When surgery makes sacroiliac joint-related pain worse | Lumbar Decompression Surgery

Danielle.Steilen.ProlotherapistDanielle R. Steilen-Matias, MMS, PA-C

We cover many topics on this website in regard to Failed Back Surgery Syndrome. This article will deal with problems of Lumbar Decompression Surgery.

Did your back surgery create a new sacroiliac joint-related pain condition?

Here is the opening statement from a new August 2018 study.

“The initial phase of (sacroiliac joint) treatment involves nonsurgical modalities such as activity modification, use of a sacroiliac (SI) belt, NSAIDs, and physical therapy. Prolotherapy and radiofrequency ablation may offer a potential benefit as therapeutic modalities, although limited data support their use as a primary treatment modality. Surgical treatment is indicated for patients with a positive response to an SI (painkiller) injection with greater than 75% relief, failure of nonsurgical treatment, and continued or recurrent sacroiliac joint pain. Percutaneous (Minimally invasive spinal procedure) SI arthrodesis (fusion surgery) may be recommended as a first-line surgical treatment because of its improved safety profile compared with open (spine fusion surgery) however, in the case of (failed surgery), nonunion, and aberrant anatomy, open (spinal fusion) should be performed.”(1)

What does all this mean to the patient being recommended to spinal surgery or with continued back pain?

Spinal surgery that makes sacroiliac joint-related pain worse is a very difficult concept for many people to understand

Lumbar decompression surgery that makes sacroiliac joint-related pain worse is a very difficult concept for many people to understand. The reason these people went to lumbar decompression surgery was to relieve sacroiliac joint-related pain.  It should also be pointed out that the surgical recommendation was also, for many, that last option following the conservative approach and failure of pain medication, steroid injections, physical therapy, massage, or traction based non-surgical decompression to relieve their symptoms.

The fact that conservative treatments failed and then minimally invasive lumbar decompression surgery failed and that their own sacroiliac joint-related pain was now worse can lead to great confusion and frustration.

A patient story we will hear is that lumbar decompression surgery was absolutely necessary because the nerves of the spine were being pinched. The pinched nerves were causing symptoms is sciatica, radiating or lumbar radiculopathy related pain and numbness into the lower back, hips, and legs.

L5 lumbar instability causing sciatica pain

In our article on Sacroiliac joint pain treatment, we cite research from doctors in Germany who examined a potential connection between  lumbar decompression surgery and new onset of sacroiliac joint-related pain causing a diagnosis of failed-back-surgery syndrome.

Here is what they said in their published research: The change of body position and walking behavior after successful surgery might lead to changed force effects on the entire spine and on the sacroiliac joint. in the future. “The adaptation of a changed body posture and gait could lead to transient overload of the sacroiliac joint and surrounding myofascial structures. The patients should be informed about this possible condition to avoid uncertainty, discontent, unnecessary diagnostics and to induce a quick, specific treatment.”(2)

Dangers of injuring spinal ligaments in surgery

Doctors at the Osaka City University Graduate School of Medicine, Japan acknowledge that spinal ligament damage is possible in spinal surgery because the posterior spinal bony prominences (parts of the vertebral structure) are commonly used as landmarks during posterior spinal surgery; however, the exact relationship of these structures with ligamentum flavum  borders and attachments has not been clarified.

Many surgeons suggest that patients should not consider conservative care prior to surgery as it may have an impact on their surgical success. Doctors at the University of Bern in Switzerland have disproved this.

“The incidence of lumbar spinal stenosis continues to rise, with both conservative and surgical management representing options for its treatment. The timing of surgery for lumbar spinal stenosis varies from shortly after the onset of symptoms to several months or years after conservative treatment.

The aim of this study was to investigate the association between the duration of pre-operative conservative treatment and the ultimate outcome following surgical interventions for lumbar spinal stenosis.

Cases of lumbar spinal stenosis with a documented duration of conservative treatment, undergoing spinal decompression with at least one post-operative patient assessment between 3 and 30 months, were included in the study.

“The duration of pre-operative conservative treatment was not associated with the ultimate outcome of decompression surgery.”(4)

Iatrogenic spondylolisthesis following decompression surgery

Iatrogenic spondylolisthesis is an acquired spondylolisthesis and a well-recognized complication after posterior decompression or fusion surgery, occurring in 3.7%–20 % of cases.(5)

Spondylolisthesis describes the forward slippage of  a vertebrae onto another. In decompression, removing too much bone can lead to post-operative lumbar instability and then to spondylolisthesis. Patients suffering from iatrogenic spondylolisthesis often complain of increased back pain and have new or deteriorating sciatic symptoms with time.

As documented in the medical journal Neurosurgical focus in a paper entitled Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts, instability following lumbar decompression is a common occurrence.(6)

Comprehensive Prolotherapy to the stabilizing posterior ligaments is very effective at resolving this.

