Abstract
Sacroiliac (SI) joint dysfunction is a significant contributor to low back pain. Percutaneous SI joint fusion is a minimally invasive procedure that can provide excellent pain relief for patients, but it is not without complications, especially in patients with abnormal lumbosacral anatomy. We report the case of a 71-year-old man with sacral dysmorphism who had a painful SI joint that was refractory to conservative therapy. After undergoing an elective percutaneous SI joint fusion, he was discharged in stable condition. He returned in a delayed fashion with a large subgluteal hematoma. Imaging revealed disruption of a branch of the superior gluteal artery (SGA). Surgical exploration and ligation of the SGA were undertaken. Sacral dysmorphism affects SI joint fusion procedures by altering sacral anatomy and the safe zones for SI joint implants. Variations in lumbosacral anatomy can also alter the course of the SGA and adjacent nerves. Due to the wide prevalence of sacral dysmorphism, especially in the setting of low back pain, pre-surgical planning to avoid iatrogenic injuries must be considered with advanced imaging studies such as a computed tomography angiogram of the pelvis or catheter-based angiogram, or alternative surgical approaches to the SI joint must be taken.
Highlights
Pain arising from the sacroiliac (SI) joint is increasingly recognized as a substantial contributor to low back pain
Sacroiliac (SI) joint dysfunction is a significant contributor to low back pain
We report here the case of a patient who underwent percutaneous, transgluteal approach SI joint fusion that was complicated by injury to a branch of the superior gluteal artery (SGA) with delayed development of a postoperative hematoma requiring a second operation
Summary
Pain arising from the sacroiliac (SI) joint is increasingly recognized as a substantial contributor to low back pain. We report here the case of a patient who underwent percutaneous, transgluteal approach SI joint fusion that was complicated by injury to a branch of the superior gluteal artery (SGA) with delayed development of a postoperative hematoma requiring a second operation. On postoperative day 19, the patient presented to the emergency room with a three-day history of pain in the right gluteal and posterior thigh regions. Due to this drop in hemoglobin over 24 hours and the patient’s increasing pain level, the decision was made to take the patient to the operating room for exploration and removal of hematoma. The patient was walking unassisted and was not requiring pain medicines
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