The Safety Profile of Percutaneous Minimally Invasive Sacroiliac Joint Fusion

Abstract

Study Design:Literature review.Objectives:Systematic review of the existing literature to determine the safety of minimally invasive (MI) sacroiliac (SI) joint fusion through the determination of the rate of procedural and device-related intraoperative and postoperative complications.Methods:All original studies with reported complication rates were included for analysis. Complications were defined as procedural if secondary to the MI surgery and device related if caused by placement of the implant. Complication rates are reported using descriptive statistics. Random-effects meta-analysis was performed for preoperative and postoperative Visual Analog Score (VAS) pain ratings and Oswestry Disability Index (ODI) scores.Results:Fourteen studies of 720 patients (499 females/221 males) with a mean follow-up of 22 months were included. Ninety-nine patients (13.75%) underwent bilateral SI joint arthrodesis resulting in a total of 819 SI joints fused. There were 91 reported procedural-related complications (11.11%) with the most common adverse event being surgical wound infection/drainage (n = 17). Twenty-five adverse events were attributed to be secondary to placement of the implant (3.05%) with nerve root impingement (n = 13) being the most common. The revision rate was 2.56%. MI SI joint fusion reduced VAS scores from 82.42 (95% confidence interval [CI] 79.34-85.51) to 29.03 (95% CI 25.05-33.01) and ODI scores from 57.44 (95% CI 54.73-60.14) to 29.42 (95% CI 20.62-38.21).Conclusions:MI SI joint fusion is a relatively safe procedure but is not without certain risks. Further work must be done to optimize the procedure’s complication profile. Possible areas of improvement include preoperative patient optimization, operative technique, and use of intraoperative real-time imaging.

The effect of minimally invasive sacroiliac joint fusion compared with sham operation: study protocol of a prospective double-blinded multicenter randomized controlled trial

“…However, a German study of 1.37 million anaesthetic procedures with elective patients, graded as ASA classification physical status I and II, showed 7.3 cases of death or serious complication per million cases, corresponding to a very low risk ( 41 ). All types of surgery are associated with risks of complications, and so also for MIS SIJ ( 42 ). In the control group the risks for surgical complications should be very low.…”

Minimally Invasive Endoscopic Spine Surgical Techniques for Treating Radiculopathy Secondary to Sacroiliac Joint Fusion Complications: Case Series

“…A recent literature review on the safety profile of percutaneous minimally invasive SI joint fusion looking at 14 studies that included 720 complications found a complication rate of 11.1% (8). The most common complication was wound infection, but 3.05% of the complications were secondary to placement of the implant, with nerve root impingement being the most common result.…”

Robot-assisted revision of sacroiliac joint fusion using a triangular titanium implant in an S2-alar-iliac trajectory: illustrative case

“…[1][2][3] The economic burden of treatment is significant, with an average cost per patient of $63,913. 10 SIJF has been demonstrated to significantly improve pain, disability, and quality of life in several retrospective studies [1][2][3]7 and three randomized controlled trials. [4][5][6] Revision rates for SIJF are acceptably low, ranging from 0% to 17% with a mean of 6% in a review by Cleveland et al 1 Two meta-analyses cited rates of 2.1% and 2.6% across 432 and 720 patients, respectively.…”

“…[4][5][6] Revision rates for SIJF are acceptably low, ranging from 0% to 17% with a mean of 6% in a review by Cleveland et al 1 Two meta-analyses cited rates of 2.1% and 2.6% across 432 and 720 patients, respectively. 7,11 Because arthrodesis may take more than 1 year to occur, 3 less obvious malpositioning that is not immediately addressed may prolong pain and disability for more than 12 months. Robot-assisted platforms for SIJF may prevent inaccuracy given their reproducibility of trajectory and advantage over conventional fluoroscopy for anatomically challenging areas, such as the pelvis.…”

“…3 Several studies have shown significant improvement in pain, disability, and quality of life after SIJ fusion (SIJF). [1][2][3][4][5][6][7] Although surgical intervention can significantly improve patient symptoms, arthrodesis may take more than 1 year to occur. 3 Robot-assisted spinal surgery has recently grown in popularity and has been used for S2-alar-iliac (S2-AI) screw placement in deformity cases.…”