Table 7 Reports of SI joint fusion

Rudolf, 2012 [27]

50

Age: 54

3 or more positive

iFuse Implant System

OR time: 65 +/- 26 min

Superficial cellulitis: 3

Gender: 34 F/16 M

provocative maneuvers, confirmatory joint

Mean improvement on VAS: -4.3 pts at 12 months

Deep wound infection:1

Prior lumbar fusion: 44%

injections

Satisfaction 82% at 12 months

Hematoma: 2

Reoperation: 3

Sachs, 2013 [26]

40

Age: 58

3 or more positive provocative maneuvers, confirmatory joint injections

iFuse Implant System

Mean improvement on VAS of -7.8 pts (p < 0.001)

Piriformis syndrome:1

Gender: 30 F/10 M

Patient satisfaction:

New LBP:1

Follow up: 12 months

Facet joint pain: 8

Prior lumbar fusion: 30%

Trochanteric bursitis: 2

Cummings, 2013 [29]

18

Age: 64

3 or more positive provocative maneuvers, confirmatory joint injections

iFuse Implant System

Mean improvement in clinical outcomes:

Trochanteric bursitis 3

Gender: 12 F/6 M

VAS -6.6pts,

Hematoma 1

Prior lumbar fusion: 61%

ODI -37.5pts,

Fluid retention

SF-12PCS 11.2,

1

SF-12 MCS 20.4

Toe numbness 1

Satisfaction:

implant malposition 1

Very 55.6%, Somewhat 39%.

Would have surgery again: yes 83%, likely 6%

Kibsgard, 2012 [34]

50, 28

Fusion (50 pts)

PSIS tenderness, positive straight leg raise, positive provocative maneuvers

Trans-iliac fusion or intra/extra-articular fusion between the ilium and the sacrum using cortical iliac window and iliac crest autograft.

Surgical patients after 1 year: 24 (48%) patients were good, 12 (24%) were fair, and 14 (28%) were poor.

Reoperation: 7

Age: 58

Post-op care: In most cases the patients were confined to 6 weeks of bed rest.

No significant difference in ODI, VAS, or SF-36 between surgery and non-surgery patients after long-term follow-up.

Nonunion: 8

Gender: 47 F/3 M

Jaundice: 1

Follow-up: 23 yrs

Pulmonary embolism: 1

Unilateral 21/Bilateral 25

Pin tract infection: 1

Dx: Post-partum (30), Trauma (8), Idiopathic (12)

Complication rate: 20%

Non-Surgery (28 pts)

Revision rate: 14%

Age: 52

Gender: 28 F

Follow-up: 17 yrs

Khurana, 2009 [22]

15

Age: 48.7 years

Tenderness over the posterior SI joint, positive provocative maneuvers, pain relief with SI joint block

10 mm Hollow Modular Anchorage Screw packed with demineralized bone matrix across the SI joint.

Blood loss: < 50 ml

None reported

Gender 11 F/4 M

Post-op care: Partial weight bearing for six weeks and full weight bearing by 12 weeks.

LOS 2.7 days

Follow-up: 17 months

SF-36 increased: PF 37 to 80, GH 53 to 86

Unilateral 11/Bilateral 4

Majeed's: 37 to 79

Previous lumbar surgery: 40%

Good/Excellent: 13/15

Dx: Osteoarthritis (7), SI joint dysfunction(4), SI joint instability (3), Inflammatory Arthritis (1)

Fusion in all patients

Al-Khayer2008 [23]

9

Age: 42 years

Tenderness over the sacral sulcus, positive provocative maneuvers,

10 mm Hollow Modular Anchorage Screw packed with demineralized bone matrix across the SI joint.

Blood loss: <50 ml

1 deep wound infection

Gender: 9 F

X-rays to exclude other pain sources, relief from SI joint block

Post-op care: early mobilization w/in pain limits

No screw loosening, nonunion, or failure

Complication rate: 11%

Follow-up: 40 mo

LOS: 6.9 days

Unilateral 6 /Bilateral 3

Return to work: 4/9

Symptom Duration: 30 mo

ODI decreased: 59 to 45

Prior treatments: Failed conservative treatment

VAS decreased: 8.1 to 4.6

Dx: Chronic SI joint pain

Satisfaction: 6.8 (out of 10)

Wise, 2008 [24]

13

Age: 53 years

Relief with SI joint block

9 mm hole drilled through the longitudinal aspect of the SI joint. 2 cages packed with BMP placed across the anterior portion of the SI joint.

