Salvage of Failed Lateral Sacroiliac Joint Fusion with a Novel Posterior Sacroiliac Fusion Device: Diagnostic Approach, Surgical Technique, and Multicenter Case Series

Abstract

Dawood Sayed,1 Nasir Khatri,1 Adam Rupp,1 Christopher Bovinet,2 Nomen Azeem,3 Sean Li,4 Youssef Josephson,5 Jason Pope6 1Department of Anesthesiology, University of Kansas, Kansas City, KS, USA; 2The Spine Center of Southeast Georgia, Brunswick, GA, USA; 3Florida Spine & Pain Specialists, Riverview, FL, USA; 4Premier Pain Centers, Shrewsbury, NJ, USA; 5National Spine & Pain Centers, Voorhees Township, NJ, USA; 6Evolve Restorative Center, Santa Rosa, CA, USACorrespondence: Dawood Sayed, Department of Anesthesiology, University of Kansas, Kansas City, KS, USA, Email [email protected]: Studies have found that up to one-third of patients with LBP have sacroiliac joint (SIJ) dysfunction as a contributing cause. Historically, the management of SIJ dysfunction has been plagued by ineffectiveness or significant morbidity. In 2008, minimally invasive lateral SIJ fusion was developed. While this procedure is a safe and effective treatment, there is still a significant proportion of patients who will not experience therapeutic success. There is a paucity of data in the literature regarding the management of these patients. Recently, a novel posterior sacroiliac joint fusion device has been developed which minimizes complications compared to lateral approaches and may serve to salvage therapeutic failures in this patient population.Objective: Determine the efficacy and feasibility of a posterior SIJ fusion device as a salvage technique in patients who have not experienced therapeutic success following lateral SIJ fusion.Design: Multi-center retrospective observational study.Methods: Patients who had previously undergone lateral SIJ fusion and had persistent LBP were evaluated and diagnosed to have persistent primary SIJ pathology. All patients underwent posterior SIJ fusion utilizing a machined allograft transfixing sacroiliac fusion device. Demographic data and patient reported pain scores were collected.Results: A total of 7 patients who had undergone lateral SIJ fusion were included in the study and underwent posterior SIJ fusion. The mean patient reported pain improvement following posterior fusion was 80% with an average follow-up time of 10 months. Median morphine milliequivalents were 20 pre-procedure and 0 post-procedure.Conclusion: We were able to show significant reductions in pain scores and opioid consumption, which suggests that minimally invasive posterior SIJ utilizing a novel implant and technique may be a viable treatment option to salvage pain relief in this patient population. Further, the favorable safety profile of this posterior technique uniquely positions it to be an appropriate first-line surgical therapy.Keywords: sacroiliac joint pain, posterior SIJ fusion, lateral SIJ fusion, salvage, low back pain

Keywords

• sacroiliac joint pain
• posterior sij fusion
• lateral sij fusion
• salvage
• low back pain