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CT-/X-Ray-Guided Technique in Sacral Fusion

  • Luigi Manfrè
Chapter
Part of the New Procedures in Spinal Interventional Neuroradiology book series (NPSIN)

Abstract

The sacroiliac joint (SIJ) is considered the largest and strongest as well as the best protected joint in the body. Despite this unique anatomical condition, there are several conditions such as joint degeneration, estrogen-dependent ligament relaxation during delivery, as well as iatrogenic causes such as posterior interbody fusion (PIF) that can cause SIJ weakness and pain. One of the characteristics of SIJI is the ambiguous clinical symptom with patients complaining about low back pain (LBP), pelvic and bottom as well as coxofemoral pain, leg numbness, and dizziness, related to the complex neural frameworks of this joint. Despite typical signs can be detected in many patients on neuroradiological examination such as CT and MRI scan and bone scanning, the only affordable test for the correct diagnosis of SIJI remains CT-guided local lidocaine injection. In the past, several techniques have been proposed such as conventional “open” surgery in an attempt to stabilize the SIJ, obtaining sacroiliac arthrodesis using different tools. Recently, however, thanks to the widespread use of CT-guided treatments, new tools have been proposed by industries, obtaining the safest and more precise stabilization of the SIJ, reducing morbidity and after treatment-recovery time, as well as avoiding general anesthesia.

Supplementary material

978-3-319-12901-3_7_MOESM1_ESM.mp4 (297.2 mb)
Video 7.1 (MP4 304343 kb)

