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Splitt T, Pflugmacher R, Soliman O, Abd Allah HM, Hering R, Kasapovic A, Rössler P, Koch EMW, Bornemann R. Surgical Treatment of Patients with Sacroiliac Joint Syndrome: Comparative Study of Two Implants. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37992733 DOI: 10.1055/a-2188-3398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The treatment of patients with ISJ dysfunction is difficult due to the multifactorial causes of pain and various problems in clarification. Treatment includes physical therapy, corticosteroids, prolotherapy, radiofrequency denervation and sacroiliac joint fusion. A new option for the surgical treatment of ISG dysfunction is the Torpedo implant system. For a safe fusion, only 2 implants are needed, which are available in lengths of 30-50 mm. The new implant system has been tested in pilot studies for efficacy and biocompatibility with good results. For further documentation for the Torpedo implant system, a comparative study against the iFuse system was carried out.Two different implants were used: Group 1: Deltacor Torpedo, Group 2: iFuse implants (Si-Bone). The data generated during admission and subsequent check-ups (VAS, ODI, opioid use) were entered into an evaluation file set up for this purpose. Follow-up appointments were set at 1 month, 3, 6 and 12 months postoperatively.The data of 65 patients were evaluated comparatively. In all comparisons, only very small effect sizes were found with regard to the differences in the decrease in pain intensities, so that equivalent effectiveness of the two methods could initially be postulated from a clinical point of view. Most patients in both groups reported taking opioids to treat pain before surgery. According to the decrease in pain intensity, opioid treatment could be discontinued in some patients after the operation. After 12 months, the number of patients treated with opioids decreases to 23% in group 1 and to 17% in group 2. The success of the fusions with the two methods can also be proven by image documentation, from which the position of the implants can also be clearly recognised. In no case was there any loosening.Overall, the evaluation of this study allows the conclusion that both implant systems can be successfully used for the treatment of patients with ISJ syndrome. The present results should be confirmed in further comparative studies with the proposed evaluation methods.
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Affiliation(s)
- Theresa Splitt
- Klinik für Wirbelsäulenchirurgie, Krankenhaus Mechernich, Mechernich, Deutschland
| | - Robert Pflugmacher
- Klinik für Wirbelsäulenchirurgie, Krankenhaus Mechernich, Mechernich, Deutschland
| | - Osama Soliman
- Klinik für Wirbelsäulenchirurgie, Krankenhaus Mechernich, Mechernich, Deutschland
| | | | - Rudolf Hering
- Klinik für Anästhesie, Kreiskrankenhaus Mechernich GmbH, Mechernich, Deutschland
| | - Adnan Kasapovic
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Philip Rössler
- Orthopädie, Gelenkzentrum Mittelrhein, Koblenz, Deutschland
| | - Ernst M W Koch
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
- mdm, Alsbach, Deutschland
| | - Rahel Bornemann
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
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2
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Midthun P, Kirkhus E, Østerås BH, Høiness PR, England A, Johansen S. Metal artifact reduction on musculoskeletal CT: a phantom and clinical study. Eur Radiol Exp 2023; 7:46. [PMID: 37524994 PMCID: PMC10390408 DOI: 10.1186/s41747-023-00354-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/10/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Artifacts caused by metal implants are challenging when undertaking computed tomography (CT). Dedicated algorithms have shown promising results although with limitations. Tin filtration (Sn) in combination with high tube voltage also shows promise but with limitations. There is a need to examine these limitations in more detail. The purpose of this study was to investigate the impact of different metal artefact reduction (MAR) algorithms, tin filtration, and ultra-high-resolution (UHR) scanning, alone or in different combinations in both phantom and clinical settings. METHODS An ethically approved clinical and phantom study was conducted. A modified Catphan® phantom with titanium and stainless-steel inserts was scanned with six different MAR protocols with tube voltage ranging from 80 to 150 kVp. Other scan parameters were kept identical. The differences (∆) in mean HU and standard deviation (SD) in images, with and without metal, were measured and compared. In the clinical study, three independent readers performed visual image quality assessments on eight different protocols using retrospectively acquired images. RESULTS Iterative MAR had the lowest ∆HU and ∆SD in the phantom study. For images of the forearm, the soft tissue noise for Sn-based 150-kVp UHR protocol with was significantly higher (p = 0.037) than for single-energy MAR protocols. All Sn-based 150-kVp protocols were rated significantly higher (p < 0.046 than the single-energy MAR protocols in the visual assessment. CONCLUSIONS All Sn-based 150-kVp UHR protocols showed similar objective MAR in the phantom study, and higher objective MAR and significantly improved visual image quality than single-energy MAR. RELEVANCE STATEMENT Images with less metal artifacts and higher visual image quality may be more clinically optimal in CT examination of musculoskeletal patients with metal implants. KEY POINTS • Metal artifact reduction algorithms and Sn filter combined with high kVp reduce artifacts. • Metal artifact reduction algorithms introduce new artifacts in certain metals. • Sn-based protocols alone may be considered as low metal artifact protocols.
