%。平均年龄为 56 岁，随访时间为 30 个月。与浮动融合相比，固定融合（OR=1.48 [0.92, 2.37]，p=0.083）、融合[公式：见正文]3 个节段（p<0.05）和男性增加了 SIJD 的发生率（OR=1.93 [1.27, 2.98]，p=0.001）。关节内注射可使视觉模拟量表（VAS）评分降低 75%，而射频消融（RFA）可使评分降低 90%。与 SIJ 固定的 iFuse 和 DIANA 方法相比，开放式手术使 VAS 评分降低 13%，分别为 68%和 29%。
腰椎融合术使患者易患 SIJD，这可能是通过对 SIJ 生物力学的操作引起的。SIJD 的明确诊断仍然是多方面的，一种新的方法，如 SPECT/CT，可能会有未来的作用。当保守治疗无效时，RFA 和使用 iFuse 系统的 SIJ 固定可使 VAS 和 ODI 得到最大程度的改善。
Zotero 插件