23. Sacroiliac fusion surgery improves gait patterns of patients with sacroiliac joint dysfunction

• Published in: The spine journal 2019-09, Vol.19 (9), p.S11-S12
• Main Authors: Mar, Damon E., Perez, Yoheli, Kutz, Scott C., Kosztowski, Thomas, Block, Andrew R., Rashbaum, Ralph F., Haddas, Ram
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2019.05.036

The sacroiliac joint (SIJ) is an underappreciated pain generator in 15-30% of patients with low back pain. The SIJ functions as a primary structure which transfers loads of the upper body to the lower extremities. Sacroiliac joint dysfunction (SIJD) is characterized by SIJ laxity with symptoms manifesting primarily as low back and lower extremity pain. Additionally, there is growing evidence that gait patterns may also be affected by SIJD. Although there is still much controversy, minimally invasive sacroiliac fusion (SIF) is gaining interest as a procedure for SIJD patients with unremitting pain. SIF aims to reduce SI pain by stabilizing the SIJ and improving structural support between the sacrum and ilium. While positive outcomes for improved pain and reduced opioid consumption have been associated with SIF, there is a lack of research concerning the effects of SIF on functional biomechanics such as gait performance. To quantify the effects of SIF on biomechanical gait parameters of SIJD patients at three months postoperative follow-up compared to their preoperative state. Non-randomized, prospective, concurrent cohort study. Twelve symptomatic SIJD patients. Spatiotemporal parameters, gait range-of-motion (RoM) parameters, and patient-reported outcomes. Clinical gait analysis was performed one week before surgery (Pre) and three months after surgery (Post). Each patient performed a series of over-ground gait trials at a comfortable, self-selected speed. Data were collected using a motion capture system and three force plates. Back and leg Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Fear Avoidance Beliefs Questionnaire (FABQ), Tampa Scale for Kinesiophobia (TSK), and Demoralization Scale (DS) scores were also collected at both time points. Patients showed increased cadence (Pre: 98.39 vs Post: 106.95 steps/min, p=0.018) and walking speed (Pre: 0.87 vs Post: 1.03 m/s, p=0.013). Patients also showed decreases in stride time (Pre: 1.28 vs Post: 1.14 s, p=0.015), step time (Pre: 0.65 vs Post: 0.58 s, p=0.015), and double-support time (Pre: 0.37 vs Post: 0.29 s, p=0.024). Patients show significant decreases in both knee RoM (Pre: 15.25 vs Post: 10.79°, p=0.02) and head motion (Pre: 4.80 vs Post: 3.18 °, p=0.045) in the coronal plane. VAS leg pain score (Pre: 4.25 vs Post: 2.69, p=0.032) improved significantly postoperatively. SIJD patients treated with SIF showed significant improvements in functional gait and leg pain at their three-month fol