Lumbar fusion and SI joint dysfunction

 

375px-lumbar_vertebrae_anterior

The lumbar spine

Hi everyone!

So… scientific studies regarding SI joint dysfunction have really been on my mind recently.

I’ve seen too many people on social media (and also met one doctor in person) making generalized statements about how SI joint dysfunction isn’t a real thing.

That the SI joint doesn’t move (at all).

That it’s virtually impossible to injure it.

Conveniently, none of these people ever seem to acknowledge the scientific studies that suggest that SI joint dysfunction is real.  So I thought I’d start highlighting some of these studies on my blog.

So what I wanted to look at today was this 2013 study published in the Indian Journal of Orthopedics.  (The study was actually conducted by two lead researchers in Germany).

It’s title is: Outcome of distraction interference arthrodesis of the sacroiliac joint for sacroiliac arthritis.

What does this mean?

Well basically, the study was looking at patients who had developed SI joint arthritis after having lumbar fusion surgery in their spine.

In a lumbar fusion, two (or more) vertebrae are surgically connected, eliminating the normal joint pattern of movement between them.  This is only done in pretty extreme circumstances, when the spine is unstable and conservative treatment isn’t going to be enough.

As I’ve mentioned in a previous post, lumbar fusion has become known as a potential cause of SI joint dysfunction.  Basically, once you eliminate normal motion from that part of the spine, other parts of the body have to start compensating, because the body still has to move somehow.

And the SI joint pretty commonly is one of those places that starts compensating.  (The term for this is adjacent segment disease).  It ends up having to move more than it’s supposed to, which can be hard on all of the structures of the joint.

This study examined 19 patients, all of whom had had lumbar fusion surgery.  They were all shown to have degeneration of the SI joint, as confirmed by MRI and CT scans.  (SI joint dysfunction is normally too subtle to show up on imaging, meaning these patients’ cases were pretty severe).

The study authors were clear about the fact that they consider conservative treatment methods to be the preferred method.  The only included patients in the study who’d already tried and failed with conservative measures, and for whom surgery was essentially a last resort.

The surgery they performed was called a distraction interference arthrodesis.

Arthrodesis means that two joints are being connected, or fused together, eliminating movement between them.

The article gives some visual explanations of how this specific procedure was performed (inserting bolts into the SI joint, from the back of the body).

All of the patients were shown to experience a significant reduction in pain and increase in function after the surgery.

15 out of 19, or 79%, said they would choose the same procedure again, in order to obtain the results they had received.  (In other words, they thought the procedure was worth the pain they endured).

Now, the study authors do acknowledge that this study is limited. 

After all, 19 patients is not a huge number.

However, as the SI joint is still so vastly misunderstood, we basically have to start somewhere.

80% of patients being pleased with the surgery, to me, is a pretty big success.

And I mean, if anyone who doesn’t believe SIJD is real happens to stop by this post… I acknowledge that we absolutely need further research.

But 80% is much bigger than the placebo effect.  This was a major surgery, with a hospital stay of 3-7 days afterward.  I don’t think it was just “in these people’s heads” that the surgery made them better.

So.. that is all I’ll leave you with for now.

The study cites several other studies that have been done on the relationship between lumbar fusion and the SI Joint (as well as a bunch of studies on SIJD in general).

This is really my main point to people who claim SIJD doesn’t exist:

Please examine the evidence against your argument, as I will happily read any peer-reviewed study that claims SI joint dysfunction does not exist.  (Feel free to leave any study links in the comments section below.  I am not afraid to read things that challenge my ideas).  It’s fine to have a difference of opinion, but please, open yourself up to the knowledge that is out there!

And for my readers… I hope this was helpful!

SIJD is real, and there is more and more research being done on it everyday!  Hang in there!

For some related reading:

Can lumbar fusion surgery lead to SI joint dysfunction?

My meeting with a spine specialist who doesn’t believe in SI joint dysfunction.

SI joint awareness is growing

 

 

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