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

Study Design. Retrospective case series.Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position.Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated.Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval.Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants.Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement.

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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.

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Utilization of Minimally Invasive Surgical Approach for Sacroiliac Joint Fusion in Surgeon Population of ISASS and SMISS Membership

The Open Orthopaedics Journal ◽

10.2174/1874325001408010001 ◽

2014 ◽

Vol 8 (1) ◽

pp. 1-6 ◽

Cited By ~ 25

Author(s):

Morgan P. Lorio ◽

David W. Polly Jr. ◽

Ivana Ninkovic ◽

Charles G.T. Ledonio ◽

Kelli Hallas ◽

...

Keyword(s):

Minimally Invasive ◽

Spine Surgery ◽

Sacroiliac Joint ◽

Average Length ◽

Standard Of Care ◽

Open Approach ◽

Fusion Procedure ◽

Minimally Invasive Surgical ◽

Joint Fusion ◽

Significant Difference

Introduction: The sacroiliac joint (SIJ) may be a source of chronic low back pain in 15 -22% of patients. Over the past four years MIS is an emerging standard of care for SI joint fusion. The International Society for the Advancement of Spine Surgery (ISASS) and Society for Minimally Invasive Spine Surgery (SMISS) conducted a survey of their members to examine current preferences in surgeon practice of MIS SI fusion. Methods: To qualify for survey participation, the surgeon had to perform at least one open or MIS SIJ fusion procedure between 2009 and 2012. All surgeons were instructed to review their records. This included the number of surgical procedures performed annually from 2009-2012, site of service where each procedure was commonly performed, and average length of stay for each approach. Results: Twenty four percent (121/500) of the eligible members participated in this survey. This survey revealed that the percentage of MIS procedures increased from 39% in 2009 to over 87% in 2012. The survey showed a significant increase in average number of MIS surgeries and a significant difference between open and MIS surgeries in 2012 (p<0.0001). In addition, 80% of the survey respondents indicated a lack of preference toward open approach if that was the only available option. Conclusions: According to performed survey, MIS SIJ fusion is preferred over open technique. Incorporation of the MIS technique into the spine surgeon's specter of skills would allow an increased number of surgical options as well as possible increase in outcome quality.

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Complications and their management

10.1093/med/9780197607947.003.0022 ◽

2021 ◽

pp. 243-246

Author(s):

Hemant Kalia

Keyword(s):

Minimally Invasive ◽

Sacroiliac Joint ◽

Posterior Approach ◽

Lateral Approach ◽

Minimally Invasive Surgical ◽

Joint Fusion ◽

Surgical Fusion ◽

Sacroiliac Joint Fusion ◽

Open Surgical Approach ◽

Pain Generator

This chapter reviews the complications that can occur after minimally invasive surgical fusion of the sacroiliac joint, focusing on infection and neurovascular injuries and their prevention and treatment. The sacroiliac joint has been identified as a potential pain generator in 15% to 30% of chronic low back pain and post-laminectomy syndrome patients. Minimally invasive sacroiliac joint fusion via the lateral approach is effective and better tolerated than the open surgical approach. Most of the current studies have focused on efficacy and patient satisfaction as opposed to the safety profile of the procedure. There is a dearth of literature regarding the safety of minimally invasive sacroiliac joint fusion. Over the past few years, a novel posterior approach to sacroiliac joint fusion has become more common that theoretically is safer and potentially as efficacious as the lateral approach.

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

The Open Orthopaedics Journal ◽

10.2174/1874325001610010679 ◽

2016 ◽

Vol 10 (1) ◽

pp. 679-689 ◽

Cited By ~ 13

Author(s):

Richard A. Kube ◽

Jeffrey M. Muir

Keyword(s):

Minimally Invasive ◽

Sacroiliac Joint ◽

Joint Pain ◽

Fusion Rate ◽

Leg Pain ◽

Post Procedure ◽

Joint Fusion ◽

One Year ◽

Sacroiliac Joint Fusion ◽

Si Joint

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 severityviavisual analog scale (VAS), disabilityviaOswestry 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.

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Minimally Invasive versus Open Sacroiliac Joint Fusion: A Comparison of Outcomes in Propensity Matched Cohorts

The Spine Journal ◽

10.1016/j.spinee.2014.08.373 ◽

2014 ◽

Vol 14 (11) ◽

pp. S154

Author(s):

Charles Gerald T. Ledonio ◽

David W. Polly ◽

Marc Swiontkowski

Keyword(s):

Minimally Invasive ◽

Sacroiliac Joint ◽

Joint Fusion ◽

Sacroiliac Joint Fusion

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