Minimally Invasive Sacroiliac Joint Fusion

• DOI: 10.2106/jbjs.st.19.00067
• Publication Date: 2020-10-21T00:00:06Z
• Authors: David W. Polly; Kenneth J. Holton
• Keywords: Sacroiliac joint; Prone position

Minimally invasive sacroiliac (SI) joint fusion is indicated for low back pain from the SI that due to degenerative sacroiliitis and/or disruption. This technique safe and effective in relieving uncontrolled by nonoperative management1-4. There some controversy, but there continues be increasing evidence of effectiveness.This procedure performed, with patient under general anesthesia prone position, using fluoroscopy or 3-dimensional (3D) navigation such as cone-beam computed tomographic (CT) imaging. After setup, a navigated probe used approximate desired location each implant trajectory. These positions are marked on skin, skin incised. A 3 5-cm lateral incision made. The gluteal fascia bluntly dissected outer table ilium. guide pin passed across into center sacrum neural foramina, which confirmed then drilled broached. Triangular titanium rods placed. Typically, implants placed, 2 S1 1 S2. Multiplanar postplacement imaging pelvis obtained. wound irrigated closed layers.Nonsurgical alternatives have been reported include pharmacological therapies, nonsteroidal anti-inflammatory drugs, therapeutic blocks5, physical therapy, core stabilization, orthotics (SI belts), radiofrequency ablation1,2,6-8. surgical alternative an open anterior posterior approach arthrodesis. differs resection cartilage, use plate screws packing bone graft facilitate fusion9. more morbid much longer recovery.Conservative management inadequate all patients. Having 5 positive examination maneuvers7, having confirmatory diagnostic block(s)10, ruling out hip spine generator provide success rate >80%. patients early sustained clinically important significantly improved outcomes varying measures compared conservative treatment1-4,11,12.Patients can expect experience decreased pain, reduced disability, increased daily function, quality life soon after performed. typically improvement ≥50% Oswestry Disability Index score significant decrease visual analog scores13. appears durable through at least years14. Complete relief rare, typical.Proper setup system needed ensure accurate starting points.For 3D navigation, reference contralateral superior iliac spine.Although used, radiographic images made periodically confirm proper placement pins implants. Images greatest benefit when establishing guide-pin outlet view allows evaluation depth, placement.Blood loss generally low, care should taken avoid vascular injury. Although improper has led injury artery15 artery16. avoided staying bone.Proper imperative this procedure. potential nerve implant: L5 if too ventral S2 deep foramen. Revision surgery commonly root impingement malpositioning.Preoperative it necessary rule differential diagnoses mimic pain. enables surgeon intrapelvic pathology, assess sacral density17, identify dysmorphic sacra transitional vertebrae.