Lateral fusion

2021 ◽  
pp. 193-208
Author(s):  
Gustaf Van Acker ◽  
Jonathon Belding ◽  
Chong H. Kim
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Chronic Back Pain ◽  
Failed Back Surgery Syndrome ◽  
Posterolateral Approach ◽  
Open Approach ◽  
Safety And Efficacy ◽  
Minimally Invasive Surgical ◽  
Lateral Fusion ◽  
Sacroiliac Joint Fusion

Sacroiliac joint pain and dysfunction has increasingly been identified as an important pain generator in patients with chronic back pain or failed back surgery syndrome, and it is estimated to account for 15% to 30% of low back pain cases. Historically, fusion of the joint has been performed with an open posterior or posterolateral approach. Minimally invasive surgical (MIS) approaches were introduced in 2008, and since that time MIS posterior and lateral approaches have become common. Numerous medical device companies have marketed MIS systems, and evidence of their safety and efficacy is mounting. This chapter will detail lateral MIS approaches using fluoroscopic and navigation system guidance, as well as the posterolateral open approach, also known as the modified Smith-Petersen approach. Evidence for safety and efficacy of lateral sacroiliac joint fusion will also be discussed.

Posterior fusion

2021 ◽  
pp. 209-234
Author(s):  
Cory Ullger ◽  
Mogana V. Jayakumar ◽  
Navdeep Jassal
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Chronic Back Pain ◽  
Failed Back Surgery Syndrome ◽  
Posterolateral Approach ◽  
Safety And Efficacy ◽  
Minimally Invasive Surgical ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Sacroiliac Joint Fusion

Sacroiliac joint pain and dysfunction has increasingly been identified as an important pain generator in patients with chronic back pain or failed back surgery syndrome. It is estimated up to 30% of patients presenting with low back pain will have contributions from a painful sacroiliac joint. Historically, fusion of the joint has been performed with an open posterior or posterolateral approach. Minimally invasive surgical (MIS) approaches were introduced in 2008, and since that time MIS posterior and lateral approaches have become common. Numerous medical device companies have marketed MIS systems, and evidence of safety and efficacy is mounting. This chapter will detail the posterior approaches using fluoroscopic and navigation system guidance. Evidence for safety and efficacy of posterior sacroiliac joint fusion approaches will also be discussed.

Sacroiliac Joint Fusion: Percutaneous and Open

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.

scholarly journals Sacroiliac joint fusion VS conservative management for chronic low back pain attributed to the sacroiliac joint

Medicine ◽  
2020 ◽  
Vol 99 (46) ◽  
pp. e23223
Author(s):  
Li-Ye Chen ◽  
Hao-Dong Liang ◽  
Qi-Ning Qin ◽  
Tian-Zhao Tian ◽  
Bao-Xin Liu ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Conservative Management ◽  
Chronic Low Back Pain ◽  
Sacroiliac Joint ◽  
Low Back ◽  
Joint Fusion ◽  
Sacroiliac Joint Fusion

Sacroiliac joint fusion for low back pain: a systematic review and meta-analysis

2016 ◽  
Vol 25 (6) ◽  
pp. 1924-1931 ◽  
Author(s):  
Kiran Kumar Lingutla ◽  
Raymond Pollock ◽  
Sashin Ahuja
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Back Pain ◽  
Sacroiliac Joint ◽  
Meta Analysis ◽  
Low Back ◽  
Joint Fusion ◽  
Sacroiliac Joint Fusion

scholarly journals Biomechanics of a laterally placed sacroiliac joint fusion device supplemental to S2 alar-iliac fixation in a long-segment adult spinal deformity construct: a cadaveric study of stability and strain distribution

2021 ◽  
pp. 1-11
Author(s):  
Bernardo de Andrada Pereira ◽  
Piyanat Wangsawatwong ◽  
Jennifer N. Lehrman ◽  
Anna G. U. Sawa ◽  
Derek P. Lindsey ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Sacroiliac Joint ◽  
Adult Spinal Deformity ◽  
Bending Moment ◽  
Axial Rotation ◽  
Minimally Invasive Surgical ◽  
Joint Fusion ◽  
Flexion Extension ◽  
Pure Moment ◽  
Sacroiliac Joint Fusion

OBJECTIVE S2 alar-iliac (S2AI) screw fixation effectively enhances stability in long-segment constructs. Although S2AI fixation provides a single transarticular sacroiliac joint fixation (SIJF) point, additional fixation points may provide greater stability and attenuate screw and rod strain. The objectives of this study were to evaluate changes in stability and pedicle screw and rod strain with extended distal S2AI fixation and with supplemental bilateral integration of two sacroiliac joint fusion devices implanted using a traditional minimally invasive surgical approach. METHODS Eight L1–pelvis human cadaveric specimens underwent pure moment (7.5 Nm) and compression (400 N) tests under 4 conditions: 1) intact (pure moment loading only); 2) L2–S1 pedicle screw and rod with L5–S1 interbody fusion; 3) added S2AI screws; and 4) added bilateral laterally placed SIJF. Range of motion (ROM), rod strain, and screw-bending moment (S1 and S2AI) were analyzed. RESULTS Compared with S1 fixation, S2AI fixation significantly reduced L5–S1 ROM in right lateral bending by 50% (0.11°, p = 0.049) and in compression by 39% (0.22°, p = 0.003). Compared with fixation ending at S1, extending fixation with S2AI significantly decreased sacroiliac joint ROM by 52% (0.28°, p = 0.02) in flexion, by 65% (0.48°, p = 0.04) in extension, by 59% (0.76°, p = 0.02) in combined flexion-extension, and by 36% (0.09°, p = 0.02) in left axial rotation. The addition of S2AI screws reduced S1 screw-bending moment during flexion (0.106 Nm [43%], p = 0.046). With S2AI fixation, posterior L5–S1 primary rod strain increased by 124% (159 μE, p = 0.002) in flexion, by 149% (285 μE, p = 0.02) in left axial rotation, and by 99% (254 μE, p = 0.04) in right axial rotation. Compared with S2AI fixation, the addition of SIJF reduced L5–S1 strain during right axial rotation by 6% (28 μE, p = 0.04) and increased L5–S1 strain in extension by 6% (28 μE, p = 0.02). CONCLUSIONS Long-segment constructs ending with S2AI screws created a more stable construct than those ending with S1 screws, reducing lumbosacral and sacroiliac joint motion and S1 screw-bending moment in flexion. These benefits, however, were paired with increased rod strain at the lumbosacral junction. The addition of SIJF to constructs ending at S2AI did not significantly change SI joint ROM or S1 screw bending and reduced S2AI screw bending in compression. SIJF further decreased L5–S1 rod strain in axial rotation and increased it in extension.

