1연세대학교 의과대학 정형외과학교실
Objective
The purpose of this study is to investigate the radiological risk factors and differences in spinopelvic parameters for radiologic degenerative changes in the sacroiliac joint after lumbar or lumbosacral fusion surgery.
Materials and Methods
From 2019 to 2020, 116 patients diagnosed with lumbar and sacral degenerative diseases who underwent lumbar or lumbar sacral fusion were included. The degenerative changes of the sacroiliac joint were measured by CT performed before and 6 months after surgery, and divided into two groups according to the presence or absence of radiographic degeneration. Evaluation factors for radiographic degeneration include sclerotic changes, erosion, osteophyte formation, intra-articular bone formation, joint space narrowing, intra-articular gas formation and subchondral cysts were evaluated. Spinopelvic radiologic parameters and surgery-related parameters including lumbar lordosis, sacral slope, pelvic incidence, global tilts, and T1PA between the two groups were analyzed using Student's t-tests and chi-square tests to determine the difference between continuous and non-continuous variables between groups. Logistic regression analysis was used for the analysis of risk factors for degeneration for SI joints after lumbar or lumbosacral fusion surgery.
Results
There was no statistically significant difference between the demographic data and surgery-related data between the group with and without sacroiliac joint degenerative changes. There was also no statistical difference in the rate of degenerative changes in the sacroiliac joint according to the presence or absence of S1 in the fusion segment. (degeneration group vs non-degeneration group; 45.5% vs 39.8%, p: 0.574) There were statistically significant differences between the two groups in lumbar lordosis (LL), pelvic angle of incidence (PI), and PI-LL. (LL; 27.2±12.0 vs. 39.8±11.3, PI; 51.3±12.0 vs. 57.2±12.6. and PI-LL; 24.1±17.0 vs 17.4±13.9, p: <0.001, 0.023, and 0.030) As risk factors for radiographic degenerative changes in the sacroiliac joint, lumbar lordosis (LL), pelvic incidence (PI), sacral inclination (SS), and sagittal vertical axis (SVA) were statistically significant factors. (lumbar lordosis Odd ratio: 0.851, 95% CI: 0.791-0.917, p-value <0.001)
Conclusions
Lumbar lordosis and pelvic incidence are related as risk factors for radiographic degenerative changes in the sacroiliac joint after surgery in patients with lumbar spinal fusion.