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Affiliation(s)
- Petter Midthun
- Health Faculty, Oslo Metropolitan University, Pilestredet 48, 0130, Oslo, Norway
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Eva Kirkhus
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Bjørn Helge Østerås
- Department of Physics and Image Analysis, Oslo University Hospital, Oslo, Norway
| | | | - Andrew England
- School of Medicine, University College Cork, Cork, England
| | - Safora Johansen
- Health Faculty, Oslo Metropolitan University, Pilestredet 48, 0130, Oslo, Norway.
- Department of Cancer Treatment, Oslo University Hospital, Oslo, Norway.
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3
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Hermans SMM, Knoef RJH, Schuermans VNE, Schotanus MGM, Nellensteijn JM, van Santbrink H, Curfs I, van Hemert WLW. Double-center observational study of minimally invasive sacroiliac joint fusion for sacroiliac joint dysfunction: one-year results. J Orthop Surg Res 2022; 17:570. [PMID: 36575465 PMCID: PMC9794474 DOI: 10.1186/s13018-022-03466-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND For a substantial part of patients with chronic low back pain, the origin is located in the sacroiliac joint (SIJ). Minimally invasive sacroiliac joint fusion (MISJF) is increasingly being implemented as a treatment option in SIJ dysfunction. Despite remaining controversy, evidence continues to increase. This study evaluates the clinical results and safety of MISJF in a double-center consecutive case series in patients with SIJ dysfunction over a one-year observation period. METHODS SIJ complaints were diagnosed after history taking, physical examination and least a 50% reduction of SIJ pain 30-60 min following image-guided injection. Primary outcome measures were patient reported outcome measurements (PROMs), consisting of Visual Analogue Scale (VAS) pain score and EuroQol 5-dimensions 3-levels (EQ-5D-3L). Patients' perspectives on the effects of surgery were collected through questionnaires. Secondary outcome measures were implant positioning and (serious) adverse events ((S)AE's). RESULTS A total of 29 patients were included. In 44.8% of patients, SIJ dysfunction was of postpartum origin. The mean VAS-pain score improved from 7.83 (± 1.71) to 4.97 (± 2.63) postoperatively (p < 0.001). EQ-5D-3L score improved from 0.266 (± 0.129) to 0.499 (± 0.260) postoperatively (p < 0.001). Opioid consumption decreased from 44.8 to 24.1% postoperatively (p = 0.026). In 13.7% of patients, an (S)AE occurred. CONCLUSION MISJF appears to be an effective and safe procedure in this cohort. Statistically significant and clinically relevant improvements in pain and quality of life were observed one-year postoperatively. Future studies should focus on the long-term outcomes to further evaluate the safety and effectiveness of MISJF.
