Early Results of Sacro–Iliac Joint Fixation Following Long Fusion to the Sacrum in Adult Spine Deformity
- 307 Downloads
The sacro–iliac joint (SIJ) is the largest joint in the human body. When the lumbar spine is fused to the sacrum, motion across the SIJ is increased, leading to increased degeneration of the SIJ. Degeneration can become symptomatic in up to 75% of the cases when a long lumbar fusion ends with a sacral fixation. If medical treatments fail, patients can undergo surgical fixation of the SIJ.
This study reports the results of short-term complications, length of stay, and clinical as well as radiographic outcomes of patients undergoing percutaneous SIJ fixation for SIJ pain following long fusions to the sacrum for adult scoliosis.
A retrospective review of all the patients who underwent a percutaneous fixation of the SIJ after corrective scoliosis surgery was performed in a single specialized scoliosis center between the years 2011–2013. Ten SIJ fusions were performed in six patients who failed conservative care for SIJ arthritis. Average age was 50 (range 25–60 years). The patients were 15.3 years in average after the original surgical procedure (range 4–25 years). Average post-operative follow-up was 10.25 months (range 15–4 months). The medical charts of the patients were reviewed for hospital stay, complications, pre- and post-operative pain, quality of life, and satisfaction with surgery using the visual analogues score (VAS), Scoliosis Research Society (SRS)22 and Oswestry Disability Index (ODI) questionnaires. Images were reviewed for fixation of the SIJ, fusion, and deviation of the implants from the SIJ.
There were no complications in surgery or post-operatively. Discharge was on post-operative day 2 (range 1–4 days). Leg VAS score improved from 6.5 to 2.0 (P < 0.005; minimal clinically important difference (MCID) 1.6). Back VAS score decreased from 7.83 to 2.67 mm (P < 0.005; MCID 1.2). ODI scores dropped from 22.2 to 10.5 (P = 0.0005; MCID 12.4). SRS22 scores increased from 2.93 to 3.65 (P = 0.035; MCID 0.2) with the largest increases in the pain, function, and satisfaction domains of the questionnaires.
Fixation of the SIJ in patients that fail conservative care for SIJ arthritis after long fusions ending in the sacrum provides a reduction in back pain and improved quality of life in the short and medium range follow-up period.
Keywordssacro–iliac joint joint fusion iFuse SI joint fusion scoliosis spine deformity
Conflict of Interest: Josh E. Schroeder, MD declares that he has no conflict of interest. Matthew E. Cunningham, MD, PhD reports personal fees from DePuy and J&J, outside the work. Tom Ross, RN reports grants from DePuy Synthes Spine, during the conduct of the study. Oheneba Boachie-Adjei, MD reports grants from DePuy Synthes Spine during the conduct of the study; is a consultant for DePuy, K2M, OsteoTech, and Trans1; receives grants from DePuy, K2M, and OsteoTech; other from DePuy, K2M, and Trans1; receives travel expenses and research support from K2M, outside the submitted work. In addition, Dr. Boachie-Adjei, MD has a patent with K2M and receives royalties from patents from DePuy and K2M.
Human/Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 .
Informed Consent: Informed consent was waived from all patients for being included in the study.
Required Author Forms
Disclosure forms provided by the authors are available with the online version of this article.
- 2.Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. Nov 2005; 101(5): 1440-1453.Google Scholar
- 3.Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. Feb 1988; 227: 67-81.Google Scholar
- 4.DePalma MJ, Ketchum JM, Saullo TR. Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Me. 12(5):732-739.Google Scholar
- 7.Hansen HC, McKenzie-Brown AM, Cohen SP, Swicegood JR, Colson JD, Manchikanti L. Sacroiliac joint interventions: a systematic review. Pain Physician. Jan 2007; 10(1): 165-184.Google Scholar
- 8.Kim JT, Rudolf LM, Glaser JA. Outcome of percutaneous sacroiliac joint fixation with porous plasma-coated triangular titanium implants: an independent review. Open Orthop J. 7:51-56.Google Scholar
- 11.Ohtori S, Sainoh T, Takaso M, et al. Clinical incidence of sacroiliac joint arthritis and pain after sacropelvic fixation for spinal deformity. Yonsei Med J. 53(2):416-421.Google Scholar
- 12.Rudolf L. Sacroiliac joint arthrodesis-mis technique with titanium implants: report of the first 50 patients and outcomes. Open Orthop J. 6:495-502.Google Scholar
- 13.Schutz U, Grob D. Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Acta Orthop Belg. Jun 2006; 72(3): 296-308.Google Scholar
- 14.Smith-Petersen MN. Arthrodesis of the sacroiliac joint, a new method of approach. J Bone Joint Surg. 1921; 3(8): 400-405.Google Scholar
- 16.Yoshihara H. Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge. Eur Spine J. 21(9):1788-1796.Google Scholar