References

  1. 1.
    Deyo RA et al (2006) Back pain prevalence and visit rates: estimates from US national surveys, 2002. Spine 31:2724–2727CrossRefPubMedGoogle Scholar
  2. 2.
    Turner JA et al (1992) Patient outcomes after lumbar spinal fusions. JAMA 268:907–911CrossRefPubMedGoogle Scholar
  3. 3.
    Goldthwaite GE, Osgood RB (1950) A consideration of the pelvic articulations from an anatomical, pathological, and clinical standpoint. Boston Med Surg J 152:593–601CrossRefGoogle Scholar
  4. 4.
    Dreyfuss P et al (1995) Sacroiliac joint injection techniques. Phys Med Rehabil Clin N Am 6:785–813CrossRefGoogle Scholar
  5. 5.
    Bernard TN, Cassidy JD (1991) The sacroiliac syndrome. Pathophysiology, diagnosis and management. In: Frymoyer JW (ed) The adult spine: principles and practice. Raven, New York, pp 2107–2130Google Scholar
  6. 6.
    Dreyfuss P et al (2004) Sacroiliac joint pain. J Am Acad Orthop Surg 12:255–265CrossRefPubMedGoogle Scholar
  7. 7.
    Sturesson B et al (1989) Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis. Spine 14:162–165CrossRefPubMedGoogle Scholar
  8. 8.
    Sturesson B et al (2000) A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine 25:364–368CrossRefPubMedGoogle Scholar
  9. 9.
    Sturesson B et al (2000) A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine 25:214–217CrossRefPubMedGoogle Scholar
  10. 10.
    Grieve EF (1983) Mechanical dysfunction of the sacroiliac joint. Int Rehabil Med 5(1):46–52CrossRefPubMedGoogle Scholar
  11. 11.
    Damen L et al (2001) Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynecol Scand 80:1019–1024CrossRefPubMedGoogle Scholar
  12. 12.
    Katz V et al (2003) The sacroiliac joint: a potential cause of pain after lumbar fusion to the sacrum. J Spinal Disord Tech 16(1):96–99CrossRefPubMedGoogle Scholar
  13. 13.
    Cook S et al (2000) Reoperation after primary posterior instrumentation and fusion for idiopathic scoliosis. Toward defining late operative site pain of unknown cause. Spine 25:463–468CrossRefPubMedGoogle Scholar
  14. 14.
    Mok JM et al (2009) Reoperation after primary fusion for adult spinal deformity: rate, reason, and timing. Spine 34(8):832–839CrossRefPubMedGoogle Scholar
  15. 15.
    Emami A et al (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: Luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine 27:776–786CrossRefPubMedGoogle Scholar
  16. 16.
    Laslett M (2008) Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther 16(3):142–152CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ivanov AA (2009) Lumbar fusion leads to increases in angular motion and stress across sacroiliac joint: a finite element study. Spine 34(5):162–169CrossRefGoogle Scholar
  18. 18.
    Frigerio NA et al (1974) Movement of the sacroiliac joint. Clin Orthop Relat Res 100:370–377CrossRefGoogle Scholar
  19. 19.
    Willard FH (1995) The anatomy of the lumbar sacral connection. Spine 9:333–355Google Scholar
  20. 20.
    Mathews V et al (2001) Early fracture of the sacrum or pelvis: an unusual complication after multilevel instrumented lumbosacral fusion. Spine 26:E571–E575CrossRefPubMedGoogle Scholar
  21. 21.
    Kee-Yong H et al (2008) Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion. A prospective cohort study over five-year follow-up. Spine 33(11):1192–1198CrossRefGoogle Scholar
  22. 22.
    Deyo RA et al (2004) Spinal-fusion surgery: the case for restraint. N Engl J Med 350:722–726CrossRefPubMedGoogle Scholar
  23. 23.
    Murata Y et al (2000) Sensory innervation of the sacroiliac joint in rats. Spine 16:2015–2019CrossRefGoogle Scholar
  24. 24.
    Grob KR et al (1995) Innervation of the sacroiliac joint in humans. Z Rheumatol 54:117–122PubMedPubMedCentralGoogle Scholar
  25. 25.
    Ikeda R (1991) Innervation of the sacroiliac joint: macroscopic and histological studies. J Nippon Med Sch 58:587–596CrossRefGoogle Scholar
  26. 26.
    Fortin JD et al (1999) Sacroiliac joint innervation and pain. Am J Orthop 28:68–90Google Scholar
  27. 27.
    Yamashita T et al (1990) Mechanosensitive afferent units in the lumbar facet joint. J Bone Joint Surg Am 72:865–870CrossRefPubMedGoogle Scholar
  28. 28.
    Yamashita T et al (1993) Mechanosensitive afferent units in the lumbar intervertebral disc and adjacent muscle. Spine 18:2252–2256CrossRefPubMedGoogle Scholar
  29. 29.
    Minaki Y et al (1996) An electrophysiological study on the mechanoreceptors in the lumbar spine and adjacent tissues. Neurol Orthop 20:23–35Google Scholar
  30. 30.
    Sembrano JN, Polly DW (2009) How often is low back pain not coming from the back? Spine 34(1):27–32CrossRefGoogle Scholar
  31. 31.
    Cohen SP (2005) Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg 10(5):1440–1453CrossRefGoogle Scholar
  32. 32.
    Schwarzer AC et al (1995) The sacroiliac joint in chronic low back pain. Spine 20:31–37CrossRefPubMedGoogle Scholar
  33. 33.
    Maigne JY et al (1996) Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine 21:1889–1892CrossRefPubMedGoogle Scholar
  34. 34.
    Laslett M (2006) Pain provocation tests for diagnosis of sacroiliac joint pain. Aust J Physiother 52:229CrossRefPubMedGoogle Scholar
  35. 35.
    Fortin JD et al (1997) The Fortin finger test: an indicator of sacroiliac pain. Am J Orthop 26:477–480PubMedPubMedCentralGoogle Scholar
  36. 36.