Blood loss: < 100 ml

Reoperation (nonunion): 1

Gender: 12 F/1 M

Post-op care: limited waist bending, and a sacral belt for 6 mo; full activity at 6 mo

Length of stay: 1.7 days

Complication and Revision rate: 8%

Follow-up: 29.5 mo

Fusion rate: 89%

Unilateral 7/Bilateral 6

Low back VAS improved 4.9 pts

Previous lumbosacral surgery: 8/13

Leg VAS improved 2.4 pts

Prior treatments: Failed > 6 mo of conservative therapy

Buchowski, 2005 [21]

20

Age: 45 years

Sacral sulcus palpation,

Modified Smith-Petersen

Blood loss: 290 mL

Pseudoarthrosis: 3

Gender: 17 F/3 M

positive provocative maneuvers,

Incision over posterior 2/3 of iliac crests. Graft stabilized w/ plate and screws.

Solid fusion: 17

Deep wound infection: 2

Follow-up: 5.8 yrs

Pain relief with intraarticular SI joint injections

Post-op care: Non-weight bearing for at least 3 months.

LOS: 5.2 days

Painful hardware: 1

Prior treatments: All failed nonoperative treatment

Return to work: 8/20

Revision surgery (anterior): 3

Previous spine surgery: 15/20

SF-36 improved (except GH & MH)

Complication rate: 30%

Symptom Duration: 2.6 yrs

AAOS MODEMS sig. improved (except Comorbidity)

Revision rate: 15%

Dx: SI joint dysfunction (13), Osteoarthritis (5), Spondyloarthropathy (1), SI joint instability (1)

60% would have surgery again

Giannikas, 2004 [35]

5

Age: 22 to 44 years

SI joint tenderness, positive provocative maneuvers, bone scan, relief with SI joint block

Two bone plugs harvested from the iliac crest and placed through the superior and inferior aspects of the SI Joint.

Complete pain relief: 4/5

None reported

Gender: 3 F/2 M

Post-op care: Non-weight bearing for at least 3 months.

Partial pain relief: 1/5

Follow-up: 29 mo

Symptom Duration: 10 to 40 mo

Dx: Idiopathic (1), Previous trauma (4)

Moore, 1997 [20]

77

Gender: 48 F/29 M

Relief with SI joint block

Modified Smith-Petersen technique with 15 cm incision to reveal the ilium and sacrum. Bone harvested from the ilium and placed in the SI joint after removing the cartilage. 2–3 cannulated screws to lock graft in place.

62/77 successful (80.5%)

Superficial wound infection: 1

Unilateral 74/Bilateral 3

Post-op care: Non-weight bearing for 8 weeks.

Post-op radicular pain: 1

Prior treatments: Failed 6 months of rehab programs

Sciatic notch fracture: 1

Symptom duration: 6 to 84 mo

Pseudoarthrosis: 7

Follow-up: 1 to 5 years

Complication rate: 13%

Dx: Chronic painful dysfunction

Keating, 1995 [19]

26

Age: 38.3 years

Relief with SI joint block

Inferior SI joint debrided, decorticated, and packed with bone graft. Secured with 2 lateral compression screws.

Pain decreased: 6.1 to 2.9

None reported

Follow-up: 16 weeks

Post-op care: 16 week rehabilitation program.

Work Status increased: 2.3 to 3.3

Prior treatments: Failed 6 weeks of aggressive rehab

5 patients returned to work after 16 mo of unemployment

Symptom duration: 38.3 mo

Dx: Chronic LBP

Waisbrod, 1987 [17]

21

Age: 42

Tenderness over the SI joint, positive provocative maneuvers, pain provocation w/ NaCL injection, relief w/ SI joint block

SI joint excised and packed w/ iliac crest bone graft and ceramic blocks.

11/21 Satisfactory results

Pseudoarthrosis: 2

Gender: 18 F/3 M

Post-op care: Spica cast for 8 weeks.

Infection: 1

Follow-up: 30 mo

Complication rate: 14%

Previous spine surgery: 7/21

Symptom duration: > 2 years

Dx: SI joint pain