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Minimally Invasive Sacroiliac Joint Fusion: A Lateral Approach Using Triangular Titanium Implants and Navigation
David W Polly1, Kenneth J Holton1
1Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota.
JBJS Essential Surgical Techniques
|November 18, 2020
Summary
Minimally invasive sacroiliac (SI) joint fusion effectively relieves chronic low back pain when conservative treatments fail. This safe and proven procedure offers significant pain reduction and improved function for patients with SI joint dysfunction.
Area of Science:
- Minimally invasive spine surgery
- Orthopedic surgery
- Pain management
Background:
- Conservative management for sacroiliac (SI) joint pain is often inadequate.
- A significant percentage of patients with SI joint pain experience inadequate relief from nonoperative treatments.
- Minimally invasive SI joint fusion is indicated for pain stemming from degenerative sacroiliitis or SI joint disruption.
Purpose of the Study:
- To evaluate the safety and effectiveness of minimally invasive SI joint fusion.
- To highlight the benefits of this procedure for patients with refractory SI joint pain.
- To provide an overview of the surgical technique and expected outcomes.
Main Methods:
- The procedure involves general anesthesia and prone positioning, utilizing fluoroscopy or 3D navigation (e.g., cone-beam CT).
- A navigated probe guides implant placement, followed by a small lateral incision, dissection to the ilium, and guide pin insertion across the SI joint.
- Triangular titanium rods are typically placed (2 in S1, 1 in S2), confirmed with postplacement imaging.
Main Results:
- Minimally invasive SI joint fusion is safe and effective in reducing pain that is uncontrolled by nonoperative management.
- Patients typically experience decreased pain, reduced disability, and improved daily function.
- Outcomes demonstrate significant improvement in Oswestry Disability Index scores and visual analog pain scores, with durability up to 5 years.
Conclusions:
- Minimally invasive SI joint fusion provides a safe and effective solution for chronic SI joint pain.
- The procedure leads to clinically significant improvements in pain, function, and quality of life.
- While complete pain relief is uncommon, substantial and sustained improvement is the typical outcome.
