Clinical Spine Surgery A Spine Publication · IF 1.6 · July 21, 2026 · LoE III
Predictors of Sacroiliac Joint Intervention Following Lumbar Spine Fusion
Ali Issani, William J. Karakash, Henry Avetisian, Marc Abdou, Dil Patel, Matthew Igbinigie, David Riopelle, Raymond J. Hah, Ram K. Alluri, John C. Liu, Jeffrey C. Wang
This retrospective database study looked at over 500,000 patients who had 1-5 level lumbar fusion and asked how often they later needed a sacroiliac (SI) joint fusion and what predicted it. Only 0.73% of patients went on to SI fusion, but the strongest predictor by far was having had an SI joint injection after the index lumbar surgery (OR 15.48), followed by anterior/lateral interbody approaches, segmental instrumentation, female sex, osteoarthritis, and higher comorbidity burden; risk of SI fusion also rose with each additional lumbar level fused (up to a HR of 1.72 for 4-level fusion) over a 5-year Kaplan-Meier follow-up.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThis gives spine surgeons real-world, large-scale data to counsel patients preoperatively about their risk of later needing SI joint intervention after multilevel lumbar fusion.
Conclusion strengthConfirms prior evidence
A clinically important harm: the entire 95% CI 14.49 to 16.54 favours the comparator.
Presenting this at rounds? Start here
- ?This is an administrative claims database study without radiographic or symptom data; how might miscoding of SI fusion indications or unmeasured surgical technique variables (e.g., specific fused levels, sacral extension) bias the identified predictors?
- ?Given that SI injection after lumbar fusion was overwhelmingly the strongest predictor of eventual SI fusion (OR >15), how should this change postoperative monitoring and threshold for early referral to interventional pain management?