Minimally Invasive Versus Open Sacroiliac Joint Fusion: Are They Similarly Safe and Effective?

Ledonio, Charles Gerald T.; Polly, David W.; Swiontkowski, Marc F.

doi:10.1007/s11999-014-3499-8

Cited by 97 publications

(86 citation statements)

References 23 publications

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“…However, the number of patients reaching the minimally clinically important difference and those showing overall improvement were greater in the minimally invasive surgery group. The same author recently have published another paper [31] with 63 patients prospectively studied (open: 36; MIS: 27) who underwent SI joint fusion with minimum 1-year follow-up. Their results have shown that patients in the open group had a higher mean estimated blood loss (681 ml versus 41 ml, p<0.001).…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Sacroiliac Joint Arthrodesis: Experience in a Prospective Series with 24 Patients

Vanaclocha¹

2014

J Spine

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Sacroiliac Joint Arthrodesis: Experience in a Prospective Series with 24 Patients

Vanaclocha¹

2014

J Spine

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“…Therefore, minimally invasive techniques [21], which can also be performed percutaneously [22], were developed to reduce postoperative morbidity while maintaining or improving upon effectiveness. Some comparative studies suggest that minimally invasive strategies may be superior to open strategies [23][24][25]. Herein, we present the first prospective multicenter European study comparing the safety and effectiveness of minimally invasive SIJF using triangular titanium implants vs CM for patients with chronic SIJ pain.…”

Section: Introductionmentioning

confidence: 99%

Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management

et al. 2016

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Purpose To compare the safety and effectiveness of minimally invasive sacroiliac joint fusion (SIJF) using triangular titanium implants vs conservative management (CM) in patients with chronic sacroiliac joint (SIJ) pain. Methods 103 adults with chronic SIJ pain at nine sites in four European countries were randomly assigned to and underwent either minimally invasive SIJF using triangular titanium implants (N = 52) or CM (N = 51). CM was performed according to the European guidelines for the diagnosis and management of pelvic girdle pain and consisted of optimization of medical therapy, individualized physical therapy (PT) and adequate information and reassurance as part of a multifactorial treatment. The primary outcome was the difference in change in self-rated low back pain (LBP) at 6 months. Additional endpoints included quality of life using EQ-5D-3L, disability using Oswestry Disability Index (ODI), SIJ function using active straight leg raise (ASLR) test and adverse events. NCT01741025. Results At 6 months, mean LBP improved by 43.3 points in the SIJF group and 5.7 points in the CM group (difference of 38.1 points, p \ 0.0001). Mean ODI improved by 26 points in the SIJF group and 6 points in the CM group (p \ 0.0001). ASLR, EQ-5D-3L, walking distance and satisfaction were statistically superior in the SIJF group. The frequency of adverse events did not differ between groups. One case of postoperative nerve impingement occurred in the surgical group. Conclusions In patients with chronic SIJ pain, minimally invasive SIJF using triangular titanium implants was safe and more effective than CM in relieving pain, reducing disability, improving patient function and quality of life.

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“…Literature is scarce when it comes to describing the efficacy of surgical intervention, 22 and the general consensus is to refrain from surgery until all nonoperative treatment modalities have been exhausted. 1,2,5,12,14,15,19,22,25 Conservative methods for managing SIJ pain include trials of physical therapy, focusing on core and pelvic stability, external orthotics, pain management, periodic intra-articular injections, anti-inflammatory medications, and life style changes including smoking cessation and weight loss. 9,22 Whether efficacy is determined by objective measures, CT-confirmed fusion, or subjective methods, patients' levels of satisfaction with the results of fusion procedures are inconsistent.…”

Section: Discussionmentioning

confidence: 99%

“…The Smith-Petersen technique uses an iliac autograft fixated within the SIJ with atlanto-occipital screws. 4,19 Other techniques described in our literature search are a midline posterior approach us- ing pedicle screws and an autograft, or Cloward instrumentation; 2,4,10,12,14 an anterior approach with 3-hole plate and autograft; 15 and a bilateral Buttress with autograft 21 (Table 1). The MIS procedures included use of hollow modular anchorage screws, autograft, and bone morphogenetic protein (BMP), 1,13 longitudinally threaded cages with BMP, 25 multiple long screws crossing both SIJs engaging the iliac bones, 18 and the iFuse Implant System (SI-BONE) 7,9,15,19,20 ( Table 2).…”

