Assessing the Impact of Radiographic Realignment on Adult Spinal Deformity Patients with Sacroiliac Joint Pain at Presentation

Author:

Onafowokan Oluwatobi O.1ORCID,Tretiakov Peter1ORCID,Lorentz Nathan1ORCID,Galetta Matthew1,Das Ankita1,Mir Jamshaid1ORCID,Roberts Timothy1,Passias Peter G.1ORCID

Affiliation:

1. Division of Spinal Surgery, Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, New York Spine Institute, New York, NY 10003, USA

Abstract

Background: Adult spinal deformity (ASD) patients with concurrent sacroiliac joint (SIJ) pain are susceptible to worse postoperative outcomes. There is scarce literature on the impact of ASD realignment surgery on SIJ pain. Methods: Patients undergoing ASD realignment surgery were included and stratified by the presence of SIJ pain at the baseline (SIJP+) or SIJ pain absence (SIJP−). Mean comparison tests via ANOVA were used to assess baseline differences between both cohorts. Multivariable regression analyses analyzed factors associated with SIJ pain resolution/persistence, factoring in BMI, frailty, disability, and deformity. Results: A total of 464 patients were included, with 30.8% forming the SIJP+ cohort. At the baseline (BL), SIJP+ had worse disability scores, more severe deformity, higher BMI, higher frailty scores, and an increased magnitude of lower limb compensation. SIJP+ patients had higher mechanical complication (14.7 vs. 8.2%, p = 0.024) and reoperation rates (32.4 vs. 20.2%, p = 0.011) at 2 years. SIJP+ patients who subsequently underwent SI fusion achieved disability score outcomes similar to those of their SIJ− counterparts. Multivariable regression analysis revealed that SIJP+ patients who were aligned in the GAP lordosis distribution index were more likely to report symptom resolution at six weeks (OR 1.56, 95% CI: 1.02–2.37, p = 0.039), 1 year (OR 3.21, 2.49–5.33), and 2 years (OR 3.43, 2.41–7.12). SIJP− patients who did not report symptom resolution by 1 year and 2 years were more likely to demonstrate PI-LL > 5° (OR 1.36, 1.07–2.39, p = 0.045) and SVA > 20 mm (OR 1.62, 1.24–1.71 p = 0.017). Conclusions: SIJ pain in ASD patients may result in worsened pain and disability at presentation. Symptom resolution may be achieved in affected patients by adequate postoperative lumbar lordosis restoration.

Publisher

MDPI AG

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