Sacroiliac Arthrodesis Using a Posterior Midline Fascial Splitting Approach and Pedicle Screw Instrumentation: A New Technique

Belanger, Theodore A.; Dall, Bruce E.

doi:10.1097/00002517-200104000-00005

Cited by 63 publications

(24 citation statements)

References 21 publications

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“…Much of the published literature on surgical fixation of SIJ dysfunction relates to the use of posterior fixation techniques [8]. Belanger and Dall [24], in their case series of four patients showed at the 10-year follow-up that all patients had some residual SIJ pain. However, all four patients stated that they had improvements in pain, mobility and functionality.…”

Section: Discussionmentioning

confidence: 99%

Documentation of outcomes for sacroiliac joint fusion: does prior spinal fusion influence the outcome?

2013

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Purpose The purpose of this prospective case series (level II) was to determine the clinical outcomes of anterior SIJ fusion, comparing the outcomes of patients who had prior spinal fusions at any level compared to patients who have not. Methods This prospective study included 25 patients who underwent SIJ fusion with anterior plate fixation. All patients had failed non-operative treatment, had a positive Patrick test, and positive response to intra-articular SIJ injections with greater than 50 % pain relief. Patients had follow-up at 3, 6, 9 and 12 months where they completed Oswestry disability index (ODI) and Short Musculoskeletal Functional Assessment (SMFA) surveys. Outcome data are available for 19 patients who completed pre-operative and 12-month follow-up surveys. Their average time of the final follow-up was 1.1 years (range 10-33 months). Results Significant improvements between pre-operative and the final follow-up in ODI (p = 0.007) and SMFA (p = 0.01) were observed; the ODI assessed outcomes in patients who had previous spinal fusion surgery were significantly worse than those that did not at the final followup (p = 0.04). Conclusion Patients who have not undergone prior spinal fusion surgery, regardless of age, gender, and BMI have better outcomes following anterior SIJ fusion.

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Section: Discussionmentioning

confidence: 99%

Documentation of outcomes for sacroiliac joint fusion: does prior spinal fusion influence the outcome?

2013

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“…However, open surgery is demanding for both the surgeon and patient since it results in substantial blood loss, pain and morbidity from soft tissue disruption, and a high frequency of non-union [16,19,20]. Therefore, minimally invasive techniques [21], which can also be performed percutaneously [22], were developed to reduce postoperative morbidity while maintaining or improving upon effectiveness. Some comparative studies suggest that minimally invasive strategies may be superior to open strategies [23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management

et al. 2016

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Purpose To compare the safety and effectiveness of minimally invasive sacroiliac joint fusion (SIJF) using triangular titanium implants vs conservative management (CM) in patients with chronic sacroiliac joint (SIJ) pain. Methods 103 adults with chronic SIJ pain at nine sites in four European countries were randomly assigned to and underwent either minimally invasive SIJF using triangular titanium implants (N = 52) or CM (N = 51). CM was performed according to the European guidelines for the diagnosis and management of pelvic girdle pain and consisted of optimization of medical therapy, individualized physical therapy (PT) and adequate information and reassurance as part of a multifactorial treatment. The primary outcome was the difference in change in self-rated low back pain (LBP) at 6 months. Additional endpoints included quality of life using EQ-5D-3L, disability using Oswestry Disability Index (ODI), SIJ function using active straight leg raise (ASLR) test and adverse events. NCT01741025. Results At 6 months, mean LBP improved by 43.3 points in the SIJF group and 5.7 points in the CM group (difference of 38.1 points, p \ 0.0001). Mean ODI improved by 26 points in the SIJF group and 6 points in the CM group (p \ 0.0001). ASLR, EQ-5D-3L, walking distance and satisfaction were statistically superior in the SIJF group. The frequency of adverse events did not differ between groups. One case of postoperative nerve impingement occurred in the surgical group. Conclusions In patients with chronic SIJ pain, minimally invasive SIJF using triangular titanium implants was safe and more effective than CM in relieving pain, reducing disability, improving patient function and quality of life.

