#497 Minimally Invasive versus Open Sacroiliac Joint Fusion: A Comparison of Process Measures and Description of Technique

General Session: Cutting Edge Technology - Imaging Guidance

Presented by: E. Santos

Author(s):

E.R.G. Santos (1)
C.G. Ledonio (1)
D.W. Polly (1)
J.N. Sembrano (1)
B. Azmoudeh (1)

(1) University of Minnesota, Orthopaedics, Minneapolis, MN, USA

Abstract

Introduction: The Sacroiliac joint (SIJ) has been implicated as a source of chronic low back pain in 15 to 30% of patients. The mainstay of therapy for disorders of the sacroiliac joint has been nonoperative treatment, including rest, nonsteroidal anti-inflammatory agents, and physical therapy. When these modalities fail, sacroiliac joint fusion may be recommended. Open anterior approach to the SIJ is the most common technique for fusion of the SIJ using a plate & screws. Recently, with advances in intraoperative imaging guidance, minimally invasive (MIS) techniques using ingrowth coated fusion rods have been utilized with increasing frequency due to its observed advantages of decrease morbidity, shorter hospital stay and shorter surgical time.The purpose of this study is to compare the operative process measures associated with both techniques.

Materials and Methods: Retrospective chart review of patients who underwent SIJ fusion were analyzed. Specifically, operative process measures were compared between MIS and the open anterior approach technique of SIJ fusion. Student's t-test was used to compare the mean estimated blood loss (EBL), length of hospital stay and length of surgery.

Results: 27 MIS and 26 open SI joint fusions were included for comparison. All patients had SIJ dysfunction confirmed by SIJ injection and have failed non-operative treatment. Mean age, mean BMI and gender distribution did not differ significantly between the two groups (p>0.05). There were statistically significant differences in EBL, length of hospital stay and length of surgery between MIS and open anterior SI joint fusion.

Conclusion: A statistical and clinical significant decrease in EBL, length of hospital days and length of surgery was observed for minimally invasive SIJ fusion compared to the open technique. Comparative effectives of patient and physician reported outcomes are not yet available. If the outcomes show comparable efficacy then the less morbid procedure may be the preferred technique.