{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:40:06Z","timestamp":1789969206624,"version":"4.0.1"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The sacroiliac joint (SIJ) is a known source of low-back pain. Randomized clinical trials support sacroiliac fusion over conservative management for SIJ dysfunction. Clinical studies suggest that SIJ degeneration occurs in the setting of lumbosacral fusions. However, there are few biomechanical studies to provide a good understanding of the effect of lumbosacral fusion on the SIJ. In the present study, researchers performed a biomechanical investigation to discern the effect of pelvic versus SIJ fixation on the SIJ in lumbosacral fusion.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Seven fresh-frozen human cadaveric specimens were used. There was one intact specimen and six operative constructs: 1) posterior pedicle screws and rods from T10 to S1 (PS); 2) PS + bilateral iliac screw fixation (BIS); 3) PS + unilateral iliac screw fixation (UIS); 4) PS + UIS + 3 contralateral unilateral SIJ screws (UIS + 3SIJ); 5) PS + 3 unilateral SIJ screws (3SIJ); and 6) PS + 6 bilateral SIJ screws (6SIJ). A custom-built 6 degrees-of-freedom apparatus was used to simulate three bending modes: flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Range of motion (ROM) was recorded at L5\u2013S1 and the SIJ.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n All six operative constructs had significantly reduced ROM at L5\u2013S1 in all three bending modes compared to that of the intact specimen (p < 0.05). In the FE mode, the BIS construct had a significant reduction in L5\u2013S1 ROM as compared to the other five constructs (p < 0.05). SIJ ROM was greatest in the FE mode compared to LB and AR. Although the FE mode did not show any statistically significant differences in SIJ ROM across the constructs, there were appreciable differences. The PS construct had the highest SIJ ROM. The BIS construct reduced bilateral SIJ ROM by 44% in comparison to the PS construct. The BIS and 6SIJ constructs showed reductions in SIJ ROM nearly equal to those of the PS construct. UIS and 3SIJ showed an appreciable reduction in unfused SIJ ROM compared to PS.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This investigation demonstrated the effects of various fusion constructs using pelvic and sacroiliac fixation in lumbosacral fusion. This study adds biomechanical evidence of adjacent segment stress in the SIJ in fusion constructs extending to S1. Unilateral pelvic fixation, or SIJ fusion, led to an appreciable but nonsignificant reduction in the ROM of the unfused contralateral SIJ. Bilateral pelvic fixation showed the greatest significant reduction of movement at L5\u2013S1 and was equivalent to bilateral sacroiliac fusion in reducing SIJ motion.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2019.3.spine181127","type":"journal-article","created":{"date-parts":[[2019,6,14]],"date-time":"2019-06-14T18:46:21Z","timestamp":1560537981000},"page":"562-567","source":"Crossref","is-referenced-by-count":14,"title":["A biomechanical investigation of the sacroiliac joint in the setting of lumbosacral fusion: impact of pelvic fixation versus sacroiliac joint fixation"],"prefix":"10.3171","volume":"31","author":[{"given":"Harry","family":"Mushlin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daina M.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center (MERC), a Division of Globus Medical Inc., Audubon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Olexa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan J.","family":"Ferrick","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Carbine","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald M.","family":"Hayward","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center (MERC), a Division of Globus Medical Inc., Audubon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon S.","family":"Bucklen","sequence":"additional","affiliation":[{"name":"Musculoskeletal Education and Research Center (MERC), a Division of Globus Medical Inc., Audubon; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A.","family":"Sansur","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Med Devices (Auckl)","first-page":"73","article-title":"Sacroiliac joint pain: burden of disease","volume":"7","author":"Cher D","year":"2014","unstructured":"Cher D, Polly D, Sigurd B: Sacroiliac joint pain: burden of disease. Med Devices (Auckl) 7:73\u201381, 201424748825"},{"key":"b2","series-title":"Int J Spine Surg","doi-asserted-by":"publisher","first-page":"587","DOI":"10.14444\/5072","article-title":"In vitro biomechanical evaluation of a novel, minimally invasive, sacroiliac joint fixation device","volume":"12","author":"Cross WW III","year":"2018","unstructured":"Cross WW III, Berven SH, Slater N, Lehrman JN, Newcomb AGUS, Kelly