Functional and Radiographic Outcome of Sacroiliac Arthrodesis for the Disorders of the SI Joint
Jacob M. Buchowski, M.D., et al., The Spine Journal, no. 5 (October 2005): 520-528; discussion 529
SI Joint Key Points
- 20 patients underwent sacroiliac joint arthrodesis (via a modified Smith-Petersen technique) between Dec. 1994 and Dec. 2001.
- Significant (p≤.05) improvement occurred in the following SF - 36 categories: physical functioning, role physical, bodily pain, vitality, social functioning, role emotional, and neurogenic and pain indices.
- For carefully selected patients, sacroiliac arthrodesis appears to be a safe, well tolerated, and successful procedure, leading to significant improvement in functional outcome and a high fusion rate.
Introduction: Sacroiliac (SI) joint pain can arise from a number of causes, including SI joint dysfunction, various arthritides, infection, and other less common disorders. Most patients respond to nonoperative treatment, which may include rest, NSAIDs, and physical therapy. Although SI joint arthrodesis has been described as a treatment for patients who have not responded to more conservative treatment, the reports have suffered from small numbers of patients and from lack of information on functional outcome. Accordingly, the authors undertook this study to examine the surgical, radiographic, and functional outcome of patients undergoing SI joint arthrodesis.
Patient Sample:
The patient population consisted of 20 patients undergoing SI joint arthrodesis between December 1994 and December 2001. Patients undergoing concomitant procedures at the time of SI joint arthrodesis were excluded. The 3 men and 17 women in the study group had an average age of 45.1 years (range 21.8–66.4 years), a mean duration of symptoms of 2.6 years (range 0.5–8.0 years), and a mean follow-up period of 5.8 years (range 2.0–9.0 years). Multiple etiologies of SI symptoms were observed: SI joint dysfunction (13 patients), osteoarthritis (5 patients), and spondyloarthropathy and SI joint instability (1 each). For all 20 patients, nonoperative treatment had failed, and the diagnosis of SI joint pain had been confirmed by intraarticular injections under fluoroscopic guidance.
Methods: SI joint arthrodesis was performed using a modified Smith-Petersen technique. All patients were evaluated radiographically in the preoperative period, postoperative period, and at the latest follow-up. Preoperative and postoperative general health and function were assessed via the 36-item Short-Form (SF-36) Health Survey and American Academy of Orthopaedic Surgeons (AAOS) Modems Instrument. Medical records and plain radiographs were reviewed retrospectively to determine the clinical and radiographic outcome.
Results: Seventeen patients (85%) had solid fusion within 1 year of surgery. Three of the 20 patients (15%) had nonunions that required revision surgery, which was performed through an anterior approach. Fifteen patients (75%) completed preoperative and postoperative SF-36 forms. Significant (p ≤ .05) improvement occurred in the following categories: physical functioning, role physical, bodily pain, vitality, social functioning, role emotional, and neurogenic and pain indices. Though not statistically significant, improvement was also noted in general and mental health.
Conclusion: The authors believe that SI joint arthrodesis should be recommended only after a documented positive response to diagnostic intraarticular injection, failure of all nonoperative treatment modalities, and recurrent symptoms despite initial positive response to the injection. For carefully selected patients, SI joint arthrodesis appears to be safe, well tolerated, and successful, leading to significant improvement in functional outcome and a high fusion rate.
