Invasive Sacroiliac Joint Fusion Research Articles

Prospective Trial of Sacroiliac Joint Fusion Using 3D-Printed Triangular Titanium Implants: 5-Year Follow-Up.

Prospective, multicenter, single arm study with 5-year follow up. To report long-term (5-year) safety, effectiveness, and radiographic outcomes after sacroiliac (SI) joint fusion (SIJF) with 3D-printed triangular titanium implants (TTI) and compare them with solid titanium plasma spray coated implants. A large literature base supports minimally invasive SIJF with TTI for chronic SIJ dysfunction. SIJF with TTI was performed in 51 subjects and scheduled follow-up occurred at 3, 6, 12, 24 and 60 months. Postoperative visits included quality of life questionnaires and functional tests. A high-resolution CT scan was performed at either 6 or 12 months, and again at 60 months. All CT scans were interpreted by an independent musculoskeletal radiologist. 5-year follow-up was available in 36 of 51 subjects (71%). At 5 years, improvements in SI joint pain (58.1 points [0-100 scale]), SIJ-related disability (Oswestry Disability Index [ODI], 25.4 points) and quality of life (EuroQOL 5D, 0.24 points, and EuroQOL visual analog scale, 13.4 points) were sustained and showed no signs of diminution. The percentage of patients using opioids for SIJ pain decreased markedly from baseline (57%) to 5 years (17%). Physical function tests showed persistent improvements from baseline. There was no evidence of device breakage, migration or subsidence and few late adverse events occurred attributable to the device. Independent analysis of CT scans showed bone opposed to implants in all cases, and evidence of bone bridging in 90% of cases, and no evidence of radiolucency or other adverse bone reactions. Prospective 5-year follow-up showed that SIJ fusion using 3D-printed TTI resulted in immediate, marked, and persistent improvements in pain and quality of life, with improved physical function, reduced opioid use, and a low rate of revision surgery. Radiographic evidence showed implant integration and joint fusion. Level II.

Effectiveness of intra-articular analgesia in reducing postoperative pain after minimally invasive sacroiliac joint fusion: a double-blind randomized controlled trial

During the first postoperative days following minimally invasive sacroiliac joint fusion (MISJF), patients often report serious pain, which contributes to high utilization of painkillers and prevention of early mobilization. This prospective, double-blind randomized controlled trial investigates the effectiveness of intraoperative SIJ infiltration with bupivacaine 0.50% versus placebo (NaCl 0.9%) in 42 patients in reducing postoperative pain after MISJF. The primary outcome was difference in pain between bupivacaine and placebo groups, assessed as fixed factor in a linear mixed model. Secondary outcomes were opioid consumption, patient satisfaction, adverse events, and length of hospital stay. We found that SIJ infiltration with bupivacaine did not affect postoperative pain scores in comparison with placebo, neither as group-effect (p = 0.68), nor dependent on time (group*time: p = 0.87). None of the secondary outcome parameters were affected in the postoperative period in comparison with placebo, including opioid consumption (p = 0.81). To conclude, intra-articular infiltration of the SIJ with bupivacaine at the end of MISJF surgery is not effective in reducing postoperative pain. Hence, we do not recommend routine use of intraoperative SIJ infiltration with analgesia in MISJF.

Minimally Invasive Sacroiliac Joint Fusion: A Systematic Review and a Meta-Analysis

Abstract Background Low back pain (LBP) is a worldwide health problem and one of the top three causes of health deterioration in affluent countries. After the common cold, LBP is the second most prevalent reason for visits to primary care providers. Aside from high levels of disability and lost income, LBP increases the risk of falls in the elderly, which can result in hip and/or spinal fractures, increasing morbidity and mortality in this vulnerable group. Materials and Methods Application of inclusion and exclusion criteria to study Abstracts yielded 9 articles. A total of 390 studies were identified from the database search. After review, a total of 9 studies consisting of 1224 patients with SIJF were selected. Results A total number of 1224 patients with SIJF were selected. The 9 studies ranging from 2012 to 2019. Among the 9 studies were 4 randomized control trials and 2 studies were retrospective studies. Among the patients, 407 males and 817 females. The age ranged from 24 years to 81 years among the 9 studies. The follow-up duration ranged from 6 months to 2 years among our studies. Conclusion The meta-analysis performed in this systematic review demonstrated that patients who fail conservative therapy and have a positive diagnostic SI joint block may clinically benefit from minimally invasive sacroiliac joint fusion using a lateral trans-articular approach. Sacroiliac joint fusion appears to be a satisfactory procedure for alleviating low back pain.