BP: In vitro biomechanical evaluation of a novel, minimally invasive, sacroiliac joint fixation device. Int J Spine Surg 12:587\u2013594, 201810.14444\/507230364882"},{"key":"b3","series-title":"Open Orthop J","doi-asserted-by":"publisher","first-page":"7","DOI":"10.2174\/1874325001812010007","article-title":"Minimally invasive sacroiliac joint fusion: 2-year radiographic and clinical outcomes with a principles-based SIJ fusion system","volume":"12","author":"Cross WW","year":"2018","unstructured":"Cross WW, Delbridge A, Hales D, Fielding LC: Minimally invasive sacroiliac joint fusion: 2-year radiographic and clinical outcomes with a principles-based SIJ fusion system. Open Orthop J 12:7\u201316, 20182943026610.2174\/1874325001812010007"},{"key":"b4","series-title":"Pain Med","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1111\/j.1526-4637.2011.01098.x","article-title":"Etiology of chronic low back pain in patients having undergone lumbar fusion","volume":"12","author":"DePalma MJ","year":"2011","unstructured":"DePalma MJ, Ketchum JM, Saullo TR: Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Med 12:732\u2013739, 20112148116610.1111\/j.1526-4637.2011.01098.x"},{"issue":"Suppl 2","key":"b5","series-title":"J Bone Joint Surg Am","first-page":"103","article-title":"Test protocols for evaluation of spinal implants","volume":"88","author":"Goel VK","year":"2006","unstructured":"Goel VK, Panjabi MM, Patwardhan AG, Dooris AP, Serhan H: Test protocols for evaluation of spinal implants. J Bone Joint Surg Am 88 (Suppl 2):103\u2013109, 200616595454"},{"key":"b6","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1097\/BRS.0b013e318170fd35","article-title":"Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion: a prospective cohort study over five-year follow-up","volume":"33","author":"Ha KY","year":"2008","unstructured":"Ha KY, Lee JS, Kim KW: Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion: a prospective cohort study over five-year follow-up. Spine (Phila Pa 1976) 33:1192\u20131198, 20081846969210.1097\/BRS.0b013e318170fd35"},{"key":"b7","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E162","DOI":"10.1097\/BRS.0b013e3181978ea3","article-title":"Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint: a finite element study","volume":"34","author":"Ivanov AA","year":"2009","unstructured":"Ivanov AA, Kiapour A, Ebraheim NA, Goel V: Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint: a finite element study. Spine (Phila Pa 1976) 34:E162\u2013E169, 200910.1097\/BRS.0b013e3181978ea3"},{"key":"b8","series-title":"Pain Med","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1111\/j.1526-4637.2011.01087.x","article-title":"Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks","volume":"12","author":"Liliang PC","year":"2011","unstructured":"Liliang PC, Lu K, Liang CL, Tsai YD, Wang KW, Chen HJ: Sacroiliac joint pain after lumbar and lumbosacral fusion: findings using dual sacroiliac joint blocks. Pain Med 12:565\u2013570, 20112146347010.1111\/j.1526-4637.2011.01087.x"},{"key":"b9","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"326","DOI":"10.3171\/2017.7.SPINE17499","article-title":"Biomechanics of unilateral and bilateral sacroiliac joint stabilization: laboratory investigation","volume":"28","author":"Lindsey DP","year":"2018","unstructured":"Lindsey DP, Parrish R, Gundanna M, Leasure J, Yerby SA, Kondrashov D: Biomechanics of unilateral and bilateral sacroiliac joint stabilization: laboratory investigation. J Neurosurg Spine 28:326\u2013332, 201810.3171\/2017.7.SPINE1749929303472"},{"key":"b10","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"1924","DOI":"10.1007\/s00586-016-4490-8","article-title":"Sacroiliac joint fusion for low back pain: a systematic review and meta-analysis","volume":"25","author":"Lingutla KK","year":"2016","unstructured":"Lingutla KK, Pollock R, Ahuja S: Sacroiliac joint fusion for low back pain: a systematic review and meta-analysis. Eur Spine J 25:1924\u20131931, 20162695709610.1007\/s00586-016-4490-8"},{"key":"b11","series-title":"J Biomech","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/j.jbiomech.2006.01.017","article-title":"Accuracy of an optical active-marker system to track the relative motion of rigid bodies","volume":"40","author":"Maletsky LP","year":"2007","unstructured":"Maletsky LP, Sun J, Morton NA: Accuracy of an optical active-marker system to track the relative motion of rigid bodies. J Biomech 40:682\u2013685, 200710.1016\/j.jbiomech.2006.01.01716580000"},{"key":"b12","series-title":"Clin Nucl Med","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1097\/00003072-199204000-00004","article-title":"Increased sacroiliac joint uptake after lumbar fusion and\/or laminectomy","volume":"17","author":"Onsel C","year":"1992","unstructured":"Onsel C, Collier BD, Kir KM, Larson SJ, Meyer GA, Krasnow AZ, : Increased sacroiliac