25 - The Safety Profile of Percutaneous Minimally Invasive Sacroiliac Joint...

Oral Posters: MIS

Presented by: A. Shamrock - View Audio/Video Presentation (Members Only)

Author(s):

A. Shamrock(1), A. Patel(1), M. Al Maaieh(1)

(1) University of Miami, Department of Orthopaedic Surgery, Miami, FL, United States

Abstract

Introduction: Sacroiliac joint (SIJ) fusion is gaining popularity among spine surgeons for treatment of SIJ dysfunction. SIJ fusion can be accomplished by open or minimally invasive (MI) surgery. The MI technique has increased in popularity as it is believed to be associated with minimal blood loss, less surgery time, and decreased length of hospital stay. This is a systematic review of the existing literature to determine the safety of MI SIJ fusion through the determination of the rate of procedural and device related intraoperative and postoperative complications.

Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Scopus were searched using the terms “sacroiliac joint AND fusion”. All original English language retrospective and prospective studies of at least five patients with reported adverse event or complication rates for MI SIJ fusion were included for analysis. Complications were defined as procedural if reported as most likely or definitely due to the MI surgery and device related if secondary to the implant device. Random effects meta-analysis was performed for pre-operative and post-operative Visual Analog Score (VAS) pain ratings and Oswestry Disability Index (ODI) to quantify the efficacy of MI fusion in studies providing both mean scores and standard deviations (SD). Postoperative VAS and ODI scores were from last recorded follow-up.

Results: Fourteen studies met our inclusion criteria. Seven studies reported VAS scores while five studies provided ODI values. Twelve of the studies investigated triangular porous titanium plasma spray coated implants while two studies used hollow modular anchorage screws packed with demineralized bone matrix. A total of 720 patients (499F/221M) with a mean follow-up of 22 months were included in the analysis. 99 patients (13.75%) underwent bilateral SIJ arthrodesis resulting in a total of 819 SI joints fused. There were 90 documented procedural-related complications (10.99%) with the most common adverse events being surgical wound infection/drainage (n=13), trochanteric bursitis (n=11), and hematoma formation (n=9). 25 adverse events were attributed to be directly caused by the implant device (3.05%) with nerve root impingement (n=13) being the most common. The rate of revision was found to be 2.56%. The association between the type of implant and device related complications was not statistically significant (p=0.955). MI SIJ fusion reduced VAS pain scores from 82.42 (95% CI 79.34-85.51) to 29.03 (95% CI 25.05-33.01) and ODI scores from 57.44 (95% CI 54.73-60.14) to 29.42 (95% CI 20.62-38.21). Patient satisfaction with outcomes was high at 93.14%, with 86.01% stating they would have the same surgery again.

Discussion and Conclusion: MI SIJ fusion reduces pain and improves functionality of accurately diagnosed SIJ dysfunction. Possible risks and complications of the procedure, including those requiring revision, are not uncommon; however patient satisfaction is high. Additional studies are needed to further enhance the safety of the procedure.