    Fortin JD et al (2003) Can the sacroiliac joint cause sciatica? Pain Physician 6:269–271PubMedPubMedCentralGoogle Scholar
  37. 37.
    van der Wurff P et al (2000) Clinical tests of the sacroiliac joint. A systematic methodological review: part 1. Reliability. Man Ther 5:30–36CrossRefPubMedGoogle Scholar
  38. 38.
    van der Wurff P et al (2000) Clinical tests of the sacroiliac joint. A systematic methodological review. Part 2: validity. Man Ther 5:89–96CrossRefPubMedGoogle Scholar
  39. 39.
    Dreyfuss P et al (1996) The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine 21:2594–2602CrossRefPubMedGoogle Scholar
  40. 40.
    Freburger JK et al (1999) Measurement of sacroiliac joint dysfunction: a multicenter intertester reliability study. Phys Ther 79:1134–1141PubMedPubMedCentralGoogle Scholar
  41. 41.
    van der Wurff P (2006) Clinical diagnostic tests for the sacroiliac joint: motion and palpation tests. Aust J Physiother 52:308CrossRefPubMedGoogle Scholar
  42. 42.
    Potter NA et al (1985) Intertester reliability for selected clinical tests of the sacroiliac joint. Phys Ther 65:1671–1675CrossRefPubMedGoogle Scholar
  43. 43.
    Riddle DL et al (2002) Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study. Phys Ther 82:772–781PubMedPubMedCentralGoogle Scholar
  44. 44.
    Robinson HS et al (2007) The reliability of selected motion- and pain provocation tests for the sacroiliac joint. Man Ther 12:72–79CrossRefPubMedGoogle Scholar
  45. 45.
    Carrera GF et al (1981) CT of sacroiliitis. AJR Am J Roentgenol 136:41–46CrossRefPubMedGoogle Scholar
  46. 46.
    Resnick D et al (1977) Comparison of radiographic abnormalities of the sacroiliac joint in degenerative disease and ankylosing spondylitis. AJR Am J Roentgenol 128:189–196CrossRefPubMedGoogle Scholar
  47. 47.
    Resnick D et al (1975) Degenerative disease of the sacroiliac joint. Invest Radiol 10:608–621CrossRefPubMedGoogle Scholar
  48. 48.
    Vogler JB III et al (1984) The normal sacroiliac joint: a CT study of asymptomatic patients. Radiology 151:433–437CrossRefPubMedGoogle Scholar
  49. 49.
    Elgafy H et al (2001) Computed tomography findings in patients with sacroiliac pain. Clin Orthop Relat Res 382:112–118CrossRefGoogle Scholar
  50. 50.
    Boden SD et al (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72:403–408CrossRefPubMedGoogle Scholar
  51. 51.
    Jensen MC (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73CrossRefPubMedGoogle Scholar
  52. 52.
    Slipman CW et al (1996) The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine 21:2251–2254CrossRefPubMedGoogle Scholar
  53. 53.
    Maigne JY et al (1998) Value of quantitative radionuclide bone scanning in the diagnosis of sacroiliac joint syndrome in 32 patients with low back pain. Eur Spine J 7:328–331CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Maigne JY et al (2005) Sacroiliac joint pain after lumbar fusion. A study with anesthetic blocks. Eur Spine J 14:654–658CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Braun J et al (1996) Computed tomography guided corticosteroid injection of the sacroiliac joint in patients with spondyloarthropathy with sacroiliitis: clinical outcome and follow-up by dynamic magnetic resonance imaging. J Rheumatol 23:659–664PubMedPubMedCentralGoogle Scholar
  56. 56.
    Bollow M et al (1996) CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast enhanced MRI. J Comput Assist Tomogr 20:512–521CrossRefPubMedGoogle Scholar
  57. 57.
    Cohen SP (2005) Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg 101:1440–1453CrossRefPubMedGoogle Scholar
  58. 58.
    Yin W et al (2003) Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine 28:2419–2425CrossRefPubMedGoogle Scholar
  59. 59.
    Rudolf L (2012) Sacroiliac joint arthrodesis-MIS technique with titanium implants: report of the first 50 patients and outcomes. Open Orthop J 6:495–502CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Sembrano JN et al (2011) Diagnosis and treatment of sacroiliac joint pain. Curr Orthop Pract 22(4):344–350CrossRefGoogle Scholar
  61. 61.
    Yap FW et al (2013) Trans-iliac pin/bolt/screw internal fixation for sacroiliac luxation or separation in cats: six cases. J Feline Med Surg Sep 16:818–821Google Scholar
  62. 62.
    Geisler F (2013) Stabilization of the sacroiliac joint with the SI-Bone surgical technique. Neurosurg Focus 35:818–821Google Scholar
  63. 63.
    Wood M et al (2011) A comparison of CT-based navigation techniques for minimally invasive lumbar pedicle screw placement. J Spinal Disord Tech 24(1):1–5CrossRefGoogle Scholar
  64. 64.
    Kraus MD et al (2010) Can computer-assisted surgery reduce the effective dose for spinal fusion and sacroiliac screw insertion? Clin Orthop Relat Res 468(9):2419–2429CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Beck M et al (2010) Intraoperative three-dimensional fluoroscopy assessment of iliosacral screws and lumbopelvic implants stabilizing fractures of the os sacrum. Arch Orthop Trauma Surg Nov 130(11):1363–1369CrossRefGoogle Scholar
  66. 66.
    Vilensky JA et al (2002) Histologic analysis of neural elements in the human sacroiliac joint. Spine 27:1202–1207CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Minimal Invasive Spine Therapy“Cannizzaro” HospitalCataniaItaly

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