Perioperative Outcomes of Minimally Invasive Sacroilliac Joint Fusion Using Hollow Screws Through a Lateral Approach: A Single Surgeon Retrospective Cohort Study

Utility of minimally invasive percutaneous arthrodesis of the sacroiliac joint for the treatment of low back pain: systematic review of the literature

BACKGROUND

The surprising increase observed in recent years in the use of minimally invasive sacroiliac joint arthrodesis techniques as a treatment for low back pain justifies an objective review of this results.

PURPOSE

carry out a systematic review of the literature to evaluate the clinical results of patients with low back pain treated with percutaneous arthrodesis of the SIJ.

STUDY DESIGN

Systematic review.

METHODS

Systematic search of the medical literature. The words used in the Search were: "Hollow screw system", "percutaneous sacroiliac joint stabilization", "sacroiliac joint", "minimally invasive", "sacroiliac pain", "sacroiliac dysfunction". With logical connectors such as "and", "not" and "or".

DATABASES

Pubmed, Scopus, Embase, Ovid, EBSCO host and google scholar. The search extended from the beginning of the databases until September 2024. The "Rayyan" program was used to collect the information and facilitate the analysis process.

INCLUSION CRITERIA

Systematic review from the literature, clinical trials, observational studies and case series. They followed PRISMA principles.

RESULTS

661 articles were found, of which 108 articles were duplicates. The criteria (Inclusion/Exclusion) were applied to the 553 articles identified based on the independent reading of the summaries by each of the authors on the Rayyan platform and 434 articles were excluded. The 119 selected articles were completely reviewed to finally obtain 102 articles included in the review. Epidemiological data were extracted into an Excel table, methodological and related to clinical results and safety of procedures made. The Prisma checklist for systematic reviews was applied in each article. The epidemiological quality of the articles was evaluated based on the checklists STROBE and CONSORT. The results regarding clinical improvement were overwhelming. However, most of the studies were sponsored by industry and with a limited population and follow-up not always prolonged.

CONCLUSIONS

Although the clinical results regarding the effectiveness of SIJ fusion are forceful for their effectiveness, we recommend considering some aspects for their analysis and especially long-term studies.

Minimally invasive lateral, posterior, and posterolateral sacroiliac joint fusion for low back pain: a systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the therapeutic effects of minimally invasive lateral, posterior, and posterolateral sacroiliac joint fusion for low back pain through a meta-analysis.

METHODS

The PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov databases were comprehensively searched for studies up to 31 August 2024. Relevant studies using lateral, posterior, and posterolateral approaches were identified. Pooled outcomes and publication bias were assessed. The study was registered with PROSPERO (registration No. CRD42023451047).

RESULTS

A total of 48 studies were included: 32 focused on the lateral approach, 10 on the posterior approach, four on the posterolateral approach, and two compared the lateral and posterolateral approaches. The pooled effect analysis showed statistically significant improvements in the visual analog scale (VAS) scores for all three approaches at 6 and 12 months postoperatively. Although no between-approach comparisons were conducted, the pooled improvements in VAS scores at 6 and 12 months postoperatively were numerically similar across all three approaches, as were the pooled fusion rates. The pooled complication rate for the lateral approach was 9.2%, numerically higher than 1% for the posterior approach. The pooled revision rate for the lateral approach was 2.4%, also numerically higher than 0.6% for the posterior approach.

CONCLUSIONS

Although pain relief and fusion rates were similar across all approaches, the lateral approach might be associated with a higher risk of total complications and revision surgery.

Efficacy of Lateral Sacroiliac Joint Fusion With the Trident™ Screw System: A Retrospective Analysis

Background Chronic lower back pain is a significant global health issue, leading to disability and a substantial economic burden. A considerable number of cases are associated with the sacroiliac joint (SIJ), especially among patients with a history of lumbar fusions. Despite various treatments, persistent SIJ pain often requires surgical intervention, with minimally invasive techniques becoming the standard due to their benefits over open surgery. This study examines the clinical outcomes of a novel minimally invasive SIJ fixation technique using the Trident™ system. Methodology The study retrospectively reviewed 39 patients who underwent SIJ fusion with the Trident™ system across four surgical sites by a single surgeon. Strict inclusion and exclusion criteria ensured a homogeneous patient population. The procedure involved placing hollow fenestrated screws in a tri-pronged fashion across the SIJ to achieve fusion. The Oswestry Disability Index (ODI) was used to measure functional outcomes, and statistical analyses were conducted to assess the efficacy of the procedure. Results The study found statistically significant improvements in most ODI categories postoperatively. Subgroup analyses revealed that patients with bilateral SIJ fusions showed the greatest improvement, while those with unilateral fusions without prior lumbar surgery showed the least improvement, though still significant. The results suggest that the Trident™ system is effective in improving patient outcomes. Conclusions Evidence indicates that the novel SIJ fixation technique could influence future standards of care for SIJ-related chronic low back pain. The Trident™ Screw System's minimally invasive approach to SIJ fusion is effective in improving functional outcomes for patients with chronic SIJ-related lower back pain. The technique's efficacy, demonstrated through significant ODI improvements, supports its potential as a valuable treatment option.

Effect of revision sacroiliac joint fusion on unresolved pain and disability: a retrospective cohort study

PURPOSE

The sacroiliac (SI) joint is recognized as a source of low back pain in 15-30% of patients. Though randomized controlled trials have shown clinical improvement following SI joint fusion in 83.1% of patients, revision rates of 2.9% within 2 years have been reported. There is a paucity of literature reviewing this small yet significant population of patients requiring revision surgery.

