Abstract
Over the past decade, minimally invasive sacroiliac joint (SIJ) fusion has become an effective treatment for patients suffering from low back pain (LBP) originating from the SIJ. Perioperative C-arm fluoroscopy-assisted surgical navigation during SIJ fusion remains challenging due to the lack of 3D spatial information. This study developed and assessed a 3D CT/2D fluoroscopy integration approach based on digitally reconstructed radiographs (DRRs) obtained from pre-operative CT scans. Development of this approach proved feasible and landmarks were successfully translated, in retrospect, to perioperatively acquired fluoroscopies. Further expansion of and research into the proposed approach to increase perioperative navigation is indicated and additional validation should be performed.
Highlights
The sacroiliac joint (SIJ) is a frequent but under-recognized and under-diagnosed origin of low back pain (LBP), mainly due to the absence of any gold standard diagnostic test
During SIJ fusion (SIJF) surgery, it is crucial that implantation trajectory and final implant position avoid the L5 nerve root located on the anterior sacral alar surface and the S1 and S2 neural foramen to reduce the chance of major complications
Results from the 3D segmentation approach were utilized in a registration algorithm in order to translate the segmentations on the digitally reconstructed radiographs (DRRs) onto the actual perioperative fluoroscopy images
Summary
The sacroiliac joint (SIJ) is a frequent but under-recognized and under-diagnosed origin of low back pain (LBP), mainly due to the absence of any gold standard diagnostic test. Once SIJ dysfunction is identified as origin of LBP and nonsurgical therapies (e.g. physical therapy or therapeutic SIJ injections) fail to provide sustained symptom relief, SIJ fusion (SIJF) may be indicated [5,6]. Minimally invasive SIJF has become the surgical approach of choice, showing promising results [7,8,9,10]. Invasive SIJF by implantation of three triangular titanium fusion implants (iFuse system, SI-BONE, Inc., San Jose, CA) assisted by C-arm fluoroscopy has shown improvements in patient-reported outcomes and provide superior outcome results in comparison to conservative treatment or screw-type and open surgery [11,12,13].
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