Salvage of Failed Lateral Sacroiliac Joint Fusion with a Novel Posterior Sacroiliac Fusion Device: Diagnostic Approach, Surgical Technique, and Multicenter Case Series

Abstract

Background Studies have found that up to one-third of patients with LBP have sacroiliac joint (SIJ) dysfunction as a contributing cause. Historically, the management of SIJ dysfunction has been plagued by ineffectiveness or significant morbidity. In 2008, minimally invasive lateral SIJ fusion was developed. While this procedure is a safe and effective treatment, there is still a significant proportion of patients who will not experience therapeutic success. There is a paucity of data in the literature regarding the management of these patients. Recently, a novel posterior sacroiliac joint fusion device has been developed which minimizes complications compared to lateral approaches and may serve to salvage therapeutic failures in this patient population. Objective Determine the efficacy and feasibility of a posterior SIJ fusion device as a salvage technique in patients who have not experienced therapeutic success following lateral SIJ fusion. Design Multi-center retrospective observational study. Methods Patients who had previously undergone lateral SIJ fusion and had persistent LBP were evaluated and diagnosed to have persistent primary SIJ pathology. All patients underwent posterior SIJ fusion utilizing a machined allograft transfixing sacroiliac fusion device. Demographic data and patient reported pain scores were collected. Results A total of 7 patients who had undergone lateral SIJ fusion were included in the study and underwent posterior SIJ fusion. The mean patient reported pain improvement following posterior fusion was 80% with an average follow-up time of 10 months. Median morphine milliequivalents were 20 pre-procedure and 0 post-procedure. Conclusion We were able to show significant reductions in pain scores and opioid consumption, which suggests that minimally invasive posterior SIJ utilizing a novel implant and technique may be a viable treatment option to salvage pain relief in this patient population. Further, the favorable safety profile of this posterior technique uniquely positions it to be an appropriate first-line surgical therapy.

Patient-Reported and Radiographic Outcomes After Revision Sacroiliac Joint Fusion

“…Sayed et al reported on the use of a minimally invasive posterior approach SIJF device (Linq [PainTeq, Tampa, FL, USA]) as a salvage of failed lateral SIJF in 7 patients. 35 The authors reported a mean NPRS improvement from 8 to 2 at final follow-up. Details regarding the indication for surgery were not included, and there was no formal evaluation of radiographic fusion prior to or after the revision procedure.…”

Posterior intra-articular fixation stabilizes both primary and secondary sacroiliac joints: a cadaveric study and comparison to lateral trans-articular fixation literature

“…However, investigators of this posterior approach have recently reported efficacies ranging from 66.5 to 76.5% [ 36 , 37 ]. Investigators have also reported in a multicenter case series, in which the posterior intra-articular technique (LinQ) was utilized as a salvage therapy for the lateral trans-articular technique (iFuse) patients who did not show pain improvement and fusion after 20 ± 8 months postoperation [ 38 ]. The investigators reported 77 ± 11% reduction in pain scores upon salvage therapy using the posterior intra-articular technique (LinQ) in all patients after 10 ± 6 months postoperation with evidence of bony bridging.…”

American Society of Pain and Neuroscience Best Practice (ASPN) Guideline for the Treatment of Sacroiliac Disorders

“…), and pain-tolerant walking distance by 55% (87 ± 267 steps to 135 ± 374 steps) I-C Sarkar, 2022 157 Retrospective, observational SI-LOK RIALTO Lateral vs Posterolateral 43 VAS, fusion rate Lateral versus posterolateral approach using robotic guidance versus Stealth Navigation System. Mean baseline VAS score decreased from 7.52 ± 1.3 to 1.43 ± 1.22; SIJ fusion rate was 61% at 6 months, 96.4% at 12 months, and 100% at 18 months I-C Sayed, 2022 158 Retrospective, observational LINQ Posterior 7 NRS, opioid use, fusion rate Subjects who failed fusion with a lateral approach underwent re-surgery with a posterior approach. The mean NRS improvement following posterior fusion was 80%; opioid use decreased with median morphine milliequivalents 20 pre-procedure and 0 post-procedure I-C Soliman, 2022 159 Retrospective, observational iFuse Lateral 33 VAS, ODI Mean VAS was 68.9 at baseline and decreased to 53.1; similarly showed a significant improvement postoperatively I-C Wessell, 2022a 160 Retrospective, observational iFuse Lateral 45 VAS, ODI, opioid use, DSIJQ No change in opioid use from baseline.…”

“…21,140 In a combined cohort of four studies involving 237 subjects who underwent posterior approach sacroiliac fusion, there were no serious adverse events reported, including no implant breakage, bone fracture, infection, bleeding requiring surgery, viscous perforation, but only one device migration. [72][73][74]158 Rajpal et al reported two hematomas and one infection on a cohort of 24 subjects. 135 Posterior sacroiliac fusion approach appears to have a significantly lower safety risk profile due to avoidance of critical neurovascular structures that can be encountered with lateral and posterolateral approaches.…”