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Affiliation(s)
- Sem M. M. Hermans
- grid.416905.fDepartment of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands ,grid.5012.60000 0001 0481 6099Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Rob J. H. Knoef
- grid.415214.70000 0004 0399 8347Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Valérie N. E. Schuermans
- grid.5012.60000 0001 0481 6099Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Neurosurgery, Maastricht University Medical Center +, Maastricht, The Netherlands ,grid.416905.fDepartment of Neurosurgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Martijn G. M. Schotanus
- grid.416905.fDepartment of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands ,grid.5012.60000 0001 0481 6099Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jorm M. Nellensteijn
- grid.415214.70000 0004 0399 8347Department of Orthopaedic Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Henk van Santbrink
- grid.5012.60000 0001 0481 6099Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands ,grid.412966.e0000 0004 0480 1382Department of Neurosurgery, Maastricht University Medical Center +, Maastricht, The Netherlands ,grid.416905.fDepartment of Neurosurgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Inez Curfs
- grid.416905.fDepartment of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Wouter L. W. van Hemert
- grid.416905.fDepartment of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
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4
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Sayed D, Grider J, Strand N, Hagedorn JM, Falowski S, Lam CM, Tieppo Francio V, Beall DP, Tomycz ND, Davanzo JR, Aiyer R, Lee DW, Kalia H, Sheen S, Malinowski MN, Verdolin M, Vodapally S, Carayannopoulos A, Jain S, Azeem N, Tolba R, Chang Chien GC, Ghosh P, Mazzola AJ, Amirdelfan K, Chakravarthy K, Petersen E, Schatman ME, Deer T. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. J Pain Res 2022; 15:3729-3832. [PMID: 36510616 PMCID: PMC9739111 DOI: 10.2147/jpr.s386879] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.
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Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA,Correspondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email
| | - Jay Grider
- University of Kentucky, Lexington, KY, USA
| | - Natalie Strand
- Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Steven Falowski
- Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nestor D Tomycz
- AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Rohit Aiyer
- Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - David W Lee
- Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Hemant Kalia
- Rochester Regional Health System, Rochester, NY, USA,Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Soun Sheen
- Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Mark N Malinowski
- Adena Spine Center, Adena Health System, Chillicothe, OH, USA,Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Michael Verdolin
- Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA
| | - Shashank Vodapally
- Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - Alexios Carayannopoulos
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA,Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA,Neurosurgery, Brown University, Providence, RI, USA
| | - Sameer Jain
- Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA
| | - Nomen Azeem
- Department of Neurology, University of South Florida, Tampa, FL, USA,Florida Spine & Pain Specialists, Riverview, FL, USA
| | - Reda Tolba
- Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates,Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA,Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA
| | | | | | | | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA,Va San Diego Healthcare, San Diego, CA, USA
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA,Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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5
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Sarkar M, Maalouly J, Ruparel S, Choi J. Sacroiliac Joint Fusion: Fusion Rates and Clinical Improvement Using Minimally Invasive Approach and Intraoperative Navigation and Robotic Guidance. Asian Spine J 2022; 16:882-889. [PMID: 35184523 PMCID: PMC9827198 DOI: 10.31616/asj.2021.0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/08/2021] [Indexed: 01/11/2023] Open
Abstract
STUDY DESIGN This study adopted a retrospective study design. PURPOSE This study was designed to describe the fusion rate and technique and patient subjective improvement after sacroiliac (SI) joint fusion using a minimally invasive surgical (MIS) approach. OVERVIEW OF LITERATURE The SI joint can mimic radicular or discogenic pain localized to the lower back, gluteal region, or sacral region, posing a challenge in the diagnosis and treatment. This study determines the radiological fusion rate and patient reported subjective clinical outcomes of SI joint fusion using an MIS approach, comparing the use of the Rialto SI joint fusion system (Medtronic, Minneapolis, MN, USA) with the help of the Stealth Navigation System with the use of ExcelsiusGPS Robotic Navigation Platform (Globus Medical Inc., Audubon, PA, USA) using SI-LOK screws (Globus Medical Inc.). METHODS In this retrospective study, 43 consecutive patients who underwent SI joint fusion between August 2017 and February 2020 were enrolled; 60 SI joints were fused. The patients' fusion was documented on computed tomography or X-rays, and Visual Analog Scale (VAS) scores were used to determine patient subjective clinical outcomes. RESULTS A total of 60 joints were fused, including 26 joints fused using robotic guidance and 34 joints fused using the Stealth Navigation System. Student t-test was used to compare the mean preoperative VAS score (7.52±1.3) with the mean postoperative VAS score at the 12-month follow-up (1.43±1.22) (p<0.05). The SI joint fusion rate using this technique was 61% at 6 months, 96.4% at 12 months, and 100% at 18 months. CONCLUSIONS The use of navigation guidance or robotic assistance enables accurate percutaneous screw placement across the SI joint. The use of bone morphogenetic protein in the screw bore hastens fusion across the joint, improving patient-perceived pain.
