Sacroiliac Joint Fusion: One Year Clinical and Radiographic Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery

Abstract

Background:Recalcitrant sacroiliac joint pain responds well to minimally-invasive surgical (MIS) techniques, although long-term radiographic and fusion data are limited.Objective:To evaluate the one-year clinical results from a cohort of patients with chronic sacroiliac (SI) joint pain unresponsive to conservative therapies who have undergone minimally invasive SI joint fusion.Methods:SI joint fusion was performed between May 2011 and January 2014. Outcomes included radiographic assessment of fusion status, leg and back pain severity via visual analog scale (VAS), disability via Oswestry Disability Index (ODI) and complication rate. Outcomes were measured at baseline and at follow-up appointments 6 months and 12 months post-procedure.Results:Twenty minimally invasive SI joint fusion procedures were performed on 18 patients (mean age: 47.2 (14.2), mean BMI: 29.4 (5.3), 56% female). At 12 months, the overall fusion rate was 88%. Back and leg pain improved from 81.7 to 44.1 points (p<0.001) and from 63.6 to 27.7 points (p=0.001), respectively. Disability scores improved from 61.0 to 40.5 (p=0.009). Despite a cohort containing patients with multiple comorbidities and work-related injuries, eight patients (50%) achieved the minimal clinically important difference (MCID) in back pain at 12 months, with 9 (69%) patients realizing this improvement in leg pain and 8 (57%) realizing the MCID in ODI scores at 12 months. No major complications were reported.Conclusion:Minimally invasive SI joint surgery is a safe and effective procedure, with a high fusion rate, a satisfactory safety profile and significant improvements in pain severity and disability reported through 12 months post-procedure.

Sacroiliac Joint Fusion – Impact of a New Image-Guidance Protocol on Safety and Complications

“…These rates of complications are somewhat higher than compared to previously published RCT and prospective cohort studies, particularly in regard to infection with has often been quoted around 1% for minimally invasive SI fusion. [8][9][10][11][14][15][16][17]20,21 Review of our complication data confirms the safety of the procedure, with an overall complication rate of 10% at mean follow-up of 7.6 months. Of note, we had no cases of infection.…”

“…Evidence in favor of minimally invasive SI joint fusion has largely been limited to retrospective studies or smaller prospective cohort studies. [8][9][10][11][14][15][16][17] Recently two reproduction of pain in at least three of five provocative SI joint testing maneuvers including pelvic distraction, thigh thrust, direct compression, flexion/abduction/ external rotation (FABER), and Gaenslen's maneuver. Intrarticular SI joint injections with local anesthetic are used to confirm the diagnosis.…”

“…Traditional treatment focused on conservative therapy, such as physical therapy with focus on core and pelvic stability, orthoses, pain and anti-inflammatory medication, weight loss, intra-or peri-articular injections, and radiofrequency ablation. 4,5,[9][10][11][12] Early surgical intervention came in the form of morbid open approaches often utilizing iliac crest autografting. More recently, minimally invasive techniques for sacroiliac fusion have been developed that allow for significant sparing of muscle dissection, shorter operating room times and blood loss, reduced length of stay, and fewer complications.…”

Predictors of Outcome in Conservative and Minimally Invasive Surgical Management of Pain Originating From the Sacroiliac Joint

“… 29 – 31 Three additional case series report good outcomes with hollow modular anchor screws 60 – 62 and a recent small case series suggests good outcomes with an additional transfixing device. 63 Minimally invasive SIJF using TTI was shown to not only improve the LBP component of SIJ pain but also the referred leg pain component. 64 Because of differences in approaches, device design, acute impact on the joint, and long-term fusion strategies, it is unclear whether results from our analysis apply to other laterally transfixing devices or to devices placed via a dorsal approach.…”

Physiological in vitro sacroiliac joint motion: a study on three‐dimensional posterior pelvic ring kinematics

“…In recent years, a number of non-surgical (Dussault et al 2000;Damen et al 2002;Fritz et al 2008;Jee et al 2014;Kasliwal & Kasliwal, 2016;Kurosawa et al 2016) and surgical techniques (Waisbrod et al 1987;Buchowski et al 2005;Al-Khayer et al 2008;Khurana et al 2009;Ebraheim et al 2010;Biswas et al 2016;Duhon et al 2016) have evolved for its treatment. A particular aim is to relieve nerve irritation related to SIJ pathology (Kibsg ard et al 2014a) or to reduce SIJ motion by means of surgical implants (Kube & Muir, 2016). One underlying assumption for these therapies is that they influence SIJ pain as a consequence of altering motion.…”