Injury to the Superior Gluteal Artery During Minimally Invasive Sacroiliac Joint Fusion: A Case Series.

A rarely reported complication with sacroiliac joint fusion (SJF) is an iatrogenic injury to the superior gluteal artery (SGA). This case series includes 3 cases which had a suspected injury to the SGA. Case 1 describes how hemostasis achieved with exploration of the wound followed by embolization by interventional radiology (IR). In Case 2, electrocautery, hemostatic agents, and pressure were used with success. Case 3 highlights the use of IR as the initial method for controlling bleeding. This report describes a rare complication during SJF and provides an algorithm to help guide surgeons in decision making.

Patient-reported outcomes after minimally invasive sacro-iliac joint surgery: a cohort study based on the Swedish Spine Registry.

There is conflicting evidence regarding treatment outcomes after minimally invasive sacroiliac joint fusion for long-lasting severe sacroiliac joint pain. The primary aim of our cohort study was to investigate change in patient-reported outcome measures (PROMs) after minimally invasive sacroiliac joint surgery in daily practice in the Swedish Spine Registry. Secondary aims were to explore the proportion of patients reaching a patient acceptable symptom score (PASS) and the minimal clinically important difference (MCID) for pain scores, physical function, and health-related quality of life outcomes; furthermore, to evaluate self-reported satisfaction, walking distance, and changes in proportions of patients on full sick leave/disability leave and report complications and reoperations. Data from the Swedish Spine Registry was collected for patients with first-time sacroiliac joint fusion, aged 21 to 70 years, with PROMs available preoperatively, at 1 or 2 years after last surgery. PROMs included Oswestry Disability Index (ODI), Numeric Rating Scale (NRS) for low back pain (LBP) and leg pain, and EQ-VAS, in addition to demographic variables. We calculated mean change from pre- to postoperative and the proportion of patients achieving MCID and PASS. 68 patients had available pre- and postoperative data, with a mean age of 45 years (range 25-70) and 59 (87%) were female. At follow-up the mean reduction was 2.3 NRS points (95% confidence interval [CI] 1.6-2.9; P < 0.001) for LBP and 14.8 points (CI 10.6-18.9; P < 0.001) for ODI. EQ-VAS improved by 22 points (CI 15.4-30.3, P < 0.001) at follow-up. Approximately half of the patients achieved MCID and PASS for pain (MCID NRS LBP: 38/65 [59%] and PASS NRS LBP: 32/66 [49%]) and physical function (MCID ODI: 27/67 [40%] and PASS ODI: 24/67 [36%]). The odds for increasing the patient's walking distance to over 1 km at follow-up were 3.5 (CI 1.8-7.0; P < 0.0001), and of getting off full sick leave or full disability leave was 0.57 (CI 0.4-0.8; P = 0.001). In the first 3 months after surgery 3 complications were reported, and in the follow-up period 2 reoperations. We found moderate treatment outcomes after minimally invasive sacroiliac joint fusion when applied in daily practice with moderate pain relief and small improvements in physical function.

Safety and Preliminary Effectiveness of Lateral Transiliac Sacroiliac Joint Fusion by Interventional Pain Physicians: A Retrospective Analysis.

