• Thomas B Freeman, Konrad Bach, and Ryan D Murtagh.
• Department of Neurosurgery and Brain Repair, University of South Florida College of Medicine, Tampa, Florida, USA. Electronic address: tbfreeman@usf.edu.
• World Neurosurg. 2020 Apr 1; 136: e386-e392.

ObjectiveTo investigate whether sacroiliac join (SIJ) pain can be secondary to walking with a flexed posture resulting from stenosis with neurogenic claudication, and resolves spontaneously after lumbar decompression.MethodsA review of charts from January 1, 2014, through March 3, 2019, was performed to identify consecutive cases of adults 35 years of age or older with surgical spinal stenosis with neurogenic claudication as well as concomitant severe SIJ pain. Posture was considered flexed during walking if self-reported, confirmed by a close companion, or observed directly. SIJ pain was diagnosed clinically ± confirmatory injection. A 10-point visual analog scale was used to assess SIJ pain. The primary endpoint was SIJ pain improvement at a minimum of 24 months' follow-up. SIJ pain improvement at 3 months was used to assess the rate of improvement as a secondary endpoint.ResultsTen patients (3 female) met entry criteria: 4 were treated with decompression alone; 6 with decompression and spinal fusion. Mean SIJ visual analog scale pain score improved by 6.9 ± 2.4 (8.7 ± 1.6-1.8 ± 2.2; P < 0.0005). Results were similar for 20 patients at the secondary endpoint of 3 months.ConclusionsSacroiliac joint pain shows robust, rapid, reliable, and durable improvement following lumbar decompressive surgery. The addition of a spinal fusion also leads to a similar improvement in SIJ pain. This study demonstrates the importance of evaluating the specific source of low back pain in patients with stenosis, claudication, and SIJ pain so as to more effectively plan appropriate surgery.Copyright © 2020 Elsevier Inc. All rights reserved.

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