Posterior Oblique Approach for Sacroiliac Joint Fusion

Abstract

IntroductionSacroiliac joint (SIJ) pain is a common source of low back pain. Though this condition can be treated with conservative measures, there is a subset of patients who fail to respond to conservative treatment. For them, surgical treatment using minimally invasive techniques could be considered. There are currently a number of SIJ fixation methods described. However, there is no case series reported on posterior oblique approach. Therefore, in this paper, the authors report their experience with the Sacrix system via the posterior oblique approach. MethodIn this series, 19 patients aged 44-84 years, with a median of 58 years, underwent SIJ fusion using this technique. This is a posterior oblique approach in which two screws are inserted into the ilium through the posterior part of the iliac crest and then advanced into the sacrum through the SIJ. ResultsThe follow-up is between 7 and 30 months, with a median of 12 months. Eighteen patients had excellent pain relief. There was no complication from the procedure, and the blood loss was minimal. All eight patients who had follow-up radiographs showed solid fusion. ConclusionPosterior oblique approach for SIJ fusion is a minimally invasive procedure that proved to be effective and safe in this series. It also resulted in solid radiographic fusion, decreased pain, and improved function.

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

“…Recent evidence by Raikar et al. [20] confirmed the efficacy and safety of the posterior oblique technique as a minimally invasive SIJ fusion procedure, based on a case series of 19 patients. They proposed that the posterior oblique technique could potentially lead to less blood loss by avoiding damage to neurovascular structures, a noteworthy advantage over the lateral technique, which reportedly involves an average blood loss between 31 and 43 cc [16 , 17] .…”

“…The posterior oblique technique is unique; it doesn't involve dissection of the gluteal fascia or SIJ ligaments. Instead, the approach is taken from the outer upper surface of the iliac crest, enabling a more direct trajectory to the SIJ through the ilium [20] .…”

“…They proposed that the posterior oblique technique could potentially lead to less blood loss by avoiding damage to neurovascular structures, a noteworthy advantage over the lateral technique, which reportedly involves an average blood loss between 31 and 43 cc [16 , 17] . Furthermore, they suggested that the posterior oblique technique enables surface-bridging with screw placement, which reduces joint movement, and that the procedure requires less soft tissue manipulation [20] .…”

“…Hence, we provide a detailed description of the posterior oblique technique as implemented in this study, building on the technique used by Raikar et al. [20] . Both groups underwent SIJ fusion using the Sacrix system (SpineFrontier SIJFuse) manufactured by Sacrix, LLC, Malden, MA.…”

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

“… I-C Wang, 2022 162 Retrospective, observational SI-LOK Lateral 10 NRS, opioid use The average NRS was 5.2 ± 1.0, and the average opioid administration was 27.6 ± 10.3 morphine equivalents preoperative. At the last follow-up, patients reported an average of 73.1% ± 30.1% improvement in their preoperative pain I-C Anton, 2023 163 Retrospective, observational RIALTO Posterolateral 118 VAS, ODI, fusion rate 94.9% fusion rate based on imaging; ODI and VAS statistically significantly improved from baseline I-C Cahueque, 2023 164 Retrospective, observational Sacrix Posterior 45 VAS, ODI The posterior approach cohort demonstrated greater VAS reduction, shorter operative time and duration of hospital stay, and improved ODI scores, compared to lateral approach I-C Cross, 2023 165 Retrospective, observational Integrity-SI Posterolateral 75 ODI, NRS, SANE, PROMIS Statistically significant improvement in ODI, NRS, PROMIS and SANE (patient satisfaction) scores and 81% fusion rate noted up to 12-month I-C Jedi, 2023 166 Retrospective, observational SI-LOK Lateral 85 VAS Statistically and clinically significant improvement in VAS in all patients at final follow-up I-C Raikar, 2023 167 Case series Sacrix Posterior …”