Sacroiliac Joint Ankylosis Decreases Intervertebral Fusion Rate in L5/S1 Single Intervertebral Transforaminal Lumbar Interbody Fusion

Masaki Tatsumura; Tomoki Koide; Yosuke Ogata; Hiroki Ito; Katsuya Nagashima; Yosuke Takeuchi; Fumihiko Eto; Toru Funayama; Masashi Yamazaki

doi:10.7759/cureus.39455

Sacroiliac Joint Ankylosis Decreases Intervertebral Fusion Rate in L5/S1 Single Intervertebral Transforaminal Lumbar Interbody Fusion

Cureus. 2023 May 24;15(5):e39455. doi: 10.7759/cureus.39455. eCollection 2023 May.

Authors

Masaki Tatsumura¹, Tomoki Koide¹, Yosuke Ogata¹, Hiroki Ito¹, Katsuya Nagashima¹, Yosuke Takeuchi¹, Fumihiko Eto², Toru Funayama², Masashi Yamazaki²

Affiliations

¹ Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, JPN.
² Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, JPN.

Abstract

Background Transforaminal lumbar interbody fusion (TLIF) is a common surgical procedure for lumbar spondylolisthesis and intervertebral foraminal stenosis. Sacroiliac joint ankylosis is also known to occur in patients without axial spondyloarthritis. When sacroiliac joint bony ankylosis occurs and sacroiliac joint mobility is lost, stresses from the lower extremities to the lumbar spine are no longer buffered and are expected to be concentrated between the fifth lumbar (L5) and the first sacral (S1) vertebrae. We hypothesized that sacroiliac joint bony ankylosis could adversely affect L5/S1 intervertebral fusion and investigated the postoperative intervertebral fusion rate in single intervertebral TLIF on L5/S1 among patients with bony ankylosis of the sacroiliac joint. Methods Seventy-two patients who had undergone TLIF in the L5/S1 single intervertebral segment since 2014 and had a follow-up of at least one year after surgery were included in the study. Seventy-two patients were divided into the following two groups for comparison: group A consisted of 17 patients with bony ankylosis of the sacroiliac joint on either side on preoperative CT, and group N consisted of 55 patients without ankylosis. We investigated the intervertebral segment fusion rate one year postoperatively. Fisher's exact tests were used for statistical analysis, with a significance level of P < 0.05. Results Twelve patients (71%) in group A and 50 patients (91%) in group N had a fusion of the L5/S1 intervertebral segment one year after TLIF surgery, with a significantly lower rate in group A (P = 0.049). Conclusions We conclude that the presence of preoperative sacroiliac joint bony ankylosis is a risk factor for postoperative intervertebral fusion failure after single-segment TLIF at L5/S1.

Keywords: fusion failure; l5/s1; mechanical stress; posterior lumbar interbody fusion (plif); sacroiliac joint ankylosis; single segment; stress concentration; transforaminal lumbar interbody fusion (tlif); union rate.