Minimally invasive sacroiliac (SI) joint fusion has become the mainstay treatment for chronic refractory sacroiliac joint dysfunction. Multiple procedures are now available including transfixing procedures with implants placed in the lateral or posterolateral transiliac trajectories, and intra-articular procedures with devices and/or allograft placed via a dorsal approach. To date, the published literature on the lateral approach has been primarily by surgeons. This retrospective chart review aims to evaluate the safety and preliminary effectiveness when the procedure is performed by physicians trained in interventional pain management. Retrospective analysis of patients who underwent lateral SI joint fusion using a lateral transiliac approach between December 2022 and September 2023 by a single physician. Data on demographics, perioperative details, complications, and postoperative outcomes were collected and analyzed. The study was reviewed by WCG IRB and received an exemption authorization. Medical charts were reviewed for the first 49 consecutive cases performed. Mean (SD, range) age was 64 (11, 34-83), BMI was 32.5 (8.4), 59% were female, 35% were smokers, and 82% were on opioids at baseline. Mean (SD) operative time was 40 (11) minutes and all procedures were performed at an ambulatory surgery center under monitored anesthesia care. No device- or procedure-related complications occurred. Mean follow up was 175 days; Mean (SD) baseline reported pain was 9 (1.5) on a 0-10 numerical rating scale. At follow up, 88% of the patients reported ≥50% pain relief. Six patients who reported 0% relief suffer from multiple pain generators and are on long term opioids. Results of this single center experience support the safety of lateral SI joint fusion using a threaded implant when performed by interventional pain management physicians. However, further prospective studies with larger sample sizes and longer follow-ups are warranted to validate these findings.

Minimally invasive sacroiliac joint fusion secondary to lumbosacral fusion: Clinical and functional results at 2 years of follow-up

IntroductionDegenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion. Materials and methodsWe carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2years’ follow-up. The primary outcome was the improvement in lumbar and radicular pain on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59years (27–88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1–7) before the SI fusion. ResultsThe lumbar and radicular NRS were 8.4 (7–10) and 5.1 (2–10) preoperatively and 5.2 (0–8) and 3.0 (0–8) at 2years postoperatively, which was a reduction of 37% and 42% (p<0.001), respectively. The Oswestry score went from 69.4 (52–86) preoperatively to 45.6 (29–70) at 2years, which was a 33% improvement (p<0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery. DiscussionAfter minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included. ConclusionMinimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally. Level of evidenceIV, retrospective study.

Osseointegration of minimally invasive sacroiliac joint fixation implants-A human retrieval study.

Minimally invasive sacroiliac joint fusion has become increasingly prevalent and is described to reduce pain and improve function. In some patients, pain can recur several months after primary surgery. Lack of early implant osseointegration might be a cause of pain and hence an indication for revision surgery. Triangular titanium implants are the most documented implant for minimally invasive sacroiliac joint fusion. There is, however, no knowledge of how triangular titanium implants osseointegrate in humans and whether fusion is induced over the sacroiliac joint. During planned revision surgery due to recurrent pain, six triangular titanium implants were retrieved from six different patients at median 9 months from primary surgery. All six implants were scanned using microcomputed tomography. The presence or absence of bone in-growth, on-growth, and through-growth of the implants was evaluated as an indication of implant osseointegration. Three of six implants showed no or minor signs of osseointegration. Of the three remaining implants, one showed partial osseointegration and two implants showed high degrees of osseointegration. This study showed that triangular titanium implants can osseointegrate into host bone in humans. When osseointegration occurs, triangular titanium implants can give fusion across the sacroiliac joint.

Hydroxyapatite-Coated Screws Versus Titanium Triangular Dowels for Sacroiliac Joint Fusion: Results From a Nonrandomized Prospective Outcome Study

This is a single-surgeon series that prospectively evaluates the results of sacroiliac joint (SIJ) fusion for patients with SIJ dysfunction using hydroxyapatite-coated screws (HACSs) compared with titanium triangular dowels (TTDs). A total of 113 patients underwent SIJ fusion surgery between 2013 and 2018 at the University Hospital Llandough to treat symptomatic SIJ dysfunction not responding to nonoperative measures. Of the 113 patients, 40 were treated with HACSs and 73 with TTDs. Patient-reported outcomes measures (PROMs) were collected preoperatively and at 12 months postoperatively, including the 36-item short-form health survey, Oswestry disability index, EuroQol-5D-5L, and Majeed pelvic score. Patients with ongoing symptoms were followed up beyond the study period. Of the 113 patients, 33 completed follow-up in the HACS group compared with 61 in the TTD group. Both groups had comparable preoperative PROMs; however, the postoperative PROMs were significantly better in the TTD group. Additionally, 21 patients (63%) in the HACS group had radiological evidence of screw lysis compared with 5 patients (9%) in the TTD group. A subgroup analysis revealed less significant improvement in PROMs for patients with screw lysis compared with those without. Four patients were offered further revision surgery. Minimally invasive SIJ fusion has been shown to have good clinical outcomes for select patients. However, our experience shows that HACSs are associated with a high rate of screw lysis and poorer patient outcomes compared with TTDs. Therefore, we recommend the use of TTDs instead of HACSs for SIJ fusion surgery.