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Affiliation(s)
- Mehul Sarkar
- Department of Orthopaedics Spine Surgery, Dr Vasantrao Pawar Medical College and Hospital, Nashik,
India
| | - Joseph Maalouly
- Spine Ortho Clinic, The Bays Hospital, Mornington, VIC,
Australia
| | - Sameer Ruparel
- Department of Orthopaedic Spine Surgery, Global Hospital, Mumbai,
India
| | - John Choi
- Spine Ortho Clinic, The Bays Hospital, Mornington, VIC,
Australia
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6
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Aranke M, McCrudy G, Rooney K, Patel K, Lee CA, Hasoon J, Kaye AD. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia) 2022; 14:34098. [PMID: 35769646 PMCID: PMC9235436 DOI: 10.52965/001c.34098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/06/2021] [Indexed: 04/05/2024] Open
Abstract
Sacroiliac joint (SIJ) pain is responsible for approximately 15-25% of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.
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Affiliation(s)
- Mayank Aranke
- Department of Anesthesiology, University of Texas Health Science Center
| | - Grace McCrudy
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kelsey Rooney
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kunaal Patel
- LSU Health Sciences Center Shreveport School of Medicine
| | - Christopher A Lee
- Department of Internal Medicine, Creighton University School of Medicine-Phoenix Regional Campus
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport
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7
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Aranke M, McCrudy G, Rooney K, Patel K, Lee CA, Hasoon J, Urits I, Viswanath O, Kaye AD. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia) 2022; 14:31915. [DOI: 10.52965/001c.31915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Grace McCrudy
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kelsey Rooney
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kunaal Patel
- LSU Health Sciences Center Shreveport School of Medicine
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8
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Meta-Analysis of the Clinical Effect of MIS-TLF Surgery in the Treatment of Minimally Invasive Surgery of the Orthopaedic Spine. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2315533. [PMID: 35341166 PMCID: PMC8942634 DOI: 10.1155/2022/2315533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/28/2022] [Indexed: 11/18/2022]
Abstract
Minimally invasive surgery (MIS) has already had a significant impact on surgical treatment (spine). Because they are less invasive, minimally invasive treatments are often preferred over open spine surgery. MIS and open spine surgery in terms of posterior lumbar fusion (PLF), lumbar disc herniation (LDH), and cervical disc herniation (CDH) were all observational studies based on randomized controlled trials. Seventeen RCTs and six observational studies were conducted. Chemotherapy had no effect on the long-term alleviation of the neck or arm pain in patients with CDH. In LDH, MIS was superior in terms of pain relief, rehospitalization rates, and improvement in quality of life. At the expense of increased perioperative endoscopic, readmission, and revision rates, MIS achieved a significant reduction in 2-year expenditures, fewer medical problems, and improved Oswestry score ratings. There is no evidence to support the use of MIS over open surgery for lumbar or cervical process disc herniation. In comparison, MIS-TLIF has several advantages, in addition to lower revision/readmission rates. However, MIS significantly increases the surgeon's radiation exposure, regardless of the patient's sign. However, the effect on patients is unknown. These findings could help patients make better decisions when comparing open spine surgery to minimally invasive spine surgery, especially given how much advertising is out there for MIS.