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“…Literature is scarce when it comes to describing the efficacy of surgical intervention, 22 and the general consensus is to refrain from surgery until all nonoperative treatment modalities have been exhausted. 1,2,5,12,14,15,19,22,25 Conservative methods for managing SIJ pain include trials of physical therapy, focusing on core and pelvic stability, external orthotics, pain management, periodic intra-articular injections, anti-inflammatory medications, and life style changes including smoking cessation and weight loss. 9,22 Whether efficacy is determined by objective measures, CT-confirmed fusion, or subjective methods, patients' levels of satisfaction with the results of fusion procedures are inconsistent.…”

Section: Discussionmentioning

confidence: 99%

“…9 There are many reported cases of successful SIJ arthrodesis that greatly improve the quality of life for the individuals and eliminate their daily pain. 1,2,4,5,7,9,10,[12][13][14][15][18][19][20][21]25 Certain etiologies-for example, acute traumatic instability-require immediate surgical intervention and have good reported outcomes; however, the majority of patients undergoing surgery are classified as having SIJ degeneration or dysfunction, and the consensus on efficacy of fusion is not as clear for these patients. To limit the amount of nonunion, unsatisfactory results, reoperations, and need for additional back surgery, a strict guideline for SIJ fusion needs to be developed and implemented.…”

Section: 14mentioning

confidence: 99%

Surgical and clinical efficacy of sacroiliac joint fusion: a systematic review of the literature

Zaidi

Montoure

Dickman

2015

SPI

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OBJECT The sacroiliac joint (SIJ) and surgical intervention for treating SIJ pain or dysfunction has been a topic of much debate in recent years. There has been a resurgence in the implication of this joint as the pain generator for many patients experiencing low-back pain, and new surgical methods are gaining popularity within both the orthopedic and neurosurgical fields. There is no universally accepted gold standard for diagnosing or surgically treating SIJ pain. The authors systematically reviewed studies on SIJ fusion in the neurosurgical and orthopedic literature to investigate whether sufficient evidence exists to support its use. METHODS A literature search was performed using MEDLINE, Google Scholar, and OvidSP–Wolters Kluwer Health for all articles regarding SIJ fusion published from 2000 to 2014. Original, peer-reviewed, prospective or retrospective scientific papers with at least 2 patients were included in the study. Exclusion criteria included follow-up shorter than 1-year, nonsurgical treatment, inadequate clinical data as determined by 2 independent reviewers, non-English manuscripts, and nonhuman subjects. RESULTS A total of 16 peer-reviewed journal articles met the inclusion criteria: 5 consecutive case series, 8 retrospective studies, and 3 prospective cohort studies. A total of 430 patients were included, of whom 131 underwent open surgery and 299 underwent minimally invasive surgery (MIS) for SIJ fusion. The mean duration of follow-up was 60 months for open surgery and 21 months for MIS. SIJ degeneration/arthrosis was the most common pathology among patients undergoing surgical intervention (present in 257 patients [59.8%]), followed by SIJ dysfunction (79 [18.4%]), postpartum instability (31 [7.2%]), posttraumatic (28 [6.5%]), idiopathic (25 [5.8%]), pathological fractures (6 [1.4%]), and HLA-B27+/rheumatoid arthritis (4 [0.9%]). Radiographically confirmed fusion rates were 20%–90% for open surgery and 13%–100% for MIS. Rates of excellent satisfaction, determined by pain reduction, function, and quality of life, ranged from 18% to 100% with a mean of 54% in open surgical cases. For MIS patients, excellent outcome, judged by patients’ stated satisfaction with the surgery, ranged from 56% to 100% (mean 84%). The reoperation rate after open surgery ranged from 0% to 65% (mean 15%). Reoperation rate after MIS ranged from 0% to 17% (mean 6%). Major complication rates ranged from 5% to 20%, with 1 study that addressed safety reporting a 56% adverse event rate. CONCLUSIONS Surgical intervention for SIJ pain is beneficial in a subset of patients. However, with the difficulty in accurate diagnosis and evidence for the efficacy of SIJ fusion itself lacking, serious consideration of the cause of pain and alternative treatments should be given before performing the operation.

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Sacroiliac Arthrodesis Using a Posterior Midline Fascial Splitting Approach and Pedicle Screw Instrumentation: A New Technique

Cited by 63 publications

References 21 publications

Documentation of outcomes for sacroiliac joint fusion: does prior spinal fusion influence the outcome?

Documentation of outcomes for sacroiliac joint fusion: does prior spinal fusion influence the outcome?

Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management

Surgical and clinical efficacy of sacroiliac joint fusion: a systematic review of the literature

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