Minimally invasive sacroiliac fusion, a case series, and a literature review

Abstract

Introduction: Non-autoimmune sacroiliac joint pain contributes to nearly a quarter of low back pain patients. Non-surgical management fails to satisfy patients. A new minimally invasive technique for sacroiliac stabilization has been introduced, defying the traditional rules of fusion. The results outside explanatory trials and in day-to-day practice have not been reported. Materials and methods: This case series includes 20 patients diagnosed with chronic sacroiliac pain resistant to conservative management for at least 6 months. The diagnosis was confirmed with a positive sacroiliac injection. Patients underwent stabilization using the iFuse® implant. Patients were followed up for a minimum of one year. The primary outcome was the functional outcomes, assessed using VAS, ODI, and SF36. Secondary procedure rates, complication rates, and radiological assessments of fusion were collected as secondary outcomes. Results: At one year, the mean VAS score improved from 81.25 ± 10.7 SD preoperatively to 52.5 ± 26.8, p-value 0.0013. The mean ODI improved from 54.8 ± 11.21 SD preoperatively to 41.315 ± 15.34, P value = 0.0079. The mean PCS and MCS of SF36 improved by 17 and 20 points, respectively. Only 55% of patients achieved the MCID for the VAS score. 35% of the cohort had secondary procedures. Discussion: Minimally invasive sacroiliac fusion resulted in an improvement in mean functional scores with a wide dispersion. Patients not achieving MCID are patients with either a malpositioned implant, an associated lumbar pathology, or an inaccurate diagnosis. Our results are underwhelming compared to similar work but are still better than conservative cohorts in comparative studies. Conclusion: Minimally invasive sacroiliac fusion can be used successfully in select patients. Attention to diagnosis and surgical technique can improve the reproducibility of results.

A New Approach to the Treatment of Sacroiliac Joint Pain and First Patient-Reported Outcomes Using a Novel Arthrodesis Technique for Sacroiliac Joint Fusion

“…Despite numerous studies on triangular implants, evidence of bone bridging between the ilium and sacrum has only been established in a minority of cases. [39][40][41][42] It therefore remains to be seen to what extent this transfixation of the joint will last in the case of decreasing bone density with age, especially in the sacrum. However, lateral implants with additional partial joint decortication achieved significantly higher radiographic fusion rates.…”

American Society of Pain and Neuroscience Best Practice (ASPN) Guideline for the Treatment of Sacroiliac Disorders

“…Preoperative features associated with poor surgical outcomes were female sex, pain in multiple regions, walking with a cane, and the use of a wheelchair preoperatively I-C Kurosawa, 2022 146 Case series iFuse Lateral 5 VAS, ODI Mean VAS improved from 88.0 ± 8.4 to 33.6 ± 31.9 mm at 3 months and 46.4 ± 30.9 mm at 36 months. Mean ODI improved significantly from 76.4% ± 3.8% to 46.2% ± 21.9% at 6 months, but not after II Rappoport, 2021 147 Prospective, observational SI-LOK Lateral 32 VAS, ODI Mean VAS decreased significantly to 20.0, 5.8 and 11.5 for back, left leg and right leg respectively; ODI score decreased significantly to 27.5 points I-B Novak, 2021 148 Prospective, observational iFuse Lateral 20 VAS Clinical improvement was reported in 81% of patients; mean VAS reduced from 6.1 points to 2.9 points postoperatively I-B Wales, 2021 149 Prospective, observational SI-LOK Lateral 33 SF-36, ODI, ED-5D, Majeed Overall improvement in all patient reported outcomes, however, only mental component of SF-36, ODI, Majeed scores, and ED-5D-5L were statistically significant I-C Calodney, 2022 74 Prospective, observational LINQ Posterior 69 VAS, ODI VAS mean average reduction 34.9; 17.7 mean ODI reduction I-B Amer, 2022 150 Case series iFuse ...…”