Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion: a prospective cohort study over five-year follow-up

Spine (Phila Pa 1976). 2008 May 15;33(11):1192-8. doi: 10.1097/BRS.0b013e318170fd35.


Study design: A prospective cohort study.

Objective: To determine the cause-effect relationship between fusion and sacroiliac joint (SIJ) degeneration after instrumented posterolateral lumbar or lumbosacral fusion.

Summary of background data: Adjacent segment degeneration following spinal fusion has attracted considerable attention. However, little attention has been paid to the SIJ, which is one of the adjacent joints.

Methods: This study prospectively examined 37 patients, who underwent instrumented posterolateral lumbar/lumbosacral fusion from July 1997 to October 1998. Among them, 32 patients were included in this study and defined as the fusion group (male/female: 10/22, mean age: 64 years). The fusion group was divided into 2 subgroups according to the range of fusion. Group 1 had floating fusion (fusion to L5) and included 22 patients (male/female: 7/15, mean age: 65.6 years). Group 2 had fixed fusion (fusion to S1) and included 10 patients (male/female: 3/7, mean age: 60.5 years). Thirty-four age-matched normal individuals (male/female: 18/16, mean age: 64.5 years) were recruited as a control group. SIJ degeneration was assessed by confirming the absence of degeneration in the SIJ by computed tomography scans before surgery and 2 weeks after surgery. The SIJ was evaluated again by taking computed tomography scans at 1 year and 5 years after surgery. The incidence of SIJ degeneration was evaluated and compared (fusion group vs. control group; group 1 vs. group 2). The clinical outcomes were evaluated using the Visual Analog Scales (VAS) and Oswestry Disability Index (ODI) before surgery and at the final follow-up.

Results: The incidence of SIJ degeneration in the fusion group was 75% (24/32), which was significantly higher than that of the control Group 38.2% (13/34) (P < 0.05). The incidence of SIJ degeneration (bilateral and unilateral) and bilateral SIJ degeneration was higher in group 2 than in group 1 (P = 0.028 and 0.04, respectively). The incidence of SIJ degeneration was not associated with the number of fusion segments. At the 5-year follow-up, the patients in groups 1 and 2 reported significant improvements in the VAS and ODI scores compared with the preoperative scores. However, there was no significant difference in the decrease in VAS and ODI scores between the 2 groups (P = 0.145 and 0.278, respectively).

Conclusion: Instrumented posterolateral lumbar/lumbosacral fusion can be a cause of SIJ degeneration. SIJ degeneration develops more often in patients undergoing lumbosacral fusion regardless of the number of fusion segments.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / surgery*
  • Male
  • Middle Aged
  • Prospective Studies
  • Prosthesis Implantation / adverse effects
  • Prosthesis Implantation / instrumentation
  • Sacroiliac Joint / pathology
  • Sacroiliac Joint / surgery*
  • Sacrum / pathology
  • Sacrum / surgery*
  • Spinal Diseases / pathology
  • Spinal Diseases / surgery*
  • Spinal Fusion / adverse effects*
  • Spinal Fusion / instrumentation*