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9
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Kurosawa D, Murakami E, Koga H, Ozawa H. Three-Year Clinical Outcomes after Minimally Invasive Sacroiliac Joint Arthrodesis Using Triangular Implants in Japan: A Pilot Study of Five Cases. Spine Surg Relat Res 2022; 6:71-78. [PMID: 35224250 PMCID: PMC8842357 DOI: 10.22603/ssrr.2021-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/22/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Sacroiliac joint (SIJ) arthrodesis using a minimally invasive technique, particularly the triangular implant system, is performed in patients with SIJ dysfunction in the United States and Europe. We report three-year clinical outcomes of the first minimally invasive SIJ arthrodesis procedures using the implants performed in Japan. Methods Five patients (one man and four women; age: 56.4±16.9 years) with SIJ pain who underwent SIJ arthrodesis using a triangular implant system in 2017 were included. In addition to operation time and blood loss, pain intensity (visual analog scale [VAS]) and functional impairment (Oswestry disability index [ODI]) were assessed preoperatively and at a 36-month follow-up. Implant loosening and osseous bridging across the joint were evaluated using computed tomography images, and patients' satisfaction with the surgery was also assessed at 12 and 36 months. Results The surgical time was 67.7±13.1 minutes, and blood loss was 7.4±6.9 mL. The mean VAS value improved significantly from 88.0±8.4 mm to 33.6±31.9 mm at 3 months and was maintained at 46.4±30.9 mm at 36 months (P<0.05). The mean ODI improved significantly from 76.4%±3.8% to 46.2%±21.9% at 6 months postoperatively (P<0.05) but had no significant improvements thereafter: 46.94±23.7% (12 months) and 66.4±8.6% (36 months). Three of five patients presented with at least one implant loosening on the sacrum side. No patient had osseous bridging across the joint. A total of 80% (4/5) of patients reported satisfaction with the surgery at 12 months and 60% (3/5) at 36 months. Conclusions The mean VAS value and ODI significantly improved until 6 months after the surgery. However, the mean ODI was reaggravated at 36 months after the surgery. Osseous bridging across the joint was not observed in all patients. We should carefully keep an eye on further long-term results to evaluate the implant.
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Affiliation(s)
- Daisuke Kurosawa
- Department of Orthopaedic Surgery / Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital
| | - Eiichi Murakami
- Department of Orthopaedic Surgery / Low Back Pain and Sacroiliac Joint Center, JCHO Sendai Hospital
| | - Hiroaki Koga
- Department of Orthopaedic Surgery / Kyushu Low Back pain and Sacroiliac Joint Center, Nanpu Hospital
| | - Hiroshi Ozawa
- Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University School of Medicine
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10
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Himstead AS, Brown NJ, Shahrestani S, Tran K, Davies JL, Oh M. Trends in Diagnosis and Treatment of Sacroiliac Joint Pathology Over the Past 10 Years: Review of Scientific Evidence for New Devices for Sacroiliac Joint Fusion. Cureus 2021; 13:e15415. [PMID: 34249562 PMCID: PMC8253473 DOI: 10.7759/cureus.15415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Sacroiliac (SI) joint pathology is a newly appreciated contributor to lower back pain. Sacroiliac joint fusion (SIJF) has grown rapidly in popularity in association with the advent of minimally-invasive surgical techniques. This has led to an explosion of new medical devices used for SIJF. The objective of this article is to outline clinical trends, summarize the current data, and categorize novel devices for SIJF. Trends in SI joint pathology and fusion were obtained via the Healthcare Cost and Utilization Project’s (HCUP) National Inpatient Sample (NIS) database and Web of Science. To review literature on devices for SIJF, PubMed was searched using the Boolean phrase “sacroiliac joint AND (fusion OR arthrodesis)” since 2010. To establish a list of SIJF devices not represented in the literature, searches were performed on the FDA 510(k), premarket approval, and de novo databases, as well as Google and LinkedIn. Literature review yielded 11 FDA-approved devices for minimally invasive SIJF. Database query yielded an additional 22 devices for a total of 33 devices. Twenty-one devices used the lateral transiliac approach, six posterior allograft approach, three posterolateral approach, and three combined the lateral transiliac and posterolateral approaches. The evidence for the lateral transiliac approach is the most robust. Many novel devices have been developed for minimally invasive SIJF over the past 10 years. Further randomized comparative trials are warranted to evaluate different surgical approaches and novel devices at this time.
