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Purpose : This study aimed to reveal the clinical features requiring sacroiliac joint (SIJ) arthrodesis, which was performed for patients who complain of severe SIJ pain. Methods : The differences in clinical features between a surgical treatment group (n = 20) and a conservative treatment group (n = 66) were investigated. All patients were definitively diagnosed with SIJ pain by the use of SIJ injections. Results : Six significant features were identified in the surgical treatment group, namely, sitting tolerance (< 15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and any accident that induced SIJ pain (P < 0.01). Univariate logistic regression analysis revealed that sitting tolerance < 15 minutes (odds ratio : 31.73), pain in the supine position (13.07), and pain while lying on the painful side (18.30) showed a high odds ratio. Conclusions : Sitting tolerance (< 15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and a history of any accident that induced SIJ pain may be considered as indicators for surgery after > 6 months of continued substantial conservative treatment.

Introduction: Lumbosacral transitional vertebrae (LSTV) can cause sacral dysmorphism. Sacroiliac joint (SIJ) arthrodesis has been widely performed as the last resort for severe SIJ pain. We report three kinds of technical pitfalls identified in the surgical records of SIJ arthrodesis for the patients with sacral dysmorphism induced by LSTV. Case Report: For the cases of a 34-year-old man with LSTV Castellvi’s Type IV, anterior SIJ arthrodesis using a plate and screws was performed. The most cranial sacral foramen was larger and irregularly round, and the nerve root ran to the lateral side from the deformed foramen more than usual. A firm medial traction of the nerve root together with the psoas major muscle for the purpose of attaching a plate and inserting screws on the sacrum side could cause the temporary radiculopathy. For a 26-year-old woman with a thin sacral alar due to IIIb, SIJ arthrodesis using multi screws with the posterolateral approach was performed. The most cranial screw penetrated the anterior margin of the sacrum and caused nerve root injury. For a 35-year-old man with Ib, posterior SIJ arthrodesis was attempted using screws and cylinder cages. The insertion of the implants using the posterior approach was technically challenging due to the small size of the sacrum. Conclusions: Pre-surgical planning for SIJ arthrodesis, including a surgical approach, is particularly important when we see patients with sacral dysmorphism induced by each type of LSTV. The presented surgical pitfalls will be valuable when surgeons perform SIJ arthrodesis for patients with LSTV.