Minimally invasive sacroiliac joint fusion for low back pain cost effective

Background:Sacroiliac joint (SIJ) degeneration is a common source of low back pain (LBP). Minimally invasive (MI) SIJ fusion procedures have demonstrated meaningful clinical improvement. A recently developed MI SIJ fusion system incorporates decortication, placement of bone graft and fixation with threaded implants (DC/BG/TF).Patients and Methods:Nineteen patients who had MI SIJ fusion with DC/BG/TF were enrolled at three centers. Fusion was assessed in CT images obtained 12 and 24 months postoperatively by an independent radiographic core laboratory. LBP was assessed using a 0-10 numerical pain scale (NPS) preoperatively and at 12 and 24 months postoperatively.Results:At 12 months, 15/19 patients (79%) had bridging bone across the SIJ, and at 24 months 17/18 patients (94%) available for follow-up had SIJ fusion. Of the patients with bridging bone 88% had fusion within the decorticated area, with solid fusion in 83%. A significant reduction in NPS scores was demonstrated, representing a 73% reduction in average low back pain.Conclusion:The patients in this series demonstrated significant improvement in LBP. Fusion rates at 24 months demonstrate promise for this system, which utilizes the established orthopedic principles of DC/BG/TF to achieve arthrodesis. Further study is warranted to demonstrate comparative fusion rates for different implant systems.

Download Full-text

Endoscopic Radiofrequency Treatment of the Sacroiliac Joint Complex for Low Back Pain: A Prospective Study with a 2-Year Follow-Up

January 2018 - Pain Physician ◽

10.36076/ppj/2019.22.e11 ◽

2019 ◽

Vol 2 (22.2) ◽

pp. E111-E118

Author(s):

Albert E. Telfeian

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Radiofrequency Ablation ◽

Minimally Invasive ◽

Sacroiliac Joint ◽

Sensory Nerve ◽

Case Series ◽

Low Back ◽

Radiofrequency Treatment ◽

Si Joint

Background: The sacroiliac joint complex (SIJC) is considered a major sources of chronic low back pain. Interventional procedures for sacroiliac (SI) joint pain tend to be short-lived and surgical treatment usually involves a fusion procedure. Objectives: To determine the clinical efficacy of endoscopically visualized radiofrequency treatment of the SIJC in the treatment of low back pain. Study Design: Retrospective chart review. Setting: This study took place in a single-center, orthopedic specialty hospital. Methods: Patients received general anesthesia and under endoscopic visualization, radiofrequency ablation was performed on 1) the perforating branches that innervate the posterior capsule of the SI joint capsule, 2) along the course of the long posterior SI ligament, 3) the lateral edges of the S1, S2, and S3 foramen, and 4) the L4, L5, and S1 medial marginal nerve branches along the lateral facet margins. Results: From January 2015 to June 2016, a total of 30 patients who met the precise inclusion criteria were treated with the endoscopic SIJC radiofrequency treatment for low back pain. The average patient was aged 56 years (19 women and 11 men), the average preoperative visual analog scale (VAS) score was 7.23, and the average Oswestry disability index (ODI) score was 44.8. VAS and ODI were measured at 3, 6, 9, 12, 15, 21 and 24 months: VAS was reduced from 7.23 at baseline to 2.82 at 24 months (61% reduction), and ODI was improved from 44.8 at baseline to 22.2 at 24 months (50% reduction). Limitations: Small retrospective case series. Conclusions: Full-endoscopic radiofrequency ablation of the large sensory SI joint innervation complex, that includes the sensory nerve branches along the lateral S1-3 foramina and the L4-S1 medial branches, is perhaps a minimally invasive surgical procedure that could provide significant relief of lumbar back pain in the carefully selected patient. Key words: Endoscopic spine surgery, minimally invasive, low back pain, sacroiliac joint, radiofrequency treatment

Download Full-text

Sacroiliac Joint Fusion: Percutaneous and Open

10.1093/med/9780199350940.003.0020 ◽

2018 ◽

Author(s):

Daraspreet Singh Kainth ◽

Karanpal Singh Dhaliwal ◽

David W. Polly

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Sacroiliac Joint ◽

Surgical Techniques ◽

Nonoperative Treatment ◽

Minimally Invasive Surgical ◽

Joint Fusion ◽

Sacroiliac Joint Fusion ◽

Invasive Techniques

Sacroiliac joint (SIJ) pain is the source of back pain in up to 25% of patients presenting with back pain. There is significant individual variation in the anatomy of the sacrum and the lumbosacral junction. SIJ pain is diagnosed with the history and physical examination. SIJ injection of a local anesthetic along with steroids is often used to confirm the diagnosis. Nonoperative treatment includes nonsteroidal anti-inflammatories, physical therapy, joint manipulation therapies, and SIJ injections. SIJ pain can also be successfully treated with radiofrequency ablation in some patients. Surgical treatment includes the open anterior sacroiliac joint fusion technique and minimally invasive techniques. The benefits of minimally invasive SIJ fusion versus open surgery include less blood loss, decreased surgical time, and shorter hospital stay. Further studies are needed to determine the long-term durability of the minimally invasive surgical techniques.

Download Full-text