Retrospective Evaluation of Minimally Invasive Surgical (MIS) Method for SI Joint Arthrodesis (CNS)

Fred H. Geisler, MD, Leonard M. Rudolf, MD. Abstract Presented at the Congress of Neurological Surgeons in Washington DC (CNS), Oct 2011

RETROSPECTIVE EVALUATION OF MINIMALLY INVASIVE SURGICAL (MIS) METHOD FOR SACROILIAC JOINT ARTHRODESIS
Fred Geisler, MD; Leonard M. Rudolf, MD

Introduction
In recent decades, interest in the SIJ as a LBP generator has renewed, and surgical treatment options have improved. Sembrano and Polly (2009) reported that the SIJ is a pain generator in approximately 15% of patients with LBP. Earlier, Bernard and Kirkaldy-Willis demonstrated close to 30%. Additionally, Ha et al. reported that up to 75% of patients with previous lumbar fusions develop SIJ degeneration. This retrospective study reports on the early findings of patients with confirmed SIJ pain treated with an MIS procedure to promote fusion.

Methods
Forty patients with pre- and post-operative VAS pain scores and post-operative satisfaction scores were followed for up to one year. Each patient was diagnosed for SIJ pain using a diagnostic algorithm similar to that described by Szadek et al., and had failed approximately 6 months of conservative therapy subsequent to the diagnosis. Patients were then treated with porous plasma-coated MIS implants placed laterally across the SIJ through an incision of approximately 3 cm. Patients were followed for up to one year and mean pain scores were compared using a paired t-test at each time point (p<0.05).

Results
28 patients were female, 12 male. Surgical time averaged <1 hour. Post-operative pain scores were significantly lower at each time point: 3 mo (7.7 to 3.4, n=38), 6 mo (7.5 to 3.0, n=33), and 12 mo (8.2 to 3.2, n=21). Additionally, at least 90% of the patients were satisfied at each time point: 3 mo (97%, n=35), 6 mo (91%, n=32), and 12 mo (90%, n=20).

Conclusions
The findings of this retrospective study suggest that SIJ arthrodesis using an MIS approach is an effective treatment for patients with diagnosed SIJ pain. These findings reinforce awareness that the SIJ is a common symptom generator in LBP and, with proper diagnosis; patients can be effectively treated with an MIS approach.

Learning Objectives
By the conclusion of this session, participants should be able to: 1) understand that the SIJ is a possible pain generator in a substantial portion of LBP patients, 2) understand the need to diagnose the SIJ in LBP patients, and 3) realize that SIJ fusion methods have improved.

Key Words
Sacroiliac joint, diagnosis, arthrodesis, low back pain

References

  • Mixter WJ and Barr JS. N Engl J Med 1934;211:210-215
  • Sembrano JN and Polly DW, Jr. Spine. 2009;34(1):E27-32
  • Bernard TN Jr. and Kirkaldy-Willis WH. Clin Orthop Relat Res. 1987;(217):266-80
  • Ha, et al. Spine. 2008;33(11):1192-1198

How will your research improve patient care?
Patient care specialists such as surgeons, pain management physicians, physical therapists, and chiropractors will have a renewed awareness that the SIJ is a source of LBP in a substantial number of patients and improved diagnostic algorithms are now available. In addition, surgeons now have an MIS option to treat these patients.

Conflict of Interest
Fred Geisler, MD, is a faculty consultant for SI-BONE, Inc. Leonard Rudolf, MD, is a faculty consultant for SI-BONE, Inc.