Minimally invasive sacroiliac joint fusion using triangular titanium implants versus nonsurgical management for sacroiliac joint dysfunction: a systematic review and meta-analysis.

Minimally invasive sacroiliac joint (MISIJ) fusion is a surgical option to relieve SIJ pain. The aim of this systematic review and meta-analysis was to compare MISIJ fusion with triangular titanium implants (TTI) to nonoperative management of SIJ dysfunction. We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included prospective clinical trials that compared MISIJ fusion to nonoperative management in individuals with chronic low back pain attributed to SIJ dysfunction. We evaluated pain on visual analogue scale, Oswestry Disability Index (ODI) score, health-related quality of life (HRQoL) using the 36-Item Short Form Health Survey (SF-36) physical component (PCS) and mental component summary (MCS) scores, patient satisfaction, and adverse events. A total of 8 articles representing 3 trials that enrolled 423 participants were deemed eligible. There was a significant reduction in pain score with MISIJ fusion compared with nonoperative management (standardized mean difference [SMD] -1.71, 95% confidence interval [CI] -2.03 to -1.39). Similarly, ODI scores (SMD -1.03, 95% CI -1.24 to -0.81), SF-36 PCS scores (SMD 1.01, 95% CI 0.83 to 1.19), SF-36 MCS scores (SMD 0.72, 95% CI 0.54 to 0.9), and patient satisfaction (odds ratio 6.87, 95% CI 3.73 to 12.64) were significantly improved with MISIJ fusion. No significant difference was found between the 2 groups with respect to adverse events (SMD -0.03, 95% CI -0.28 to 0.23). Our analysis showed that MISIJ fusion with TTI shows a clinically important and statistically significant improvement in pain, disability score, HRQoL, and patient satisfaction with a similar adverse event profile to nonoperative management in patients with chronic low back pain attributed to SIJ dysfunction.

Effectiveness of intra-articular analgesia in reducing postoperative pain after minimally invasive sacroiliac joint fusion: A double-blind randomized controlled trial

Effectiveness of intra-articular analgesia in reducing postoperative pain after minimally invasive sacroiliac joint fusion: A double-blind randomized controlled trial

Duration and Magnitude of Opioid Use After Minimally Invasive Sacroiliac Joint Fusion.

Retrospective cohort study performed in a nationwide insurance claims database. To evaluate the duration and magnitude of post-operative opioid prescriptions after minimally invasive surgical sacroiliac joint fusion (MIS SIJF) as compared to other common spine surgeries. MIS SIJF has been reported to significantly improve quality of life and reduce pain. However, there is a paucity of reported data on post-operative opioid use in patients undergoing MIS SIJF for sacroiliac joint dysfunction. A nationwide insurance claims database was queried to identify 4,666 patients who underwent MIS SIJF. Patients were stratified by pre-operative opioid use: Opioid naïve, sporadic use, or chronic use were respectively defined as 0,1, or≥2 opioid prescriptions filled within 6 months prior to surgery. Duration of opioid use was defined by the time between MIS SIJF and last opioid prescription filled while magnitude of opioid use was determined by milligram morphine equivalents filled by 30 days post-operation. This opioid use data was compared to that of other common spine surgeries. Patients undergoing MIS SIJF continued to fill opioid prescriptions 1-year post-operatively at significantly higher proportions than those undergoing other common spine procedures assessed by prior literature within each of the pre-operative opioid use cohorts (chronic: 73% vs. 49-62%; P <0.0001, sporadic: 39% vs. 23-28%; P <0.0001, opioid naïve: 22% vs. 15-18%; P <0.0001). Chronic users filled the highest opiate dosages during the 30-day post-operative period, filling on average 64.75 MME/d compared to 19.75 MME/d and 24.25 MME/d by the opioid naïve and sporadic users, respectively. After MIS SIJF, opioid naïve patients use fewer opioids and for a shorter period of time compared to patients with sporadic or chronic pre-operative opioid use. MIS SIJF may result in less effective pain reduction when compared to other common spine surgeries evaluated via identical methodology. 3.

