Introduction

• Sacroiliac joint dysfunction and pain is being more recognized as a source of low back

pain, estimated to be responsible for 15-30% of non-radicular low back pain(1).

• The sacroiliac joint (SIJ) is diarthrodial joint that plays an important role in maintenance

of a normal gait. In bipedal gait, the SIJ are the ‘hub’ of forces transferred from the trunk

to the ground and vice versa(2).

• Individuals with SIJ dysfunction exhibit both reduced activation of gluteus maximus

during a loading synergy present in walking and greater asymmetry between legs when

walking compared with age-matched controls(3).

• Gait abnormality may contribute to additional comorbid conditions and pain.

• In this prospective, single-arm longitudinal multicenter clinical study we assessed gait

impairment in patients with SIJ dysfunction and analyzed the improvement in gait

dysfunction following minimally invasive posterior SIJ fusion.

• Though studies detailing device efficacy and long-term relief are being published, there is

no current study detailing the improvement on gait abnormality with dynamic non patient

reported data following posterior SIJ fusion.

Materials/Methods

• IRB approval for this study was secured and patient consent has been received.

• After screening for appropriateness for posterior SIJ fusion, if th

• e patient met inclusion/exclusion criteria they were provided with informed consent to

participate in the study.

• We then conducted a prospective non-patient reported analysis of all patients who

underwent a posterior SIJ fusion procedure at 2 private interventional pain practices.

• A portable kinesis gait assessment tool was attached to the patients for gait assessment

at baseline, one month, and 6 months post-operatively.

• Gait assessment data that was collected included gait velocity, impairment in speed,

symmetry, variability, and fall risk assessment.

Results

• In a cohort of 10 patients (52 yo-75yo; 3 male; 7 female) that underwent posterior SIJ

fusion and met inclusion/exclusion all were found to have favorable results.

• The average improvement in gait velocity was 24.5 cm/s (6.5-49.8cm/s);

• The average improvement in impairment of speed was 22.1% (4-43%)

• The average improvement impairment of symmetry was 14.5% (1-29%)

• The average improvement impairment of variability was 14.6% (4-29%)

• The average improvement fall risk was 15.5% (1-39%).

• There were no intra-operative or post-operative adverse effects or complications.

• (There was one patient that did present at baseline assessment reliant on a rolling

walker that was able to walk without assistive device at 6 months post-operatively.).

 

Discussion

As SIJ dysfunction is better understood as a significant contributor of low back pain, it is

important to find long term solutions for the improvement of both pain and the

restoration of function. Arthrodesis of the sacroiliac joint using an invasive, lateral

approach has been the established surgical intervention. This approach although

effective in treating pain has been found to have potentially catastrophic adverse

complications. Further, this procedure may lead to further gait impairment. According to

Busso et al. in a cohort of 21 patients that underwent lateral approach SIJ fusion

(both open and percutaneous), long term impaired walking performance was noted,

specifically patients walked slower and used shorter steps compared with healthy

controls (4).

As demonstrated in this study the minimally invasive posterior SIJ fusion procedure is a

safe and effective way in which to improve gait impairment that is caused by sacroiliac

joint dysfunction. This improvement in gait impairment can prevent further comorbid

conditions and improve fall risk which may lead to significant future medical cost savings

for patients with degenerative conditions.

References

1. Cohen SP, Chen Y, Neufeld NJ. Sacroiliac Joint Pain: A Comprehensive Review of

Epidemiology, Diagnosis and Treatment. Exp Rev of Neurotherapeutics. 2014; 13:1, 99-

116.

2. Lovejoy Co. Evolution of Human Walking. Scientific American. 1988; 259:5, 118-125.

3. Feeney DF, Capobianco RA, Montgomery JR, Morreale J, Grabowski AM, Enoka

RM. Individuals with Sacroiliac Joint Dysfunction display asymmetrical gait and a

depressed synergy between muscles providing sacroiliac joint force closure when

walking. Journal of Electromyography and Kinesiology. 2018. 2018; 43, 95-103.

4. Busso C, Cambursano S, Aprato A, Destefanis C, Gianotti A, Massazza G, Massè A, Minetto MA. Algo-

Functional Indexes and Spatiotemporal Parameters of Gait after Sacroiliac Joint Arthrodesis. Journal of

Clinical Medicine. 2020; 9(9):2860. https://doi.org/10.3390/jcm9092860