Patgaonkar Prasad Ramesh, Kokate Sagar Kishor, Subith S, Borole Pushkar
Department of Spine Surgery, Indore Spine Centre and Care CHL Hospital, Indore, Madhya Pradesh, India.
J Orthop Case Rep. 2024 May;14(5):36-41. doi: 10.13107/jocr.2024.v14.i05.4426.
Low back pain persisting after spine surgery presents diagnostic and treatment complexities for spine surgeons. Failed back syndrome is a term usually used to characterize chronic back or leg pain following spine surgery. Research has indicated a range of persistent pain occurrences after spine surgery. The sacroiliac joint (SIJ) has been recognized as a potential source of pain for a long time but has not received sufficient attention in subsequent years. Dysfunctions in the SIJ can result in a spectrum of clinical conditions, such as low back pain and lower limb radiculopathy. Traditional treatment approaches for SIJ disorders often involve conservative measures such as physical therapy, medications, intra-articular injections, and surgical options. In the past decade, endoscopic SIJ ablation has emerged as a minimally invasive alternative for managing SIJ pain and dysfunction. This approach combines minimal invasiveness with precise targeting, potentially reducing morbidity and enabling quicker recovery compared to open surgical procedures.
A 60-year-old female patient with grade 2 L5-S1 lytic listhesis initially underwent lumbar interbody fusion to address chronic low back pain and radiculopathy, resulting in significant symptom resolution for a brief period. The patient experienced a resurgence of symptoms within a short duration that proved refractory to conventional medical management and interventional pain management procedures. Ultimately, the patient achieved sustained relief after undergoing endoscopic SIJ ablation.
This case report highlights the importance of endoscopic SIJ ablation as an innovative treatment for recurrent lower limb radiculopathy. Focusing on the SIJ, often neglected in lumbar spine surgery, this minimally invasive procedure shows promise in alleviating symptoms and enhancing patient outcomes.
脊柱手术后持续存在的腰痛给脊柱外科医生带来了诊断和治疗上的复杂性。失败的脊柱手术综合征是一个通常用于描述脊柱手术后慢性背痛或腿痛的术语。研究表明脊柱手术后存在一系列持续性疼痛情况。骶髂关节（SIJ）长期以来一直被认为是潜在的疼痛来源，但在随后的几年中并未得到足够的重视。骶髂关节功能障碍可导致一系列临床病症，如腰痛和下肢神经根病。骶髂关节疾病的传统治疗方法通常包括保守措施，如物理治疗、药物治疗、关节内注射和手术选择。在过去十年中，内镜下骶髂关节消融术已成为治疗骶髂关节疼痛和功能障碍的一种微创替代方法。这种方法将微创性与精确靶向相结合，与开放手术相比，可能降低发病率并实现更快的恢复。
一名60岁女性患者，患有2级L5-S1溶解性椎体滑脱，最初接受了腰椎椎间融合术以解决慢性腰痛和神经根病，短期内症状得到了显著缓解。患者在短时间内症状复发，事实证明对传统药物治疗和介入性疼痛管理程序均无效。最终，患者在接受内镜下骶髂关节消融术后实现了持续缓解。
本病例报告强调了内镜下骶髂关节消融术作为复发性下肢神经根病创新治疗方法的重要性。这种微创手术关注在腰椎手术中经常被忽视的骶髂关节，在缓解症状和改善患者预后方面显示出前景。
