Minimally Invasive Sacroiliac Joint Fusion with Decortication and Bone Grafting 1-year Clinical Outcomes

• Published in: Neurosurgery Vol. 67; no. Supplement_1
• Main Author: Grunch, Betsy H
• Format: Journal Article
• Language: English
• Published: Philadelphia Wolters Kluwer Health, Inc 01.12.2020
• Subjects: Back pain; Clinical outcomes; Neurosurgery; Surgical outcomes; Surgical techniques
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyaa447_715

INTRODUCTION Minimally invasive (MI) sacroiliac joint fusion (SIJF) has become a preferred treatment alternative for pain originating in the SI joint that is refractory to conservative treatment. METHODS The key inclusion criteria were ≥18 years of age; at least 6-months of non-operative management; three positive provocative tests; at least one positive diagnostic SI joint injection resulting in ≥50% pain reduction; Visual Analog Scale (VAS) SIJ pain score of ≥60; and Oswestry Disability Index (ODI) score of ≥40. Primary endpoints were fusion at 12-months and a decrease in VAS back pain from baseline to 6-months. Fusion was defined as presence of a continuous segment of solid bridging bone that extended from the sacrum to the ilium. Independent radiologists evaluated fusion at 12- and 24-months. Additional endpoints included changes in QoL measures. RESULTS All 250 participants have been enrolled. 12-month evaluable data are described (N = 201). Mean VAS pain was significantly reduced from 76.6 at baseline to 33.9 at six months, and 32.9 at 12-months. 72% of patients attained the ≥20-point improvement minimal clinically important difference (MCID) at 12-months. Mean ODI improved from a baseline of 54.5 to 33.2 and 30.6 at 6- and 12-months respectively, with 62% of patients achieving the MCID (≥15-point improvement) at 12 months. Opioid usage reduced over time with a 55% decrease from baseline at 12-months. Additionally, 86% of subjects were satisfied with the procedure at 12-months. Most subjects showed fusion at 12-months; 45.7% showed solid fusion, 23.6% showed possible fusion, with no fusion evident in 30.7% of cases. Device related serious adverse events were rare, 5/250 (2%) cases reported back pain, implant loosening, implant malposition, pain in extremity and bilateral sacroiliac joint pain. Revision surgery occurred in 6/250 (2.4%) subjects. CONCLUSION We conclude MI SIJF with decortication can be performed safely and has a positive impact on patient pain, function and QoL with evidence of a high degree of fusion.