31 - Sacroiliac Joint Arthrodesis MIS Technique with Titanium Implants: Rep...

#31 Sacroiliac Joint Arthrodesis MIS Technique with Titanium Implants: Report of the First 50 Patients and Outcomes with Minimum 24 Month Follow up

MIS Techniques and Outcomes

Poster Presented by: L. Rudolf

Author(s):

L. Rudolf (1)

(1) Alice Peck Day Memorial Hospital, Lebanon, NH, USA

Abstract

Introduction: Sacroiliac (SI) joint pain is a challenging condition to manage due to 1) the lack of awareness and training among the surgical community, 2) the complexity of diagnosis and 3) limited treatment options. When conservative measures fail, SI joint arthrodesis has been recommended. Until recently, no minimally invasive surgical arthrodesis options existed for the SI joint. Many studies have shown the benefits of an MIS approach including smaller exposure, less blood loss and minimal wound related morbidity.

The purpose of this study is to evaluate the safety and efficacy of minimally invasive SI joint arthrodesis using a series of triangular, porous plasma spray coated titanium implants.

Methods: A retrospective medical chart review of the first 50 consecutive patients treated between October 2007 and July 2010 with MIS SI joint fusion at a single institution was undertaken. Charts were reviewed for complications, pain, quality of life, satisfaction and return to work status up to 12 month follow up. A telephone survey was performed at a minimum of 24 months post-operatively to assess SI joint pain, satisfaction and work status.

Results: A total of 55 joints were treated. Mean age was 54 (range 24-85), patients were mostly female (68%) and 44% had prior lumbar fusion. Mean operating time was 65±26 minutes and blood loss was minimal in all cases. Peri-operative complications consisted of superficial cellulitis in 3 patients and 2 buttock hematomas. Two patients early in our experience returned to the OR shortly after surgery for partial retraction of the implant. At 3 years post-op one patient returned to have 2 additional implants placed after experiencing gradually increasing SI joint pain.

Mean follow up period was 40 months (range 24-56). An early and sustained clinically (>2points) and statistically significant (p=0.00) improvement was observed in 7/9 domains at all time points including pain, ability to perform activities regardless of perceived difficulty (light, moderate, vigorous), sleep, happiness and effect of pain on social life. Percentage of patients who experienced a clinically significant improvement in pain was 70% at 12 months and 82% at mean 40months. Satisfaction was high: 82% of patients would have the same surgery again.

Discussion & Conclusion: When conservative measures fail, MIS SI joint arthrodesis using a series of triangular porous plasma coated implants is a safe and effective treatment option in carefully selected patients.