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Purpose: Sacroiliac fixation using iliac screws for highly unstable lumbar spine has been reported with an improved fusion rate and clinical results. On the other hand, there is a potential for clinical problems related to iliac fixation, including late sacroiliac joint arthritis and pain. Materials and Methods: Twenty patients were evaluated. Degenerative scoliosis was diagnosed in 7 patients, failed back syndrome in 6 patients, destructive spondyloarthropathy in 4 patients, and Charcot spine in 3 patients. All patients underwent posterolateral fusion surgery incorporating lumbar, S1 and iliac screws. We evaluated the pain scores, bone union, and degeneration of sacroiliac joints by X-ray imaging and computed tomography before and 3 years after surgery. For evaluation of low back and buttock pain from sacroiliac joints 3 years after surgery, lidocaine was administered in order to examine pain relief thereafter. Results: Pain scores significantly improved after surgery. All patients showed bone union at final follow-up. Degeneration of sacroiliac joints was not seen in the 20 patients 3 years after surgery. Patients showed slight low back and buttock pain 3 years after surgery. However, not all patients showed relief of the low back and buttock pain after injection of lidocaine into the sacroiliac joint, indicating that their pain did not originate from sacroiliac joints. Conclusion: The fusion rate and clinical results were excellent. Also, degeneration and pain from sacroiliac joints were not seen within 3 years after surgery. We recommend sacroiliac fixation using iliac screws for highly unstable lumbar spine.

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Kim YJ / 2006 / Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases / Spine 31 : 2329 ~ 2336 | 2. [학술지(정기간행물)] - Tsuchiya K / 2006 / Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity / Spine 31 : 303 ~ 308 | 3. [학술지(정기간행물)] - Kuklo TR / 2001 / Minimum 2-year analysis of sacropelvic fixation and L5-S1 fusion using S1 and iliac screws / Spine 26 : 1976 ~ 1983 | 4. [학술지(정기간행물)] - Bernhardt M / 1992 / Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation / Clin Orthop Relat Res : 109 ~ 115 | 5. [학술지(정기간행물)] - Horowitch A / 1989 / The Wiltse pedicle screw fixation system. Early clinical results / Spine 14 : 461 ~ 467 | 6. [학술지(정기간행물)] - Molinari RW / 1999 / Complications in the surgical treatment of pediatric high-grade, isthmic dysplastic spondylolisthesis. A comparison of three surgical approaches / Spine 24 : 1701 ~ 1711 | 7. [학술지(정기간행물)] - Rechtine GR / 1996 / The efficacy of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusion in adult patients with degenerative spondylolisthesis / J Spinal Disord 9 : 382 ~ 391 | 8. [학술지(정기간행물)] - Farcy JP / 1992 / Technique and results of fixation to the sacrum with iliosacral screws / Spine 17 (6 Suppl) : 190 ~ 195 | 9. [학술지(정기간행물)] - Louis R. / 1986 / Fusion of the lumbar and sacral spine by internal fixation with screw plates / Clin Orthop Relat Res : 18 ~ 33 | 10. [학술지(정기간행물)] - Roy-Camille R / 1986 / Internal fixation of the lumbar spine with pedicle screw plating / Clin Orthop Relat Res : 7 ~ 17 | 11. [학술지(정기간행물)] - Winter RB / 1986 / Pelvic obliquity. Its causes and its treatment / Spine 11 : 225 ~ 234 | 12. [학술지(정기간행물)] - Wood EG III / 1991 / Lumbar disc herniation and open limited discectomy: indications, techniques and results / Oper Tech Orthop 1 : 23 ~ 28 | 13. [학술지(정기간행물)] - Dreyfuss P / 1996 / The value of medical history and physical examination in diagnosing sacroiliac joint pain / Spine 21 : 2594 ~ 2602 | 14. [학술지(정기간행물)] - Maigne JY / 1996 / Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain / Spine 21 : 1889 ~ 1892 | 15. [학술지(정기간행물)] - Alderink GJ. / 1991 / The sacroiliac joint: review of anatomy, mechanics, and function / J Orthop Sports Phys Ther 13 : 71 ~ 84 | 16. [단행본] - Cassidy JD / 1992 / Pathophysiology of the sacroiliac joint, In Principles and Practice of chiropractic. 2nd ed / Appleton & Lange : 211 ~ 224 | 17. [학술지(정기간행물)] - Murata Y / 2000 / Sensory innervation of the sacroiliac joint in rats / Spine 25 : 2015 ~ 2019 google schola

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