Lumbar decompression surgery can reduce symptoms and problems for patients when it is done to correct problems of progressive neurological deficit. However, when done for the wrong reasons, such as ligament laxity in the spine or pelvis, instability and symptoms can worsen. In most instances it is appropriate for a person to seek out a consultation with a Prolotherapist before undergoing surgery. A Prolotherapist can let the person know what the chances are that the condition and its associated symptoms will be helped by Prolotherapy. Receiving Prolotherapy first will not in any way impede or hamper a person’s response to surgery later.

A Prolotherapist will help remind a person about some questions to ask a surgeon when getting a consultation:

When surgery is indicated

Spinal decompression is indicated in the presence of a progressive neurological deficit such as loss of muscle strength and the  ability  to  walk  or  use  an  extremity.  A microdiscectomy involves removing part of a disc, generally  because  of  a  herniation  pressing  on  a nerve.

Spinal decompression is indicated in the presence of a progressive neurological deficit such as loss of muscle strength and the  ability  to  walk  or  use  an  extremity.  A microdiscectomy involves removing part of a disc, generally  because  of  a  herniation  pressing  on  a nerve.

Laminotomy is the removal of all or part of a lamina, the flattened or arched part of the vertebral arch. Complete laminectomy or bilateral laminectomy means removal of the spinous process and the entire lamina on each side of it. Hemilaminectomy or unilateral laminectomy means removal of the lamina on one side of the spinous process only. When the opening to the nerve root is enlarged, this is called a foraminotomy. For the right indications, spinal surgery can resolve symptoms.

Special note: Lumbar decompression in patients over 80

Doctors at the Mayo Clinic evaluated lumbar decompression in the elderly, including octogenarians, to evaluate for associations between age and patient outcomes.

The doctors looked at patients 65 and older with diagnosis and procedure codes inclusive of degenerative spine disease and lumbar decompression without fusion.

Morbidity (complications) and mortality (death) within the 30-day postoperative period were the primary outcomes. Secondary outcomes of interest included unplanned readmission (return to hospital stay) within 30 days or discharge to a non-home (nursing home) facility.

Increased age was associated with readmissions within 30 days, non-home discharge, any complication, length of stay, and blood transfusion.

With younger than 65 years as the reference, increased age, including patients older than 80 years, demonstrates that increased age is associated with more extensive operations, resulting in longer hospital stays, increased rates of non-home discharge, and minor complications.(7)

Avpoidance of surgery

At the top of this article we noted that a new study suggested

The video below describes the technique, we have performed this technique on thousands of patients over the decades.

Do you have a question about your back pain? You can get help and information from our Caring Medical Staff

Prolotherapy Specialists

1 Hauser R. The deterioration of articular cartilage in osteoarthritis by corticosteroid injections. Journal of Prolotherapy. 2009;2:107-23. [Google Scholar]

Schmidt GL, Bhandutia AK, Altman DT. Management of Sacroiliac Joint Pain. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2018 Sep 1;26(17):610-6. [Google Scholar]

3 Schomacher M, Kunhardt O, Koeppen D, Moskopp D, Kienapfel H, Kroppenstedt S, Cabraja M. Transient sacroiliac joint-related pain is a common problem following lumbar decompressive surgery without instrumentation. Clin Neurol Neurosurg. 2015 Sep 11;139:81-85. doi: 10.1016/j.clineuro.2015.09.007. [Google Scholar]

4 Akhgar J, Terai H, Rahmani MS, Tamai K, Suzuki A, Toyoda H, Hoshino M, Ikebuchi M, Ahmadi SA, Hayashi K, Nakamura H. Anatomical analysis of the relation between human ligamentum flavum and posterior spinal bony prominence. J Orthop Sci. 2017 Mar;22(2):260-265. doi: 10.1016/j.jos.2016.11.020. Epub 2016 Dec 23. [Google Scholar]

Zweig T, Enke J, Mannion AF, Sobottke R, Melloh M, Freeman BJ, Aghayev E. Is the duration of pre-operative conservative treatment associated with the clinical outcome following surgical decompression for lumbar spinal stenosis? A study based on the Spine Tango Registry. Eur Spine J. 2017 Feb;26(2):488-500. doi: 10.1007/s00586-016-4882-9. Epub 2016 Dec 15. [Google Scholar?]

6 König MA, Ebrahimi FV, Nitulescu A, Behrbalk E, Boszczyk BM. Early results of stand-alone anterior lumbar interbody fusion in iatrogenic spondylolisthesis patients. European Spine Journal. 2013 Dec 1;22(12):2876-83. [Google Scholar.]

7 Guha D, Heary RF, Shamji MF. Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts. Neurosurgical focus. 2015 Oct;39(4):E9. [Google Scholar]

8 Murphy ME, Gilder H, Maloney PR, McCutcheon BA, Rinaldo L, Shepherd D, Kerezoudis P, Ubl DS, Crowson CS, Krauss WE, Habermann EB. Lumbar decompression in the elderly: increased age as a risk factor for complications and nonhome discharge. Journal of Neurosurgery: Spine. 2017 Mar;26(3):353-62. [Google Scholar]

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