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

Robert M. Pflugmacher, MD, Leonard M. Rudolf, MD. Abstract Presented at 2011 Eurospine Meeting in Milan, Italy, Oct 2011

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

Introduction
Before the 1930’s, treatment for low back pain (LBP) was focused on the sacroiliac joint (SIJ). Following Mixter and Barr’s seminal study on herniated discs, treatment shifted to lumbar spine and interest in SIJ waned. In recent decades, interest in the SIJ as LBP generator has renewed, and surgical treatment options have improved. Recently, Sembrano and Polly demonstrated the SIJ is a pain generator in approximately 15% of patients with LBP and earlier Bernard and Kirkaldy-Willis demonstrated close to 30%. Additionally, Ha et al. reported that the incidence of SIJ degeneration is up to 75% in patients with previous lumbar fusions. This retrospective study reports on the early findings of patients with confirmed SIJ pain treated with an MIS procedure to promote fusion.

Materials and 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 coated 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, 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.

References:

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

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