Section: 14mentioning

confidence: 99%

“…Other issues include short follow-up periods ranging from 6 to 40 months, and several potential conflicts of interest. 7,9,15,19,20 Longer follow-up, third-party investigation, and randomized control studies are needed to assess the true efficacy for this up-and-coming intervention. A true arthrodesis requires apposition of 2 bone surfaces, allowing for approximation without compromising the stability of the joint.…”

Section: 14mentioning

confidence: 99%

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Surgical and clinical efficacy of sacroiliac joint fusion: a systematic review of the literature

Zaidi

Montoure

Dickman

2015

SPI

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OBJECT The sacroiliac joint (SIJ) and surgical intervention for treating SIJ pain or dysfunction has been a topic of much debate in recent years. There has been a resurgence in the implication of this joint as the pain generator for many patients experiencing low-back pain, and new surgical methods are gaining popularity within both the orthopedic and neurosurgical fields. There is no universally accepted gold standard for diagnosing or surgically treating SIJ pain. The authors systematically reviewed studies on SIJ fusion in the neurosurgical and orthopedic literature to investigate whether sufficient evidence exists to support its use. METHODS A literature search was performed using MEDLINE, Google Scholar, and OvidSP–Wolters Kluwer Health for all articles regarding SIJ fusion published from 2000 to 2014. Original, peer-reviewed, prospective or retrospective scientific papers with at least 2 patients were included in the study. Exclusion criteria included follow-up shorter than 1-year, nonsurgical treatment, inadequate clinical data as determined by 2 independent reviewers, non-English manuscripts, and nonhuman subjects. RESULTS A total of 16 peer-reviewed journal articles met the inclusion criteria: 5 consecutive case series, 8 retrospective studies, and 3 prospective cohort studies. A total of 430 patients were included, of whom 131 underwent open surgery and 299 underwent minimally invasive surgery (MIS) for SIJ fusion. The mean duration of follow-up was 60 months for open surgery and 21 months for MIS. SIJ degeneration/arthrosis was the most common pathology among patients undergoing surgical intervention (present in 257 patients [59.8%]), followed by SIJ dysfunction (79 [18.4%]), postpartum instability (31 [7.2%]), posttraumatic (28 [6.5%]), idiopathic (25 [5.8%]), pathological fractures (6 [1.4%]), and HLA-B27+/rheumatoid arthritis (4 [0.9%]). Radiographically confirmed fusion rates were 20%–90% for open surgery and 13%–100% for MIS. Rates of excellent satisfaction, determined by pain reduction, function, and quality of life, ranged from 18% to 100% with a mean of 54% in open surgical cases. For MIS patients, excellent outcome, judged by patients’ stated satisfaction with the surgery, ranged from 56% to 100% (mean 84%). The reoperation rate after open surgery ranged from 0% to 65% (mean 15%). Reoperation rate after MIS ranged from 0% to 17% (mean 6%). Major complication rates ranged from 5% to 20%, with 1 study that addressed safety reporting a 56% adverse event rate. CONCLUSIONS Surgical intervention for SIJ pain is beneficial in a subset of patients. However, with the difficulty in accurate diagnosis and evidence for the efficacy of SIJ fusion itself lacking, serious consideration of the cause of pain and alternative treatments should be given before performing the operation.

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Minimally Invasive Versus Open Sacroiliac Joint Fusion: Are They Similarly Safe and Effective?

Abstract: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Cited by 97 publications

References 23 publications

Minimally Invasive Sacroiliac Joint Arthrodesis: Experience in a Prospective Series with 24 Patients

Minimally Invasive Sacroiliac Joint Arthrodesis: Experience in a Prospective Series with 24 Patients

Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management

Surgical and clinical efficacy of sacroiliac joint fusion: a systematic review of the literature

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