Biomechanics of unilateral and bilateral sacroiliac joint stabilization: laboratory investigation

Lindsey, Derek P.; Parrish, Robin; Gundanna, Mukund; Leasure, Jeremi; Yerby, Scott A.; Kondrashov, Dimitriy

doi:10.3171/2017.7.spine17499

Cited by 38 publications

(83 citation statements)

References 32 publications

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“…A biomechanical study showed that SIJF does not significantly alter the loading across the contralateral SIJ, suggesting no increase in the likelihood of adjacent segment degeneration. 37 Our data provide little evidence that SIJF increases the risk of hip or lumbar spine pathology. One subject underwent revision surgery of the index side at his request by a non-study physician.…”

Section: Discussioncontrasting

confidence: 54%

Long-term prospective outcomes after minimally invasive trans-iliac sacroiliac joint fusion using triangular titanium implants

Darr

Meyer

Whang

et al. 2018

MDER

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BackgroundMinimally invasive sacroiliac joint fusion (SIJF) has become an increasingly accepted surgical option for chronic sacroiliac (SI) joint dysfunction, a prevalent cause of unremitting low back/buttock pain.ObjectiveThe objective of this study was to report clinical and functional outcomes of SIJF using triangular titanium implants (TTI) in the treatment of chronic SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint (SIJ) disruption at 3 years postoperatively.MethodsA total of 103 subjects with SIJ dysfunction at 12 centers were treated with TTI in two prospective clinical trials (NCT01640353 and NCT01681004) and enrolled in this long-term follow-up study (NCT02270203). Subjects were evaluated in study clinics at study start and again at 3, 4, and 5 years.ResultsMean (SD) preoperative SIJ pain score was 81.5, and mean preoperative Oswestry Disability Index (ODI) was 56.3. At 3 years, mean pain SIJ pain score decreased to 26.2 (a 55-point improvement from baseline, p<0.0001). At 3 years, mean ODI was 28.2 (a 28-point improvement from baseline, p<0.0001). In all, 82% of subjects were very satisfied with the procedure at 3 years. EuroQol-5D (EQ-5D) time trade-off index improved by 0.30 points (p<0.0001). No adverse events definitely related to the study device or procedure were reported; one subject underwent revision surgery at year 3.7. SIJ pain contralateral to the originally treated side occurred in 15 subjects of whom four underwent contralateral SIJF. The proportion of subjects who were employed outside the home full- or part-time at 3 years decreased somewhat from baseline (p=0.1814), and the proportion of subjects who would have the procedure again was lower at 3 years compared to earlier time points.ConclusionIn long-term (3-year) follow-up, minimally invasive trans-iliac SIJF with TTI was associated with improved pain, disability, and quality of life with relatively high satisfaction rates.Level of evidenceLevel II.Clinical relevanceSIJF with TTI.

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Section: Discussioncontrasting

confidence: 54%

Long-term prospective outcomes after minimally invasive trans-iliac sacroiliac joint fusion using triangular titanium implants

Darr

Meyer

Whang

et al. 2018

MDER

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“…While our study did not incorporate this additional modality of testing, the biomechanics literature provides evidence that higher bone density does correspond to increased pullout force. A number of cadaveric biomechanical studies utilizing lateral or posterolateral implants have been performed to investigate the influence on sacroiliac joint stability [22][23][24], but a direct comparison using the two approaches may provide an interesting follow-up to this analysis. Based on these findings, we hypothesize that a lateral approach may provide a fixation that is more secure and less likely to loosen when compared to a SIJ fusion utilizing the posterolateral approach.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of the lateral and posterolateral trajectories for fixation of the sacroiliac joint—a cadaveric study

