(I-695) Sacroiliac Joint Fusion with a Single, Transfixation Implant via Inferior-Posterior Approach

Thursday, March 16, 2023

Presenting Author(s)

Michael Chaparro, Fellow of the American Association of Neurological Surgeons, Fellow of the American College of Surgeons, Diplomat of the American Board of Neurological Surgery Diplomat of the National Board of Medical Examiners Member, North American Spine Society (he/him/his)

Intracranial and Spinal Surgery for Adults and Pediatrics
South Florida Neurosurgical and Spinal Wellness Center, United States

Introduction: Sacroiliac joint degeneration is the source of low back and posterior pelvic pain in up to 30% of patients with this complaint. Successful SI joint fusion can provide relief of pain caused by SI joint dysfunction. Although new surgical techniques are emerging, complications persist and outcomes are mixed, with up to 30% of patients reporting poor or no pain improvement.

Methods: A new SI joint transfixation device is implanted via inferior-posterior surgical approach and is designed to address SI joint fusion issues. This titanium device consists of two hollow fenestrated pontoons to be filled with autologous bone, connected by a bridge that spans the SI joint space, and provides transfixation with a single device.
We report on a retrospective case series of 16 patients (8 males) who underwent SI joint fusion surgery with this device via 3D navigation in an inferior-posterior approach. All patients failed nonoperative treatment and had SI Joint dysfunction confirmed with diagnostic testing. One male and one female had secondary contralateral SI joint fusion. Criteria for surgery: pain compatible with SI dysfunction, positive result for 3+ provocative tests, degenerative SI joint confirmed on radiograph, and >70% pain reduction following intra-articular injection. Exclusion criteria included tobacco use, infection, and neoplasm at the affected joint.

Mean age 47.4 years (22-68). Mean duration of symptoms: 16.1 months (1-72). Prior surgeries: 10 (62.5%) L5/S1 fusion; 12 (75%) fusions above L5/S1. Prior relevant trauma: 7 (38.9%).

Results: Average OR minutes: 106.6 (61-220); fluoro time: 66.4 seconds; blood loss: 35.6 ml. No complications were reported. X-ray confirmed successful placement of the device in all patients. Six-month postop x-ray showed maintenance of placement across the SI joint space with evidence of bridging bone in all patients. Mean VAS: preop 8.6 (7-10); 6 weeks postop: 1.3. The 8 patients who reached 12-month follow-up reported VAS score of 0. At 6 weeks and 12 months postop, 81% and 90% of patients, respectively, required no narcotic pain medications.

Conclusion : Preliminary results suggest this transfixation implant with inferior-posterior approach is a viable treatment option with minimal risk of complication for patients with SI Joint dysfunction. Future prospective studies are warranted.

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