Summary of Sacroiliac Joint Fixation with an MIS Approach Using Fusion Implants
Joseph Schifini, M.D. Abstract Presented at the Kaiser Orthopedic and Pain Department Grand Rounds, Mar 2010
Summary of Sacroiliac Joint Fixation with an MIS Approach Using Fusion Implants
Presented in March 2010 to Kaiser Orthopedic and Pain Department Grand Rounds By Joseph Schifini, MD
Control Pain Clinic Las Vegas, NV
There is an enormous vacuum in the education of orthopedic surgeons regarding the painful SI joint, and an equally large unmet need for a simple, reliable, orthopedic, stabilization procedure of the SI joint. At our current level of understanding orthopedic spine surgeons will more readily treat an asymptomatic bulging disc than a painful SI joint.
Gold standard of the diagnosis of the pathological SI joint is one or two injections with lidocaine and contrast (diagnostic block). Paul Dreyfuss (JAAOS 2004) recommends using no more than 1 cc of fluid in the injection.
After SI joint injections fail to relieve pain for longer than 2 months, Dreyfuss believes referral for surgical stabilization should not be delayed on the outside chance that future injections may be efficacious.
This new MIS fixation/fusion procedure is now being performed in 14 states. It utilizes triangular shaped titanium implants with a surface plasma spray and is designed to allow bony fixation of the implants on either side of the joint. Over time on imaging, the implants are noted to ‘white out’ over the SI joint. We’ve elected to call this a second‐generation fusion.
The procedure requires a 3cm incision and takes about 45 minutes. Patients can go home the same day or spend one night in the hospital.
Patients are encouraged to be non-¬‐weight-¬‐bearing for up to 6 weeks, or earlier based on physician recommendation. This MIS procedure provides pain physicians with an additional treatment option for SI joint patients that are refractory to conservative therapy.
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Dr. Schifini grew up in southern Nevada where he eventually returned to start his medical practice after graduating from University of California, Irvine’s Anesthesiology Program in 1997. While at U.C. Irvine, he focused on Pain Management as his primary specialty. He currently runs a very successful Anesthesiology-¬‐based Pain Management private practice, mainly dealing with industrial injuries. His practice is focused on the proper diagnosis and treatment of spinal disorders. He has academic affiliations with University of Nevada School of Medicine as well as Touro University Medical School.
