Triangular titanium implants for sacroiliac joint fusion

Abstract

Background Sacroiliac joint (SIJ) dysfunction is an underdiagnosed condition. Several published cohorts have reported favorable midterm outcomes after SIJ fusion using titanium implants placed across the SIJ. Herein, we report 12-month follow-up from SIJ fusion in a standard clinic setting. Methods A carefully selected group of 160 consecutive patients with painful SIJ dysfunction were diagnosed at a single center and underwent unilateral or staged bilateral SIJ fusion using triangular titanium implants. Patients were routinely seen in clinic for follow-up every 3 months where they completed visual analog scale (0-10 range) pain ratings and Oswestry Disability Index (ODI). Follow-up CT scan was performed at 1 year. Results Mean patient age was 58 years, and 68% were women. 30% underwent staged bilateral SIJ fusion. By month 12, SIJ pain decreased from 8.0 to 2.5 (p < 0.0001) and disability (ODI) decreased from 45.3 to 16.4 (p < 0.0001). The proportion with clinically significant improvements in SIJ pain and ODI was high (> 95%). Perioperative adverse events were mild and decreased with increasing surgical experience with the procedure. Subgroup analysis showed slightly smaller improvements in those undergoing bilateral surgery and those with a spinal cord stimulator in place. CT scan at 1 year showed reabsorption along one or more implants in 16% of cases, but there were no breakages or implant removals. Conclusions In standard clinical practice, SIJ fusion with triangular titanium implants produces significant improvement in pain and disability related to SIJ dysfunction. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

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.…”

International Society for the Advancement of Spine Surgery Policy 2020 Update—Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity

“…Several case series add to the literature supporting lateral transiliac MIS SIJF with placement of transfixing device(s). [167][168][169][170][171][172][173][174][175][176][177][178][179][180][181][182][183][184][185] These studies demonstrate generally consistent results across device types within this group and among geographies. Longterm studies with 5-178 and 6-year 165 follow-up were similar to results of a prospective 5-year study of iFuse.…”

The Sacroiliac Joint

“…Current surgical techniques can be categorized as lateral transiliac, posterolateral transiliac, and posterior interpositional. A recent systematic review has provided aggregate data to assess efficacy 41-62 . In general, the lateral transiliac approach with triangular titanium rods has the highest level and greatest volume of data.…”