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Affiliation(s)
- Alexander S Himstead
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Nolan J Brown
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Shane Shahrestani
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Katelynn Tran
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Jordan L Davies
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
| | - Michael Oh
- Department of Neurological Surgery, University of California Irvine, Irvine, USA
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Lorio M, Kube R, Araghi A. International Society for the Advancement of Spine Surgery Policy 2020 Update-Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity. Int J Spine Surg 2020; 14:860-895. [PMID: 33560247 DOI: 10.14444/7156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The index 2014 International Society for the Advancement of Spine Surgery Policy Statement-Minimally Invasive Surgical Sacroiliac Joint Fusion-was generated out of necessity to provide an International Classification of Diseases, Ninth Revision (ICD-9)-based background and emphasize tools to ensure correct diagnosis. A timely ICD-10-based 2016 update provided a granular threshold selection with improved level of evidence and a more robust and relevant database (Appendix Table A1). As procedures and treatment options have evolved, this 2020 update reviews and analyzes the expanding evidence base and provides guidance relating to differences between the lateral and dorsal surgical procedures for minimally invasive surgical sacroiliac joint fusion.
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Affiliation(s)
- Morgan Lorio
- Advanced Orthopedics, Altamonte Springs, Florida
| | - Richard Kube
- Prairie Spine & Pain Institute, Peoria, Illinois
| | - Ali Araghi
- The CORE Institute, Sun City West, Arizona
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12
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Martin CT, Haase L, Lender PA, Polly DW. Minimally Invasive Sacroiliac Joint Fusion: The Current Evidence. Int J Spine Surg 2020; 14:20-29. [PMID: 32123654 DOI: 10.14444/6072] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Fusion of the sacroiliac (SI) joint as a treatment for low back pain remains controversial. The purpose of this manuscript is to review the current literature and clinical outcomes of SI joint fusion surgery. Methods We conducted a literature review and included studies with the term "sacroiliac joint fusion" that had at least 12 months of clinical follow-up, reported on minimally invasive techniques, and included patient-reported outcome measures. Results Two approach types (dorsal and lateral) and numerous different implant manufacturers were identified. Most studies included level 4 data, with a small number of level 2 prospective cohort studies and 2 prospective level 1 studies. Every reviewed study reported clinical benefit in terms of improved pain scores or improvement in validated disability measures. Complication rates were low. Conclusions Minimally invasive SI joint fusion provides clinically significant improvement in pain scores and disability in most patients, across multiple studies and implant manufacturers. Level of Evidence 5. Clinical Relevance Emerging evidence in support of SI joint fusion indicates that clinicians should examine the SI joint and include SI joint pain in their differential diagnosis for low back pain patients.
