Minimally Invasive Sacroiliac Joint Surgery

A. Traditional sacroiliac joint fusion involves open surgery that may last up to several hours. Open surgery includes a significant incision to access the joint, removal of cortical tissue from the joint and use of bone grafts from another part of your body to help fuse the joint. Patients typically require a several day hospital stay. The minimally invasive surgical (MIS) iFuse Implant System® is now available. This MIS procedure requires a smaller incision and uses a guide pin to place the titanium implants across the sacroiliac joint. These small implants are designed to fix the sacroiliac (SI) joint and allow stable healing through minimization of micromotion. Typically three iFuse implants are used in an iFuse procedure.

A. Once the source of your low back pain has been diagnosed as SI joint in origin, your surgeon will discuss the iFuse Implant System procedure as a potential intervention with you. You may be an iFuse surgical candidate if your low back symptoms are predominantly below your L5 vertebra, your doctor does not find any neurological problems, and is able to determine through maneuvering your joint that your pain originates in the sacroiliac joint. To confirm your diagnosis, your doctor may administer a CT guided injection of pain reducing medication to your sacroiliac joint and verify that you experience significant pain relief from it. Some doctors may repeat the injection to be sure.

A. The iFuse Implant System® is used in a surgical procedure that is performed in an operating room with either general or spinal anesthesia. You will be lying face down while your surgeon uses the specially designed system to guide the instruments that prepare the bone and insert the implants. The surgical technique, iFuse implant, and supporting instrumentation are designed to offer maximum protection to your tissues during the surgical procedure. The entire procedure is performed through a small incision (approximately 2-3cm long), along the side of your buttock. During the procedure, X-ray guidance provides your surgeon with live imaging to facilitate proper placement of the implants. Typically three implants are placed, depending on your size.

A. The iFuse implants are small titanium rods about the size of your little finger. Titanium is a very strong but lightweight material, commonly used for medical device implants.

A. The iFuse implants have triangular cross-sections to keep them from rotating once they have been implanted. They are also coated with a titanium plasma spray that creates a rough surface which is designed to promote bone ingrowth. This helps to better secure the iFuse implants to bone. The stiffness of the implants holds the joint in place.

A. In contrast to the placement of screws across the sacroiliac joint, the iFuse implants are designed to maintain their implant position over time. Regardless of the implants used, there are two separate fusion mechanisms that fuse the sacroiliac (SI) joint over the long run - intra-articular fusion that occurs across the joint and extra-articular fusion due to the stiffness of the implants. The iFuse implants are designed to firmly fuse the joint.

A. Your doctor will provide recommendations. These may include post-operatively using crutches, a cane or a walker for 3 to 6 weeks, depending upon what your doctor recommends. You should not travel by air for a minimum of 2 weeks after an iFuse surgery. This limitation on air travel is strictly a precaution, and has to do with decreasing what is already a low risk of clots forming in the veins of your legs. It is also recommended that you see your surgeon for a post-operative visit between 1 and 2 weeks following surgery. However each surgeon may have specific recommendations as patient situations may vary. Based upon your doctor’s recommendation, you will need to come back at or around 12 weeks for more X-rays and, barring any complications and your doctor’s ok, you may resume full weight-bearing activities. At discharge, your doctor may arrange follow-up visits to assess the incision and take follow-up X-rays.

A. Your doctor will advise you on resuming your daily living activities as your healing and symptoms allow. Depending on your occupation, you may be able to return to work at this time. You will need to have additional X-rays taken at 6 months and later at 1 year in order your progress.

A. The iFuse may be used in patients with previous orthopedic surgeries and spinal implants. SI joint problems may coexist with lumbar spine or hip conditions. SI problems may appear after lumbar spine surgery or hip replacements. The iFuse can be safely used after either lumber or hip surgeries or both. Your doctor will determine whether your health, including any impact from previous surgeries, influences your being a candidate for MIS sacroiliac joint fusion.

A. In some cases, a person may require other surgeries after having an iFuse procedure. The iFuse implants are not anticipated to affect the ability to have other surgeries.

A. Major complications from this procedure appear to be uncommon, but like any surgery you may undergo, there are always some risks. Postoperative bruising and local swelling are part of the expected surgical recovery. One example of a major complication that may occur is infection. Infection may happen with any interventional procedure. This is why antibiotics are typically used both before and after surgery. This greatly lessens the risk of infection.

A. Although infrequent, there may be a reason (e.g. malpositioning, loosening, trauma, etc.) an iFuse implant may need to be repositioned or removed. The determination to remove an implant will be based on the treating physician’s informed decision. SI-BONE has developed a detailed algorithm to guide the physician through the revision procedure.

A. SI-BONE has received a number of inquiries related to manually adjusting and aligning the sacroiliac joint on the day of surgery, before the iFuse procedure is performed. In response to these inquiries, SI-BONE polled a number of surgeons who perform the iFuse procedure. It was determined that there is currently no consensus as to which manual alignment procedure is best, or if pre-operative alignment is even necessary to achieve successful results. In addition, there are currently no peer-reviewed publications that address the pros and cons of pre-operative adjustment and its effect on patient outcomes. Until such data is available, if you wish please discuss this issue with your surgeon as he or she is in the best position to determine your optimal treatment.