Predictors of Sacroiliac Joint Intervention Following Lumbar Spine Fusion
Clinical Spine Surgery A Spine Publication · 21 Jul 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Helps spine surgeons identify which lumbar fusion patients (women, more levels fused, segmental instrumentation, osteoarthritis) are at higher risk of later SI joint pain requiring intervention, informing preoperative counselling.
The evidence
This retrospective database study looked at over 500,000 patients who underwent 1-5 level lumbar fusion and tracked how many later needed a sacroiliac (SI) joint fusion. Only 0.73% (3718 patients) went on to SI fusion, but among those, the strongest predictor by far was having had an SI joint injection after the index lumbar surgery (OR 15.48), followed by anterior/lateral approaches (OR 1.86), posterior approaches (OR 1.36), segmental instrumentation (OR 1.29), osteoarthritis (OR 1.14), and female sex (OR 1.09); risk of SI fusion also rose with more fused levels (HR up to 1.72 for 4-level fusion).
Subsequent SI joint fusion after lumbar fusion: Odds ratio 15.48 (95% CI 14.49 to 16.54; units not reported). Interpret in the study's stated comparison; this alone does not establish a treatment's causal effect.
Why this rigour score?
Retrospective cohort
Methods at a glance
Recorded assessment- Confounding adjustmentMultivariable regression
- Covariate balance confirmedNot applicable
- Outcome assessors blindedNot applicable
- Comparable start of follow-upMet
- Adequate statistical powerNot reported
- Prospective registrationNot applicable
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.This is a large administrative database study using ICD/CPT codes without radiographic, symptom, or surgical technique detail; how might coding inaccuracies and lack of clinical granularity (e.g., unknown levels fused, indication for SI injection) bias the identified risk factors?
2.Given that only 0.73% of patients required SI fusion and the strongest predictor was a prior SI injection (which itself signals emerging symptoms rather than an independent risk factor), how should this information change preoperative counselling versus intraoperative decision-making about concurrent SI fixation?
Original publication title
Predictors of Sacroiliac Joint Intervention Following Lumbar Spine Fusion