joint uptake after lumbar fusion and\/or laminectomy. Clin Nucl Med 17:283\u2013287, 1992153335610.1097\/00003072-199204000-00004"},{"key":"b13","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1227\/NEU.0000000000000988","article-title":"Randomized controlled trial of minimally invasive sacroiliac joint fusion using triangular titanium implants vs nonsurgical management for sacroiliac joint dysfunction: 12-month outcomes","volume":"77","author":"Polly DW","year":"2015","unstructured":"Polly DW, Cher DJ, Wine KD, Whang PG, Frank CJ, Harvey CF, : Randomized controlled trial of minimally invasive sacroiliac joint fusion using triangular titanium implants vs nonsurgical management for sacroiliac joint dysfunction: 12-month outcomes. Neurosurgery 77:674\u2013691, 20152629133810.1227\/NEU.0000000000000988"},{"key":"b14","series-title":"Int J Spine Surg","doi-asserted-by":"publisher","first-page":"28","DOI":"10.14444\/3028","article-title":"Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. Non-surgical management for sacroiliac joint dysfunction","volume":"10","author":"Polly DW","year":"2016","unstructured":"Polly DW, Swofford J, Whang PG, Frank CJ, Glaser JA, Limoni RP, : Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. Non-surgical management for sacroiliac joint dysfunction. Int J Spine Surg 10:28, 201610.14444\/302827652199"},{"key":"b15","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/00007632-199501000-00007","article-title":"The sacroiliac joint in chronic low back pain","volume":"20","author":"Schwarzer AC","year":"1995","unstructured":"Schwarzer AC, Aprill CN, Bogduk N: The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976) 20:31\u201337, 1995770927710.1097\/00007632-199501000-00007"},{"key":"b16","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E27","DOI":"10.1097\/BRS.0b013e31818b8882","article-title":"How often is low back pain not coming from the back?","volume":"34","author":"Sembrano JN","year":"2009","unstructured":"Sembrano JN, Polly DW Jr: How often is low back pain not coming from the back? Spine (Phila Pa 1976) 34:E27\u2013E32, 200910.1097\/BRS.0b013e31818b8882"},{"key":"b17","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E525","DOI":"10.1097\/BRS.0000000000000839","article-title":"The effect of implant placement on sacroiliac joint range of motion: posterior versus transarticular","volume":"40","author":"Soriano-Baron H","year":"2015","unstructured":"Soriano-Baron H, Lindsey DP, Rodriguez-Martinez N, Reyes PM, Newcomb A, Yerby SA, : The effect of implant placement on sacroiliac joint range of motion: posterior versus transarticular. Spine (Phila Pa 1976) 40:E525\u2013E530, 201510.1097\/BRS.0000000000000839"},{"key":"b18","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1007\/s00586-016-4599-9","article-title":"Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management","volume":"26","author":"Sturesson B","year":"2017","unstructured":"Sturesson B, Kools D, Pflugmacher R, Gasbarrini A, Prestamburgo D, Dengler J: Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management. Eur Spine J 26:708\u2013719, 20172717966410.1007\/s00586-016-4599-9"},{"key":"b19","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1097\/BRS.0000000000001409","article-title":"Fusion of multiple segments can increase the incidence of sacroiliac joint pain after lumbar or lumbosacral fusion","volume":"41","author":"Unoki E","year":"2016","unstructured":"Unoki E, Abe E, Murai H, Kobayashi T, Abe T: Fusion of multiple segments can increase the incidence of sacroiliac joint pain after lumbar or lumbosacral fusion. Spine (Phila Pa 1976) 41:999\u20131005, 20162668957610.1097\/BRS.0000000000001409"},{"key":"b20","series-title":"Int J Spine Surg","doi-asserted-by":"publisher","first-page":"6","DOI":"10.14444\/2006","article-title":"Sacroiliac joint fusion using triangular titanium implants vs. non-surgical management: six-month outcomes from a prospective randomized controlled trial","volume":"9","author":"Whang P","year":"2015","unstructured":"Whang P, Cher D, Polly D, Frank C, Lockstadt H, Glaser J, : Sacroiliac joint fusion using triangular titanium implants vs. non-surgical management: six-month outcomes from a prospective randomized controlled trial. Int J Spine Surg 9:6, 201510.14444\/200625785242"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/31\/4\/article-p562.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/31\/4\/article-p562.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/31\/4\/article-p562.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T18:39:57Z","timestamp":1681583997000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/31\/4\/article-p562.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":20,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2019.3.spine181127","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2019,10]]}}}