Lateral-decubitus MIS SI Joint Fusion Technique (Kazemi - World Neurosurg 2021)
Novel Lateral Approach for MIS Sacro-Iliac Joint Arthrodesis - an Assessment of Feasibility and Outcomes
Objectives: The prevalence of physicians experiencing work-related musculoskeletal disorders is high. Traditionally, minimally invasive (MIS) SI joint fusions are performed with the patient-oriented in the prone position, with an incision made inferior to the iliac crest. However, a novel technique that orients the patient in the lateral-decubitus position has the potential of significantly enhancing ergonomics and ease of approach. The primary objectives of this study are to quantify surgical parameters, describe this "lateral-decubitus MIS" technique, and identify imaging angle parameters that predict feasibility.
Methods: A prospective cohort of patients who underwent MIS SI joint arthrodesis in the lateral-decubitus position was evaluated at a single institution between 2017 and 2020. Medians and ranges of intraoperative blood loss, operative time, revision rate, infection, and total radiation dose were recorded. Sacral inlet and outlet angles were defined and collected to assess for operative candidacy.
Results: 39 cases were identified in 34 patients who underwent the technique with an age range of 31 to 78 years. Median blood loss was 22.5 mL, OR time was 32.5 min, and radiation dose was 30.9 rads. Average sacral inlet was 24.51° and average sacral outlet was 65.44°. Median length of stay was 0.94 days. No cases were aborted or required revision. 93% of study participants reported improvement in pain. Operative parameters were comparable to the traditional prone approach.
Conclusions: The aim is to provide an insight into outcomes and metrics observed from pioneering this style of procedure. A future study comparing traditional peri-operative parameters together with surgical ergonomics is needed.
Keywords: Lateral Approach; Minimally Invasive Surgery; Sacroiliac Joint; Sacroiliitis; Spine; Spino-Pelvic Parameters; Surgical Ergonomics.