Sacroiliac Joint Pain after Lumbar and Lumbosacral Fusion: Findings Using Dual Sacroiliac Joint Blocks

• Published in: Pain medicine (Malden, Mass.) Vol. 12; no. 4; pp. 565 - 570
• Main Authors: Liliang, Po-Chou, Lu, Kang, Liang, Cheng-Loong, Tsai, Yu-Duan, Wang, Kuo-Wei, Chen, Han-Jung
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.04.2011; Oxford University Press
• Subjects: Adult; Aged; Aged, 80 and over; Body Mass Index; Cohort Studies; Female; Humans; Low Back Pain - etiology; Low Back Pain - physiopathology; Lumbar Fusion; Lumbosacral Fusion; Lumbosacral Region - surgery; Male; Medical research; Middle Aged; Nerve Block; Pain management; Pain Measurement; Pain, Postoperative - physiopathology; Postoperative Back Pain; Prospective Studies; Sacroiliac Joint - physiopathology; Sacroiliac Joint Blocks; Sacroiliac Joint Pain; Spinal Fusion - adverse effects; Treatment Outcome
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/j.1526-4637.2011.01087.x

Objective.  The present study was performed to ascertain whether sacroiliac joint (SIJ) pain represents a potential source of pain in patients who have undergone lumbar or lumbosacral fusions. Design.  Prospective cohort study. Patients and Methods.  Between June 2007 and June 2009, 130 patients who underwent lumbar or lumbosacral fusions were evaluated for SIJ pain. Fifty‐two patients for whom positive findings were obtained on at least three of the provocating tests for SIJ pain were selected to receive dual diagnostic blocks. Outcome Measures.  A positive response was defined as characteristic pain reduction of 75% for 1–4 hours following the SIJ blocks. Predictive factors for a positive response to the SIJ blocks were also investigated. Results.  Among the 52 patients, 21 were considered to have SIJ pain on the basis of two positive responses to diagnostic blocks. Univariate analysis revealed that the predictive factors related to positive responses were unilateral pain (P = 0.002), more than three positive responses to provocating maneuvers (P = 0.02), and postoperative pain with characteristics different from those of preoperative pain (P = 0.04). Conclusions.  SIJ pain is a potential source of pain after lumbar and lumbosacral fusion surgeries. Provocating SIJ maneuvers represent reliable tests for SIJ pain. The characteristics of postoperative SIJ pain frequently differ from those of preoperative pain.