scholarly journals MRI compared with low-dose CT scanning in the diagnosis of axial spondyloarthritis

2019 ◽  
Vol 39 (4) ◽  
pp. 1295-1303 ◽  
Author(s):  
Lusi Ye ◽  
Yuncai Liu ◽  
Qinqin Xiao ◽  
Ledan Dong ◽  
Caiyun Wen ◽  
...  
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Chronic Back Pain ◽  
Axial Spondyloarthritis ◽  
Significant Proportion ◽  
High Specificity ◽  
Ct Scanning ◽  
Conventional Radiography ◽  
Plain Radiography ◽  
Inflammatory Back Pain

Abstract Objectives To compare the performance of conventional radiography, ldCT, and MRI in the diagnosis of sacroiliitis in suspected axial spondyloarthritis (axSpA). Methods Patients presenting with > 3 months chronic back pain were assessed by axSpA-experienced rheumatologists and diagnosed as axSpA or not; axSpA patients were then considered nr-axSpA or AS using plain radiography. Non-axSpA patients were recruited as controls, and divided into non-inflammatory and inflammatory groups on the basis of inflammatory back pain and/or CRP/ESR elevation. Clinical variables, pelvic radiography, sacroiliac joint (SIJ) ldCT, and SIJ MRI were obtained. Results A total of 121 patients were included and had SIJ radiography and ldCT, of whom 71 additionally had an SIJ MRI. These included 23 non-inflammatory controls, 21 inflammatory controls, 32 nr-axSpA cases, and 45 AS cases. Fourteen of 32 (44%) nr-axSpA patients had positive ldCT scans, 21/24 (88%) had MRI-BMO, and 11/24 (46%) had MRI-structural lesions. ldCT had high specificity with only 1/23 (4%) non-inflammatory controls being positive. MRI-BMO had the highest sensitivity for nr-axSpA, but compared with ldCT lower specificity, with 5/15 (33%) of non-inflammatory controls being positive, and similar sensitivity for AS (20/22 (91%) vs 44/44 for ldCT). Conclusions ldCT identifies evidence of radiographic change in a significant proportion of nr-axSpA cases and is highly specific for axSpA. MRI-BMO lesions are more sensitive than either conventional radiography or MRI-structural assessment for axSpA. The relative position of these imaging modalities in screening for axSpA needs to be reconsidered, also taking into account the costs involved.Key Points• ldCT is more sensitive for erosions or sclerosis in axSpA than plain radiography, with 44% of patients with nr-axSpA having evidence of AS-related sacroiliac joint changes on ldCT.• MRI-structural lesions are no more sensitive but are less specific for AS than ldCT.• MRI-BMO is the most sensitive test for nr-axSpA of the modalities tested but is less specific for axSpA than for ldCT.

scholarly journals Lumbar Radiofrequency Rhizotomy in Patients with Chronic Low Back Pain Increases the Diagnosis of Sacroiliac Joint Dysfunction in Subsequent Follow-Up Visits

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Varun Kumar Rimmalapudi ◽  
Sanjeev Kumar
Keyword(s):  
Back Pain ◽  
Sacroiliac Joint ◽  
Joint Pain ◽  
Chronic Back Pain ◽  
Medial Branch ◽  
Sacroiliac Joint Pain ◽  
Joint Pathology ◽  
Medial Branch Block ◽  
New Diagnosis ◽  
Si Joint

Chronic back pain is often a result of coexisting pathologies; secondary causes of pain can become more apparent sources of pain once the primary pathology has been addressed. The objective of our study was to determine if there is an increase in diagnosis of Sacroiliac joint pain following a Lumbar Rhizotomy. A list of patients who underwent Lumbar Radiofrequency during a 6-month period in our clinic was generated. Records from subsequent clinic visits were reviewed to determine if a new diagnosis of SI joint pathology was made. In patients who underwent a recent Lumbar Rhizotomy procedure to treat facetogenic pain, the prevalence of Sacroiliac joint pain increased to 70%. We infer that there is a significant increase in the diagnosis of Sacroiliac joint syndrome following a Lumbar Rhizotomy, potentially due to unmasking of a preexisting condition. In patients presenting with persistent back pain after Lumbar Rhizotomy, the clinician must have a high degree of suspicion for latent Sacroiliac joint pain prior to attributing the pain to block failure. It would be prudent to use >80% relief of pain after a diagnostic medial branch block as a diagnostic criterion for facetogenic pain rather than the currently accepted >50% in order to minimize unmasking of preexisting subclinical pain from the SI joint.

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