1. 2021;24;E357-E365Lumbar Disc Herniation is a Nonnegligible Factor for the Degeneration of Sacroiliac Joints
   Observational Study
   Tianwang Li, MD, PhD, Meng Liu, MD, Guochao Li, MD, Weiming Deng, MD, and Zhixiang Huang, MD.

BACKGROUND: Sacroiliac joint (SIJ) abnormality is a potential source of low back pain (LBP), therefore numerous patients receive various treatments because of the degenerative changes of SIJ. However, the outcome is unfavorable for patients because these morphologic alterations are common but not the origins of LBP. Previous studies revealed lumbar fusion and transitional vertebra increased the prevalence of degeneration of SIJ. Lumbar disc herniation (LDH) is one of the most common lumbar diseases, but there is no study regarding the relationship between LDH and SIJ degradation.

OBJECTIVES: The aim of this study was to investigate the severity of SIJ degeneration in patients with LBP with LDH. The relationship between degenerative changes of SIJ and LDH was also assessed.

STUDY DESIGN: Retrospective observational study.

SETTING: This study was conducted in 2 medical centers located in southeast and midwest China, respectively.

METHODS: Lumbar and pelvic computed tomography (CT) scans of patients with LDH (LDH group) from January 2016 to May 2020 were reviewed using a picture archiving and communication system. The control group was age, gender, and body mass index–matched patients with LBP without LDH. Patients underwent whole abdomen and pelvic CT examinations due to non-musculoskeletal disorders. Scores of SIJ degeneration were compared between patients with LDH and the control group. Differences in SIJ degeneration among patients with LDH with diverse characteristics, symptoms, and complications were also evaluated. Univariate and multivariate linear mixed model (LMM) was chosen to identify the factors associated with SIJ degeneration.

RESULTS: CT examinations of 782 patients with LDH were assessed, whereas 223 patients were in the control group. The SIJ degeneration score of the LDH group and control group were 6.00 (5.00) and 3.00 (4.00) (P < 0.05). Age and whether patients suffered from LDH were included in the LMM, which involved all reviewed patients (P < 0.05). Regarding the characteristics of LDH, the patients with more herniated discs had more severe SIJ degeneration. The score of SIJ degradation in patients with upper LDH was significantly higher than the other patients with LDH (12.00 [4.00] vs. 6.00 [4.00]; P < 0.05). Similarly, more significant SIJ degeneration was observed in patients with LDH who had secondary lumbar spinal stenosis (10.00 [4.00] vs. 5.00 [4.00]; P < 0.05). The scores of SIJ degradation were significantly greater in patients with LDH with sciatica, numbness, weakness, and/or cauda equina syndrome. Age and LDH were identified as associated factors for more serious degeneration of SIJ among patients with LDH.

LIMITATIONS: The main limitation of this study was the retrospective observational nature. Hence our study described that SIJ degeneration was relevant to LDH, but the causal relationship was uncertain. Magnetic resonance imaging was not chosen in this study.

CONCLUSIONS: The SIJ degeneration in patients with LDH was more serious than in individuals without LDH. SIJ degeneration was more significant in patients with LDH with more pathological alterations, symptoms, and complications. Age and LDH relate to SIJ degeneration. Therefore the diagnosis and selection of treatment for SIJ changes should comprehensively consider the coexistence of LDH.

KEY WORD: Lumbar disc herniation, low back pain, sacroiliac joint, degeneration, sciatica, numbness, weakness, cauda equina syndrome, computed tomography, linear mix model