et al. 2020

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Background A number of minimally invasive sacroiliac (SI) joint fusion solutions for placing implants exist, with reduced post-operative pain and improved outcomes compared to open procedures. The objective of this study was to compare two MIS SI joint fusion approaches that place implants directly across the joint by comparing the ilium and sacrum bone characteristics and SI joint separation along the implant trajectories. Methods Nine cadaveric specimens (n = 9) were CT scanned and the left and right ilium and sacrum were segmented. The bone density, bone volume fraction, and SI joint gap distance were calculated along lateral and posterolateral trajectories and compared using analysis of variance between the two orientations. Results Iliac bone density, indicated by the mean Hounsfield Unit, was significantly greater for each lateral trajectory compared to posterolateral. The volume of cortical bone in the ilium was greater for the middle lateral trajectory compared to all others and for the top and bottom lateral trajectories compared to both posterolateral trajectories. Cortical density was greater in the ilium for all lateral trajectories compared to posterolateral. The bone fraction was significantly greater in all lateral trajectories compared to posterolateral in the ilium. No differences in cortical volume, cortical density, or cancellous density were found between trajectories in the sacrum. The ilium was significantly greater in density compared with the sacrum when compared irrespective of trajectory (p < 0.001). The posterolateral trajectories had a significantly larger SI joint gap than the lateral trajectories (p < 0.001). Conclusion Use of the lateral approach for minimally invasive SI fusion allows the implant to interact with bone across a significantly smaller joint space. This interaction with increased cortical bone volume and density may afford better fixation with a lower risk of pull-out or implant loosening when compared to the posterolateral approach.

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“…Triangular titanium implant with porous coating; lateral approach. 25 techniques and different types or designs of SIJ fusion implants. These studies, however, do not elucidate the biomechanical effects of surgical parameters such as number and positioning of implants one may use, unilateral versus bilateral placement, etc.…”

Section: Minimally Invasive Sij Fusionmentioning

confidence: 99%

“…Lindsey et al 25 compared the stabilization characteristics of unilateral and bilateral triangular implant placements across the SIJ during the oneleg stance condition. Unilateral instrumentation significantly decreased the ROM of the treated side, and did not affect nontreated contralateral SIJ motion during the one-leg stance condition.…”

Section: In Vitro Studiesmentioning

confidence: 99%

Biomechanics of the Sacroiliac Joint: Surgical Treatments

et al. 2020

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Background: Fixation is one of the most common surgical techniques for the treatment of chronic pain originating from the sacroiliac joint (SIJ). Many studies have investigated the clinical outcomes and biomechanics of various SIJ surgical procedures. However, the biomechanical literature points to several issues that need to be further explored, especially for the devices used in minimally invasive surgery of the SIJ. This study (part II) aims to assess biomechanical literature to understand the existing information as it relates to efficacies of the surgical techniques and the gaps in the knowledge base. Part I reviewed basic anatomy and mechanics of the SIJ joint, including difference between males and females, and causes of pain emanating from these joints. Methods: A thorough literature review was performed pertaining to studies related to SIJ fixation techniques and the biomechanical outcomes of the surgical procedures. Results: Fifty-five studies matched the search criteria and were considered for the review. These articles predominantly pertained to the biomechanical outcomes of the minimally invasive surgery with different instrumentation systems and surgical settings. Conclusions: The SIJ is one of the most overlooked sources of lower back pain. The joint is responsible for the pain in 15% to 30% of people suffering from lower back pain. Various studies have investigated the clinical outcomes of different surgical procedures intended to improve the pain and quality of life following surgery. The data show that these techniques are indeed effective. However, clinical studies have raised several issues, like optimal number and positioning of implants, unilateral versus bilateral placements, adjacent segment disease, implant designs, and optimal location of implants with respect to variations in bone density across the SIJ. Biomechanical studies using in vitro and in silico techniques have addressed some of these issues. Studies also point out the need for additional investigations for a better understanding of the underlying mechanics for the improved long-term surgical outcomes. Further long-term clinical follow-ups are essential as well. This review presents pertinent findings.

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Biomechanics of unilateral and bilateral sacroiliac joint stabilization: laboratory investigation

Cited by 38 publications

References 32 publications

Long-term prospective outcomes after minimally invasive trans-iliac sacroiliac joint fusion using triangular titanium implants

Long-term prospective outcomes after minimally invasive trans-iliac sacroiliac joint fusion using triangular titanium implants

Comparative analysis of the lateral and posterolateral trajectories for fixation of the sacroiliac joint—a cadaveric study

Biomechanics of the Sacroiliac Joint: Surgical Treatments

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