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

Abstract

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.

Minimally Invasive Versus Open Sacroiliac Joint Fusion: Are They Similarly Safe and Effective?

“…Although the use of MIS techniques is becoming more common among surgeons [14], it is difficult to determine the effectiveness of MIS techniques for sacroiliac joint fusion compared to open techniques when only observational studies with no control groups are available as evidence. This is especially true when covariates such a history of lumbar spine surgery have been reported to be an important factor in the clinical results of sacroiliac joint fusions after failed nonoperative management [22].…”

“…However, morbidity with the open technique of sacroiliac joint fusion is not inconsequential, including intraoperative blood loss, multiple-day hospital stay, and limits on postoperative weightbearing. In light of these concerns, recent advances in intraoperative image guidance have led to minimally invasive surgical (MIS) techniques being utilized with increasing frequency over traditional open procedures [14]. While the technique appears promising, to our knowledge, no outcome data are reported in the literature comparing the two surgical techniques with regard to intraoperative blood loss, surgical time, hospital stay, or patient-reported outcomes.…”

Minimally Invasive Sacroiliac Joint Fusion: The Current Evidence

“…Open SI joint fusion has been performed since the 1920s but is no longer the preferred approach to SI joint fusion because of its invasiveness and long recovery periods. 13 Several comparisons of minimally invasive (MIS) SI joint fusion and open SI joint fusion have been reported.…”

Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: 2-Year Follow-Up from a Prospective Multicenter Trial

“…Complication rates are high, 19 non-union relatively common [20][21][22] and patient satisfaction variable. 19 Minimally invasive alternatives to open SI joint fusion have gained popularity in recent years 23 and most published reports describe use of a series of triangular titanium implants coated with a porous titanium plasma spray (iFuse Implant System®, SI-BONE, Inc., San Jose, CA, USA). [24][25][26][27][28][29][30] Previously we reported 1-year outcomes from a prospective, multicenter clinical trial of this device in SI joint dysfunction due to degeneration and/or disruption of the joint.…”