Effects of BMI on SI joint fusion outcomes: examining the evidence to improve insurance guidelines

BACKGROUND CONTEXTObesity is increasing. Previous studies have demonstrated an association between obesity and adverse events after lumbar fusion. There is limited evidence on the effect of obesity on minimally invasive SI joint fusion (SIJF) outcomes. PURPOSEThe purpose of this study was to investigate the impact of obesity on patient-reported outcomes in patients undergoing SIJF surgery using triangular titanium implants (TTI). STUDY DESIGNRetrospective cohort study based on four prospective clinical trials (INSITE [NCT01681004], SIFI [NCT01640353], iMIA [NCT01741025], and SALLY [NCT03122899]). PATIENT SAMPLEAdult patients ≥18 years of age who underwent minimally invasive surgery (MIS) sacroiliac joint (SIJ) fusion between 2012 and 2021. OUTCOME MEASURESVisual analog scale (VAS Pain), Oswestry Disability Index (ODI). METHODSParticipants were classified using the National Institutes of Health body mass index (BMI). Patients with a BMI of 30 to 39 with no significant comorbidity are considered obese, patients with a BMI of 35 to 39 with a significant comorbidity or a BMI of 40 or greater are considered morbidly obese. All subjects underwent either minimally invasive SIJ fusion with TTI or nonsurgical management (INSITE and iMIA studies only). All subjects completed SIJ pain scale scores (measured with a 100-point VAS) and disability scores (measured with ODI) at baseline and at scheduled visits to 24 months. Repeated measures analysis of variance was used to examine the impact of BMI category on score changes. RESULTSIn the SIJF group, mean SIJ pain improved at 24 months by 53.3 points (p<.0001). Over the 24-month follow-up period, BMI category did not impact mean improvement in SIJ pain scale score (repeated measures analysis of variance (ANOVA) p=.44). In the SIJF group, mean ODI at 24 months improved by 25.8 points (p<.0001). BMI category did not impact mean improvement in ODI (ANOVA p=.60). In the nonsurgical management (NSM) group, mean improvements in SIJ pain scale and ODI were clinically small (8.7 and 5.2 points, respectively) and not affected by BMI category (ANOVA p=.49 and .40). CONCLUSIONThis study demonstrates similar benefits and risks of minimally invasive SIJ fusion with TTI across all BMI categories. This analysis suggests that obese patients benefit from minimally invasive SIJ fusion and should not be denied this procedure based solely on elevated BMI.

Patient-Specific 3D Virtual Surgical Planning Using Simulated Fluoroscopic Images to Improve Sacroiliac Joint Fusion

Sacroiliac (SI) joint dysfunction can lead to debilitating pain but can be treated with minimally invasive sacroiliac joint fusion (SIJF). This treatment is commonly performed using 2D fluoroscopic guidance. This makes placing the implants without damaging surrounding neural structures challenging. Virtual surgical planning (VSP) using simulated fluoroscopic images may improve intraoperative guidance. This article describes a workflow with VSP in SIJF using simulated fluoroscopic images and evaluates achieved implant placement accuracy. Ten interventions were performed on 10 patients by the same surgeon, resulting in a total of 30 implants; the median age was 39 years, and all patients were female. The overall mean implant placement accuracy was 4.9 ± 1.26 mm and 4.0 ± 1.44°. There were no malpositioning complications. VSP helped the surgeon understand the anatomy and determine the optimal position and length of the implants. The planned positions of the implants could be reproduced in surgery with what appears to be a clinically acceptable level of accuracy.

Minimally Invasive SI Joint Fusion Procedures for Chronic SI Joint Pain: Systematic Review and Meta-Analysis of Safety and Efficacy.

Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available. Data abstraction and random effects meta-analysis of safety and efficacy outcomes from published patient cohorts. Patient-reported outcomes (PROs) and safety measures were stratified by surgical technique: transiliac, including lateral transiliac (LTI) and posterolateral transiliac (PLTI), and posterior interpositional (PI) procedures. Fifty-seven cohorts of 2851 patients were identified, including 43 cohorts (2126 patients) for LTI, 6 cohorts (228 patients) for PLTI, and 8 cohorts (497 patients) for PI procedures. Randomized trials were only available for LTI. PROs were available for pain (numeric rating scale) in 57 cohorts (2851 patients) and disability (Oswestry Disability Index [ODI]) in 37 cohorts (1978 patients).All studies with PROs showed improvement from baseline after surgery. Meta-analytic improvements in pain scores were highest for LTI (4.8 points [0-10 scale]), slightly lower for PLTI (4.2 points), and lowest for PI procedures (3.8 points, P = 0.1533). Mean improvements in ODI scores were highest for LTI (25.9 points), lowest for PLTI procedures (6.8 points), and intermediate for PI (16.3 points, P = 0.0095).For safety outcomes, acute symptomatic implant malposition was 0.43% for LTI, 0% for PLTI, and 0.2% for PI procedures. Wound infection was reported in 0.15% of LTI, 0% of PLTI, and 0% of PI procedures. Bleeding requiring surgical intervention was reported in 0.04% of LTI procedures and not reported for PLTI or PI. Breakage and migration were not reported for any device. Radiographic imaging evaluation reporting implant placement accuracy and fusion was only available for LTI. Literature support for SI joint fusion is growing. The LTI procedure contains the largest body of available evidence and shows the largest improvements in pain and ODI. Only LTI procedures have independent radiographic evidence of fusion and implant placement. The adverse event rate for all procedures was low.

Return to Duty inMilitary Service Members Following Minimally Invasive Sacroiliac Joint Fusion.

As the utilization of minimally invasive sacroiliac joint fusion (SIJF) continues to expand, a better understanding of postoperative outcomes is needed, particularly in young and active individuals. The purpose of this study is to assess the outcomes of this procedure in an active duty military population by examining return-to-duty (RTD) rates. A retrospective review of the electronic medical record from a tertiary military medical center was performed for active duty service members undergoing SIJF from January 2013 to January 2019. The primary outcome measured was RTD at 6 months, with active duty status at 1 year, last follow-up, and revision surgery as secondary outcomes. Demographic and surgical variables recorded included patient age, gender, military rank, utilization of navigation, and implant type. Sixteen service members met the inclusion criteria, with a mean age of 40.5 ± 6.7 years. The mean follow-up after surgery was 24 ± 15 months. Patients received either cylindrical (n = 6) or triangular (n = 10) implants placed with (n = 6) or without (n = 10) navigation. Within 6 months of surgery, 56% of patients were able to RTD. Patients undergoing navigation-assisted procedures were significantly more likely to RTD at 6 months (100% vs. 30%, P = .011) compared to those undergoing surgery performed with orthogonal fluoroscopic imaging. Compared to those with cylindrical implants, patients with triangular implants were also more likely to RTD at 6 months (80% vs. 17%, P = .035). Following SIJF, a small majority of service members were able to return to full active duty status by 6 months. Further studies are needed to assess the potential benefits of navigation and implant selection, as our retrospective review noted differences in outcomes based on these variables.

Posterior oblique technique for sacroiliac joint fusion leads to greater pain relief and similar improvement in function compared to the lateral technique: A retrospective, comparative study

