Unexpected Sex Differences in the Relationship of Sacroiliac Joint and Lumbar Spine Degeneration

The relationship between degenerative changes of the sacroiliac joints and the lumbar spine on CT has not been studied yet. The aim of this analysis is to determine the nature of their association as well as the influence of fixed anatomical spinopelvic parameters on sacroiliac joint degeneration. For this institutional review-board-approved investigation, imaging datasets as well as electronic medical records of 719 patients without back pain from the clinical routine of our department of radiology were included. Age, sex, weight category (slim, normal, obese), parity in women and indication for imaging were noted for all patients. The presence of degenerative lesions of the lumbar spine (disc degeneration, endplate degeneration, spondylophytes, and facet joint osteoarthritis) was noted separately at each lumbar segment (L1 to L5). Sacroiliac joints were assessed for sclerosis and osteophytes. Fixed anatomical spinopelvic parameters were measured: pelvic radius = PR; pelvic incidence = PI; sacral table angle = STA. Correlation as well as regression analyses were performed; data were analyzed for males and females separately. PI increased significantly with age in both women and men, while STA decreased and PR remained constant; neither of them was associated with SIJ degeneration. SIJ degeneration correlated with disc degeneration (tau = 0.331; p < 0.001), spondylophytes (tau = 0.397; p < 0.001), and facet joint degeneration (tau = 0.310; p < 0.001) in men, but with no parameter of spinal degeneration in women. Lumbar spinal degeneration increased the risk of sacroiliac joint degeneration in men significantly (OR 7.2; 95%CI 2.8-19.0), but it was not a significant covariable in women. Fixed spinopelvic parameters have little impact on sacroiliac joint degeneration. The degeneration of the sacroiliac joints and the lumbar spine appear to be parallel processes in men, but are largely unrelated in women.