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Affiliation(s)
- Christopher T Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Lucas Haase
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Paul A Lender
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - David W Polly
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
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Polly DW. Minimally invasive sacroiliac joint fusion vs. conservative management for chronic sacroiliac joint pain. JOURNAL OF SPINE SURGERY 2019; 5:381-383. [PMID: 31663051 DOI: 10.21037/jss.2019.06.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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14
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Patel V, Kovalsky D, Meyer SC, Chowdhary A, Lockstadt H, Techy F, Billys J, Limoni R, Yuan PS, Kranenburg A, Cher D, Tender G. Minimally invasive lateral transiliac sacroiliac joint fusion using 3D-printed triangular titanium implants. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:203-214. [PMID: 31239791 PMCID: PMC6551609 DOI: 10.2147/mder.s205812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Minimally invasive sacroiliac joint (SIJ) fusion (SIJF) has become an increasingly accepted surgical option for chronic SI joint dysfunction, a prevalent cause of chronic low back/buttock pain. Objective: To report clinical and functional outcomes of SIJF using 3D-printed triangular titanium implants (TTI) for patients with chronic SI joint dysfunction. Methods: A total of 28 subjects with SIJ dysfunction at 8 centers underwent SIJF with 3D TTI and had scheduled follow-up to 6 months (NCT03122899). Results: Mean preoperative SIJ pain score was 79.1 and mean preoperative Oswestry Disability Index (ODI) was 49.9. At 6 months, pain scores decreased by 51 points and ODI decreased by 23.6 points (both p<0.0001). The proportion of subjects able to perform various back/pelvis-related physical functions with minimal difficulty improved significantly for nearly all activities. Opioid use decreased and physical function, as assessed with three objective tests, improved. Conclusion: Early results from this prospective multicenter trial confirm that clinical responses to a 3D triangular titanium implant for SIJF are similar to those from prior trials, with improved physical function and decreased opioid use. Level of evidence: Level II.
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Affiliation(s)
- Vikas Patel
- Department of Orthopedics, University of Colorado, Aurora, CO, USA
| | - Don Kovalsky
- Orthopaedic Center of Southern Illinois, Mt. Vernon, IL, USA
| | - S Craig Meyer
- Columbia Orthopaedic Medical Group, Columbia, MO, USA
| | | | | | | | | | - Robert Limoni
- BayCare Clinic Orthopedics & Sports Medicine, Green Bay, WI, USA
| | - Philip S Yuan
- Memorial Orthopaedic Surgical Group, Long Beach, CA, USA
| | | | | | - Gabriel Tender
- Department of Neurosurgery, Louisiana State University, New Orleans, LA, USA
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15
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Darr E, Cher D. Four-year outcomes after minimally invasive transiliac sacroiliac joint fusion with triangular titanium implants. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:287-289. [PMID: 30214322 PMCID: PMC6120564 DOI: 10.2147/mder.s179003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Increasing long-term evidence supports the safety and effectiveness of minimally invasive sacroiliac joint fusion (SIJF) for sacroiliac joint (SIJ) dysfunction, an important cause of chronic low-back/buttock pain. Objective To report 4-year follow-up in patients undergoing SIJF using triangular titanium implants (TTI) as part of two prospective trials. Methods We enrolled 103 subjects at 12 centers treated with TTI in two prospective clinical trials (NCT01640353 and NCT01681004) and followed them in the current study (NCT02270203), with clinic visits at 3, 4, and 5 years. Results At 4 years, mean SIJ pain scores (available in 91 subjects [88.3%]) had decreased by 54 points from baseline; disability (Oswestry Disability Index) scores decreased by 26 points; and quality of life (EuroQOL-5D) improved by 0.3 points (0-1 scale). Satisfaction rates were high and the proportion of subjects taking opioids decreased from 77% at baseline to 43% at 4-year follow-up. Conclusion Four-year follow-up showed continued excellent responses in patients with SIJ pain treated with SIJF using triangular titanium implants.
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Affiliation(s)
- Emily Darr
- Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, SC, USA,
| | - Daniel Cher
- Clinical Affairs, SI-BONE, Inc., Santa Clara, CA, USA
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