Persistent Iliosacral Joint Syndrome following Instrumentation to the Sacropelvis in Patients with Adult Spinal Deformity

Diesing, Daniela; Franke, Jöerg; Tschoeke, Sven K.; Schultheiß, R.; Scheufler, Kai-Michael

doi:10.1055/s-0038-1655732

Cited by 8 publications

(6 citation statements)

References 78 publications

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“…Degeneration of the SIJ after lumbar fusion is likely to result from increased force transmission across the SIJ due to permanent stabilization of the lumbar spine. SIJ pain after long fusions to the sacrum, which increase stress on the SIJ, also occurs commonly [20]. In our study, the relationship was high, with 64% of our cohort having a history of prior instrumented lumbar spine fusion.…”

Section: Discussionmentioning

confidence: 53%

Triangular titanium implants for sacroiliac joint fusion

Rainov¹,

Schneiderhan²,

Heidecke

2018

Eur Spine J

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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.

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Section: Discussionmentioning

confidence: 53%

Triangular titanium implants for sacroiliac joint fusion

Rainov¹,

Schneiderhan²,

Heidecke

2018

Eur Spine J

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“…A number of possible indications exist for surgical fusion of the SIJ other than secondary arthrosis, such as primary, post-traumatic or post-partum arthrosis, accessory joints, dysplasia and axial spondylarthropathy [9]. Therefore, during the course of a lifetime, either an isolated SIJ fusion or an SIJ fusion following lumbar spondylodesis in the sense of an adjacent segment degeneration [30], or a combination of both SIJ fusion and lumbar spondylodesis may be required. Existing devices on the market, however, are unable to fully address these surgical needs.…”

Section: Discussionmentioning

confidence: 99%

A novel arthrodesis technique of the sacroiliac joint

Fuchs¹

2019

Preprint

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Purpose The aim of the study was to develop an implant for fusion of the sacroiliac joint (SIJ) which, in contrast to known implant systems, can be used for isolated fusion of the SIJ as well as in combination with a lumbar instrumentation procedure or as an alternative to existing sacropelvic fixation (SPF) methods. Methods Following a comprehensive review of more than 200 high-resolution pelvic CT data sets, an implant body with high porosity and a large contact surface to the ilium and sacrum favoring integration was designed. Its shape was modeled based on the recess of the SIJ. A screw anchored in the ilium secures the position of the implant in the recess and allows connection to a lumbar instrumentation via an S1 screw. After receiving a detailed explanation and information about the novelty of the procedure, two patients with confirmed SIJ syndrome, who had undergone conservative treatment for more than 6 months without success, were operated on with a patient individual implant adapted to their anatomy. Results There were no intraoperative or postoperative complications. The postoperative CT and pelvic X-rays showed a good form fit of the implant body in the respective recess as well as correct positioning of the inserted screws. Conclusions The implant used first takes into account the special anatomy of the SIJ and also meets the requirements of a true arthrodesis of the joint. Clinical studies will now have to show whether the considerable theoretical advantages of the new implant system over existing SIJ implants and SPFs can be put into practice.

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“…64,65 Over the course of a lifetime, either isolated SIJF, SIJF following lumbar spondylodesis for adjacent segment degeneration, or a combination of both SIJF and lumbar spinal fusion may be required. 66 Currently available implants for SIJF cannot be connected to lumbar stabilization systems. The aim was therefore to develop an implant for fusion of the SIJ that can be inserted via a safe dorsal approach with high primary stability using the largest possible space in the recess with distraction of the SIJ even under soft bone conditions and, if necessary, connected with lumbar instrumentation (Figures 2 and 7a).…”

Section: Dovepressmentioning

confidence: 99%

A New Approach to the Treatment of Sacroiliac Joint Pain and First Patient-Reported Outcomes Using a Novel Arthrodesis Technique for Sacroiliac Joint Fusion

Fuchs,

Rieger

2024

ORR

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Purpose To report the development of a new sacroiliac joint (SIJ) arthrodesis system that can be used for isolated fusion of the SIJ and, unlike known implant systems, in combination with lumbar instrumentation or as an alternative to existing sacropelvic fixation (SPF) methods, and the patient-reported outcomes in two cases. Materials and Methods After a comprehensive review of 207 pelvic computed tomography (CT) datasets, an implant body was designed. Its shape was modeled based on the SIJ recess. A screw anchored in the ilium secures the position of the implant and allows connection to lumbar instrumentation. Two patients with confirmed SIJ syndrome underwent surgery with the anatomically adapted implant. They were evaluated preoperatively, 6 months, and 12 months postoperatively. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Million Visual Analogue Scale (MVAS), Roland Morris Score (RMS), reduction of SIJ/leg pain, and work status were assessed. Bony fusion of the SIJ was evaluated by radiographs and CT 12 months after the procedure. Results Analysis of pelvic CT data revealed a wedge-shaped implant body in four different sizes. In the two patients, VAS decreased from 88 to 33 points, ODI improved from 67 to 35%, MVAS decreased from 80 to 36%, and RMS decreased from 18 to 9 points 12 months after surgery. SIJ pain reduction was 80% and 90%, respectively. Follow-up CT and radiographs showed solid bony integration. Conclusion The implant used takes into account the unique anatomy of the SIJ and also meets the requirements of a true arthrodesis. Initial results in two patients are promising. Biomechanical and clinical studies will have to show whether the considerable theoretical advantages of the new implant system over existing SIJ implants – in particular the possibility of connection to a lumbar stabilization system - and SPFs can be put into practice.

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Persistent Iliosacral Joint Syndrome following Instrumentation to the Sacropelvis in Patients with Adult Spinal Deformity

Cited by 8 publications

References 78 publications

Triangular titanium implants for sacroiliac joint fusion

Triangular titanium implants for sacroiliac joint fusion

A novel arthrodesis technique of the sacroiliac joint

A New Approach to the Treatment of Sacroiliac Joint Pain and First Patient-Reported Outcomes Using a Novel Arthrodesis Technique for Sacroiliac Joint Fusion

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