METHODS

Following IRB approval, retrospective review of patients, who underwent a revision SI joint fusion from 2009 to 2021 was completed. Patient-reported outcomes were measured before and at each clinic visit after surgery with visual analoge scale (VAS) for back pain and Oswestry Disability Index (ODI). Patient characteristics (chronic opiate use and prior lumbar fusion) and surgical factors (operative approach, type/number of implants and use of bone graft) were recorded. Patient-reported outcomes were evaluated with Paired t and Wilcoxon signed rank tests. Univariate and multivariate logistic regression determined if patients met the minimally clinical important differences (MCID) for VAS-back pain and ODI scores at 1 year.

RESULTS

Fifty-two patients (77% female) with an average age of 49.1 (SD ± 11.1) years met inclusion criteria. Forty-four had single sided revisions and eight bilateral revisions. At 1 year follow-up there was no significant improvement in VAS-Back (p = 0.06) or ODI (p = 0.06). Patients with chronic opioid use were 8.5 times less likely to achieve the MDC for ODI scores (OR 0.118, p = 0.029). There was no difference in outcomes when comparing the different surgical approaches (p = 0.41).

CONCLUSION

Our study demonstrates patients undergoing revision surgery have moderate improvement in low back pain, however, few have complete resolution of their symptoms. Specific patient factors, such as chronic opiate use and female sex may decrease the expected improvement in patient-reported outcomes following surgery. Failure to obtain relief may be due to incorrect indications, lack of biologic fusion and/or presence of co-pathologies. Further clinical examination and consistent long-term follow-up, clarify the role revision surgery plays in long-term patient outcomes.

Minimally Invasive SI Joint Fusion Procedures for Chronic SI Joint Pain: Systematic Review and Meta-Analysis of Safety and Efficacy

BACKGROUND

Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available.

METHODS

Data abstraction and random effects meta-analysis of safety and efficacy outcomes from published patient cohorts. Patient-reported outcomes (PROs) and safety measures were stratified by surgical technique: transiliac, including lateral transiliac (LTI) and posterolateral transiliac (PLTI), and posterior interpositional (PI) procedures.

RESULTS

Fifty-seven cohorts of 2851 patients were identified, including 43 cohorts (2126 patients) for LTI, 6 cohorts (228 patients) for PLTI, and 8 cohorts (497 patients) for PI procedures. Randomized trials were only available for LTI. PROs were available for pain (numeric rating scale) in 57 cohorts (2851 patients) and disability (Oswestry Disability Index [ODI]) in 37 cohorts (1978 patients).All studies with PROs showed improvement from baseline after surgery. Meta-analytic improvements in pain scores were highest for LTI (4.8 points [0-10 scale]), slightly lower for PLTI (4.2 points), and lowest for PI procedures (3.8 points, P = 0.1533). Mean improvements in ODI scores were highest for LTI (25.9 points), lowest for PLTI procedures (6.8 points), and intermediate for PI (16.3 points, P = 0.0095).For safety outcomes, acute symptomatic implant malposition was 0.43% for LTI, 0% for PLTI, and 0.2% for PI procedures. Wound infection was reported in 0.15% of LTI, 0% of PLTI, and 0% of PI procedures. Bleeding requiring surgical intervention was reported in 0.04% of LTI procedures and not reported for PLTI or PI. Breakage and migration were not reported for any device. Radiographic imaging evaluation reporting implant placement accuracy and fusion was only available for LTI.

DISCUSSION

Literature support for SI joint fusion is growing. The LTI procedure contains the largest body of available evidence and shows the largest improvements in pain and ODI. Only LTI procedures have independent radiographic evidence of fusion and implant placement. The adverse event rate for all procedures was low.

LEVEL OF EVIDENCE: 1

Posterior oblique technique for sacroiliac joint fusion leads to greater pain relief and similar improvement in function compared to the lateral technique: A retrospective, comparative study

BACKGROUND

Management of chronic sacroiliac joint (SIJ) pain among patients who do not respond to nonsurgical treatment is increasingly turning toward minimally invasive SIJ fusion. There are different techniques available to perform this procedure, with the lateral technique being more commonly studied than the posterior oblique technique. This study examined the effects of these techniques on pain relief and functional improvement, both preoperatively and at a 12-month follow-up.

METHODS

This retrospective cohort study analyzed data from 45 patients who underwent SIJ fusion. Included patients were ≥50 years old, nonresponsive to conservative treatment. Subjects were divided into 2 cohorts based on the SIJ fusion technique. Primary outcomes were pain relief, measured by Visual Analog Scale (VAS), and functional improvement, determined by the Oswestry Disability Index (ODI); both were recorded and assessed at baseline, postoperative, and the change from pre- to postoperative. Additionally, data regarding patient demographics, previous lumbar fusion, operative time, and duration of hospital stay were collected and analyzed.

RESULTS

Baseline demographic and clinical variables exhibited no significant differences in distribution between groups. The posterior oblique cohort demonstrated a substantial reduction in operative time (over 50%) and duration of hospital stay compared to lateral cohort. Pain relief (postoperative VAS: lateral 3.5±1.7 vs. posterior oblique 2.4±1.5 [p=.02]) and functional improvement (postoperative ODI: lateral 29.6±7.3 vs. posterior oblique 21±5.7 [p≤.001]) were significantly better in the posterior oblique group. Pre- to postoperative improvement analysis indicated greater reduction in pain (VAS: lateral -4.4±1.9 vs. posterior oblique -6.1±1.5 [p=.002]) in the posterior oblique group.

CONCLUSIONS

Compared to the lateral technique group, patients undergoing minimally invasive SIJ fusion through the posterior oblique technique experienced greater pain relief and demonstrated a trend toward better functional improvement, with shorter operative times and duration of hospital stay. The posterior oblique technique may be more efficient and beneficial to manage patients suffering from chronic SIJ pain through joint fusion.