186 - Minimally Invasive SI Joint Fusion for SI Joint Pain: 6 Month Results...

#186 Minimally Invasive SI Joint Fusion for SI Joint Pain: 6 Month Results from the Initial 8 Patients

MIS Techniques and Outcomes

Poster Presented by: R. Kube

Author(s):

R.A. Kube (1)
A. Blood (1)

(1) Prairie Spine & Pain Institute, Peoria, IL, USA

Abstract

Purpose: Historically Sacro-iliac (SI) Joint Fusion has been performed to control pain, using a massively invasive open procedure to achieve fixation and fusion. As a result, open SI Fusion has been infrequently used. Alternatives, such as SI injection and nerve ablation have also been used, with long term results reported to be >50% pain relief for >3 months (Cochrane Review by Hansen HC et al.). This study reports on an initial series of patients treated with minimally invasive SI joint (MIS SIJ) fusion, which includes decortication, bone graft introduction, and fixation techniques more frequently associated with open procedures, demonstrating good results for >6 months. This is believed to be the first MIS classically prepared fusion data for the sacro-iliac joint evidencing long term treatment for SIJ pain.

Methods: A retrospective review was performed on the charts of 8 patients treated with either a right or left true MIS SIJ fusion, including decortication and bone grafting within the SIJ. All patients had diagnoses confirmed pre-operatively on physical exam (2 or more positive findings) and with guided SI joint injections (>75% SI pain relief). Pre-operative VAS and Oswestry (ODI) scores were obtained at regular intervals to a minimum of 6 months. One patient was lost in follow-up. CT scans were performed at 6 months and evaluated for fusion by an independent group of Radiologists. Of the 8 patients reviewed, 5 were smokers and 5 had workers' compensation claims.

Results: Results for the 7 patients who completed 6 months of follow up (table 1). None of the subjects experienced intraoperative complications or adverse events. All patients were discharged to home the day of the surgery except one who was kept 2 days for pain control. Six of seven patients (86%) had evidence of bone formation on CT scan at 6 months. The patient with poor bone formation was a smoker. Workers compensation patients showed similar improvement.

Discussion: This pilot cohort demonstrates good 6 month clinical outcomes for SI joint pain treated with MIS SIJ fusion. These results exceed those reported in the Cochrane Review of current interventional pain options by Hansen HC et al,. Early CT scans suggest a significant (86%) fusion rate may be anticipated, however longer follow-up is needed. If current pain scores and fusion rates continue to trend, this MIS SIJ technique, using fusion techniques that normally require an open surgical approach, will demonstrate excellent efficacy and thereby provide patients with a true long term and cost effective solution for SI joint pain.

Table 1