Best Practices for Postoperative Management of Posterior Sacroiliac Joint Fusion

Abstract

Patrick Buchanan,1 David W Lee,2 Ashley Comer,3 Zohra Hussaini,4 Casey Grillo,5 Shashank Vodapally,6 Natalie H Strand,7 Dawood Sayed,4 Timothy R Deer3 1Department of Pain Medicine, Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA; 2Department of Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA; 3Department of Pain Medicine, The Spine and Nerve Center of the Virginias, Charleston, WV, USA; 4Department of Anesthesiology, Division of Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA; 5Department of Pain Medicine, The Spine & Pain Institute of New York, New York, NY, USA; 6Department of Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA; 7Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USACorrespondence: Patrick Buchanan, Email [email protected]: Sacroiliac joint (SIJ) pain is a common cause of low back pain. Traditionally, treatment for SIJ joint pain and dysfunction has consisted of physical therapy, medication management, SIJ injections, and SIJ ablations. Improved recognition of the SIJ as an etiology for back pain has led to advances in treatment options. Radiofrequency of the lateral sacral branches has been shown to be effective, though evidence is fraught with inconsistent patient selection, study design and procedural technique. It also does not directly address the mechanical dysfunction of the SIJ. In order to create a more enduring approach SIJ fusion has become an attractive option to reduce pain and to improve function. This method of SI joint treatment requires guidance in the perioperative phase of care from both the physicians and advanced practice providers (APP). In order to improve care and outcomes of those undergoing posterior SI joint fusion the American Society of Pain and Neuroscience appointed an expert panel of physicians and advanced practice providers to create a best practice for the post operative care of this approach. As with any best practice, the panel considered current peer reviewed literature and clinical expertise to create guidance today. This is intended to be a living document with modifications as additional evidence comes to light in data publication. The goals of this paper are to focus on (1) wound care, (2) medication use, (3) physical activity and (4) therapeutic exercises.Keywords: sacroiliac joint, SIJ, low back pain, postoperative care, best practices, review, physical therapy, minimally invasive

Keywords

• sacroiliac joint
• sij
• low back pain
• postoperative care
• best practices
• review
• physical therapy
• minimally invasive