Minimally invasive arthrodesis of the sacroiliac joint (SIJ)

Abstract

Pain reduction and improvement in quality of life with sacroiliac joint (SIJ) fusion. Chronic SIJ-associated pain; positive response to SIJ injection with local anesthetic; positive SIJ provocation tests; failed conservative therapy over 6months. Non-SIJ-associated pain; tumor/infection/unstable fracture in the implantation area; malformations; tumor or osteolysis of the sacrum or ilium bone; active infection at the implantation site; allergy to metal components; secondary gain from illness, request for apension; inadequately treated osteoporosis. Transarticular placement of Kirschner's wires through the SI joint via minimally invasive lateral approach. Guided preparation of implant site over Kirschner's wires and implantation of 3 triangular, transarticular titanium implants for SIJ fusion. Deep vein thrombosis prophylaxis. 3weeks partial weight-bearing and then moving on to full weight-bearing. X‑ray controls at defined intervals. Physiotherapy. We enrolled 26patients who were followed up over the period of 4years. The evaluated endpoints were low back pain on the visual analog scale (VAS 0-10), grade of disability with the Oswestry Disability Index (ODI) and quality of life with the EuroQOL-5D. At 4years, mean low back pain improved compared to preoperative (VAS preoperative 8.4, VAS 4years postoperative 4.6). Mean improvements in ODI (ODI preoperative 58.1, ODI 4years postoperative 32.1) and EQ-5D (preoperative 0.5, after 4years 0.7) could be evaluated over the long-term period of 4years. Satisfaction rates were high and the proportion of subjects taking opioids decreased at the 4‑year follow-up (preoperative 82%, postoperative 39%). Implant loosening could not be detected on plain radiograph.