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  • Title: Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint: a finite element study.
    Author: Ivanov AA, Kiapour A, Ebraheim NA, Goel V.
    Journal: Spine (Phila Pa 1976); 2009 Mar 01; 34(5):E162-9. PubMed ID: 19247155.
    Abstract:
    STUDY DESIGN: The assessment of sacrum angular motions and stress across sacroiliac joint (SIJ) articular surfaces using finite element lumbar spine-pelvis model and simulated posterior fusion surgical procedures. OBJECTIVE: To quantify the increase in sacrum angular motions and stress across SIJ as a function of fused lumbar spine using finite element lumbar spine-pelvis model. SUMMARY OF BACKGROUND DATA: A review of the literature suggests that for 20% to 30% of spine surgery patients, failed back surgery syndrome as a possible complication. The SIJ might be a contributing factor in failed back surgery syndrome in 29% to 40% of cases. The exact pathomechanism which leads to SIJ pain generation is not well understood. We hypothesized that lumbar spine fusion leads to increased motion or stresses at the SIJ; this alone could be a trigger of the pain syndrome. METHODS: A finite element model of the lumbar spine-pelvis was used to simulate the posterior fusion at L4-L5, L4-S1, and L5-S1 levels. The magnitude of the sacrum angular motion and average of stresses across SIJ articular surfaces were compared with intact model in flexion, extension, lateral bending, and axial rotation motions. RESULTS: The computed sacrum angular motions in intact spine, after L4-L5, L5-S1, and L4-S1 fusion gradually increased with maximum value in L4-S1 fusion model. Also, the average stress on SIJ articular surfaces progressively increased from minimum in L4-L5 to maximum in L4-S1 fusion models. CONCLUSION: The fusion at the lumbar spine level increased motion and stresses at the SIJ. This could be a probable reason for low back pain in patients after lumbar spine fusion procedures.
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