BackgroundManagement of chronic sacroiliac joint (SIJ) pain among patients who do not respond to nonsurgical treatment is increasingly turning toward minimally invasive SIJ fusion. There are different techniques available to perform this procedure, with the lateral technique being more commonly studied than the posterior oblique technique. This study examined the effects of these techniques on pain relief and functional improvement, both preoperatively and at a 12-month follow-up. MethodsThis retrospective cohort study analyzed data from 45 patients who underwent SIJ fusion. Included patients were ≥50 years old, nonresponsive to conservative treatment. Subjects were divided into 2 cohorts based on the SIJ fusion technique. Primary outcomes were pain relief, measured by Visual Analog Scale (VAS), and functional improvement, determined by the Oswestry Disability Index (ODI); both were recorded and assessed at baseline, postoperative, and the change from pre- to postoperative. Additionally, data regarding patient demographics, previous lumbar fusion, operative time, and duration of hospital stay were collected and analyzed. ResultsBaseline demographic and clinical variables exhibited no significant differences in distribution between groups. The posterior oblique cohort demonstrated a substantial reduction in operative time (over 50%) and duration of hospital stay compared to lateral cohort. Pain relief (postoperative VAS: lateral 3.5±1.7 vs. posterior oblique 2.4±1.5 [p=.02]) and functional improvement (postoperative ODI: lateral 29.6±7.3 vs. posterior oblique 21±5.7 [p≤.001]) were significantly better in the posterior oblique group. Pre- to postoperative improvement analysis indicated greater reduction in pain (VAS: lateral −4.4±1.9 vs. posterior oblique −6.1±1.5 [p=.002]) in the posterior oblique group. ConclusionsCompared to the lateral technique group, patients undergoing minimally invasive SIJ fusion through the posterior oblique technique experienced greater pain relief and demonstrated a trend toward better functional improvement, with shorter operative times and duration of hospital stay. The posterior oblique technique may be more efficient and beneficial to manage patients suffering from chronic SIJ pain through joint fusion.

Minimally Invasive Postero-Inferior Sacroiliac Joint Fusion: Surgical Technique and Procedural Details.

(1) Background: Minimally invasive sacroiliac joint (SIJ) fusion is the preferred surgical intervention to treat chronically severe pain associated with SIJ degeneration and dysfunction. (2) Methods: This paper details the ten-step surgical procedure associated with the postero-inferior approach using the PsiF™ DNA Sacroiliac Joint Fusion System. (3) Results: The posterior surgical approach with an inferior operative trajectory (postero-inferior) utilizes easily identifiable landmarks to provide the safest, most direct access to the articular joint space for transfixing device placement. Implanting the device through the subchondral bone provides maximum fixation and stabilization of the joint by utilizing an optimal amount of cortical bone-implant interface. Approaching the joint from the inferior trajectory also places the implant perpendicular to the S1 endplate at a "pivot point" near the sacral axis of rotation, which addresses the most significant motion of the joint. (4) Conclusions: Further observational data from real-world clinical use are encouraged to further validate this procedure as the surgical preference for minimally invasive SIJ fusion.

Ethnic Differences in Western and Asian Sacroiliac Joint Anatomy for Surgical Planning of Minimally Invasive Sacroiliac Joint Fusion.

Pain originating in the sacroiliac joint (SIJ) is a contributor to chronic lower back pain. Studies on minimally invasive SIJ fusion for chronic pain have been performed in Western populations. Given the shorter stature of Asian populations compared with Western populations, questions can be raised regarding the suitability of the procedure in Asian patients. This study investigated the differences in 12 measurements of sacral and SIJ anatomy between two ethnic populations by analyzing computed tomography scans of 86 patients with SIJ pain. Univariate linear regression was performed to evaluate the correlations of body height with sacral and SIJ measurements. Multivariate regression analysis was used to evaluate systematic differences across populations. Most sacral and SIJ measurements were moderately correlated with body height. The anterior-posterior thickness of the sacral ala at the level of the S1 body was significantly smaller in the Asian patients compared with the Western patients. Most measurements were above standard surgical thresholds for safe transiliac placement of devices (1026 of 1032, 99.4%); all the measurements below these surgical thresholds were found in the anterior-posterior distance of the sacral ala at the S2 foramen level. Overall, safe placement of implants was allowed in 84 of 86 (97.7%) patients. Sacral and SIJ anatomy relevant to transiliac device placement is variable and correlates moderately with body height, and the cross-ethnic variations are not significant. Our findings raise a few concerns regarding sacral and SIJ anatomy variation that would prevent safe placement of fusion implants in Asian patients. However, considering the observed S2-related anatomic variation that could affect placement strategy, sacral and SIJ anatomy should still be preoperatively evaluated.

Motion analysis after minimally invasive sacroiliac joint fusion in patients with postpartum sacroiliac joint dysfunction: An observational case-control study

Motion analysis after minimally invasive sacroiliac joint fusion in patients with postpartum sacroiliac joint dysfunction: An observational case-control study