P154. Low back pain with surgical and nonsurgical treatment of closed pelvic ring fractures with sacral injuries: a single institutional retrospective review

Abstract

<h3>BACKGROUND CONTEXT</h3> Sacroiliac joint (SIJ) fusion surgery for chronic back pain has grown in popularity since 2011. A variety of implants have been developed since then to allow surgeons to perform this technique with ease while decreasing complications associated with a new technology. Despite the wide acceptance of this technology, factors that would lead to a satisfactory surgical outcome still remain unclear. Due to the robust mechanical properties of the incongruent sacroiliac joint, one could argue that the joint is truly not unstable. Adding additional stability by fusing the joint that is already stable does not explain why the procedure would be beneficial. Based on the hypothesis that SIJ pain is not necessarily due to mechanical instability, this study will review patients with pelvic trauma who either underwent nonoperative management versus operative management to assess who eventually developed chronic SIJ pain and required further ongoing intervention. For patients who underwent sacroiliac joint fusion, theoretically they should not develop chronic SIJ pain afterward. For patients who were treated nonoperatively, leading to potential mechanical instability, they would be more likely to develop chronic sacroiliac joint pain. This study will either validate or refute the belief that sacroiliac joint dysfunction is truly mechanically related. <h3>PURPOSE</h3> The purpose of this study is to determine if surgery negates the need for additional intervention for SI joint pain and determine if any displacement addressed during surgery contributes to better outcomes for the patient. <h3>STUDY DESIGN/SETTING</h3> This is a retrospective review of patients from a single Level I trauma center. <h3>PATIENT SAMPLE</h3> A total of 68 patients (56% male) from the University of Missouri-Columbia were included between 2015 and 2019. Patients between 18 and 65 years of age who sustained closed pelvic ring fractures with SI joint involvement were included in the study. Exclusion criteria include no contact information listed in chart, history of back pain prior to the injury, lack of appropriate followup radiographs and previous history of lumbar surgery or lumbar surgery as a result of the inciting injury. <h3>OUTCOME MEASURES</h3> The amount of anterior-posterior and vertical displacement were measured both pre- and postsurgery. Patients were separated into surgical and nonsurgical groups, with additional interventions of chiropractic manipulation, narcotics, physical therapy, non-steroidal anti-inflammatory medications and home exercises. <h3>METHODS</h3> Data analysis was performed with student's T test, Wilcoxon rank sum test and Fischer exact test with statistical significance achieved when p <0.05. A stepwise regression model was used to determine if comorbidities are associated with increased interventions in both the surgical and nonsurgical group. <h3>RESULTS</h3> No significant difference was found between the surgical and nonsurgical groups in terms of both demographics and comorbidities. There was also no significant difference between the number of interventions needed for patients treated with or without surgery. Increased comorbidities are not associated with an increased number of interventions needed in either the surgical or nonsurgical group. Additionally, surgery did not significantly decrease the amount of anterior-posterior and vertical displacement as measured on X-rays. <h3>CONCLUSIONS</h3> Conservative management is likely just as effective for certain pelvic ring injuries involving the SIJ. Based on current findings, providing additional mechanical stability for the SIJ does not necessarily provide a greater clinical outcome in these fractures. Therefore, the explanation for the clinical improvement of SIJ fusion in nontrauma patients remains elusive. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.