Minimally Invasive Versus Open Sacroiliac Joint Fusion: Are They Similarly Safe and Effective?
Tóm tắt
The sacroiliac joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, sacroiliac joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the sacroiliac joint using plates and screws is not known. We compared estimated blood loss (EBL), surgical time, length of hospital stay (LOS), and Oswestry Disability Index (ODI) between patients undergoing MIS and open sacroiliac joint fusion. We retrospectively studied 63 patients (open: 36; MIS: 27) who underwent sacroiliac joint fusion with minimum 1-year followup at our institution from 2006 to 2011. Of those, 10 in the open group had incomplete records. All patients had sacroiliac joint dysfunction confirmed by image-guided intraarticular anesthetic sacroiliac joint injection and had failed nonoperative treatment. Patients were matched via propensity score, adjusting for age, sex, BMI, history of spine fusion, and preoperative ODI scores, leaving 22 in each group. Nine patients were not matched. We reviewed patient medical records to obtain EBL, length of surgery, LOS, and pre- and postoperative ODI scores. Mean followup was 13 months (range, 11–33 months) in the open group and 15 months (range, 12–26 months) in the MIS group. Patients in the open group had a higher mean EBL (681 mL versus 41 mL, p < 0.001). Mean surgical time and LOS were shorter in the MIS group than in the open group (68 minutes versus 128 minutes and 3.3 days versus 2 days, p < 0.001 for both). With the numbers available, mean postoperative ODI scores were not different between groups (47% versus 54%, p = 0.272). EBL, surgery time, and LOS favored the MIS sacroiliac fusion group. With the numbers available, ODI scores were similar between groups, though the study size was relatively small and it is possible that the study was underpowered on this end point. Because the implants used for these procedures make assessment of fusion challenging with available imaging techniques, we do not know how many patients’ sacroiliac joints successfully fused, so longer followup and critical evaluation of outcomes scores over time are called for. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Tài liệu tham khảo
Al-Khayer A, Hegarty J, Hahn D, Grevitt MP. Percutaneous sacroiliac joint arthrodesis: a novel technique. J Spinal Disord Tech. 2008;21:359–363.
Bernard TN Jr, Cassidy JD. The Sacroiliac Joint Syndrome: Pathophysiology, Diagnosis and Management. New York, NY: Raven Press; 1991.
Bernard TN Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res. 1987;217:266–280.
Buchowski JM, Kebaish KM, Sinkov V, Cohen DB, Sieber AN, Kostuik JP. Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint. Spine J. 2005;5:520–528; discussion 529.
Chan KF. Musculoskeletal pain clinic in Singapore—sacroiliac joint somatic dysfunction as cause of buttock pain. Ann Acad Med Singapore. 1998;27:112–115.
Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8:968–974.
Gemmell HA, Jacobson BH. Incidence of sacroiliac joint dysfunction and low back pain in fit college students. J Manipulative Physiol. Ther. 1990;13:63–67. 6
Katz V, Schofferman J, Reynolds J. The sacroiliac joint: a potential cause of pain after lumbar fusion to the sacrum. J Spinal Disord Tech. 2003;16:96–99.
Khurana A, Guha AR, Mohanty K, Ahuja S. Percutaneous fusion of the sacroiliac joint with hollow modular anchorage screws: clinical and radiological outcome. J Bone Joint Surg Br. 2009;91:627–631.
Kibsgard TJ, Roise O, Sudmann E, Stuge B. Pelvic joint fusions in patients with chronic pelvic girdle pain: a 23-year follow-up. Eur Spine J. 2013;22:871–877.
Kirkaldy-Willis WH. Five common back disorders: how to diagnose and treat them. Geriatrics. 1978;33:32–33, 37–41.
Kirkaldy-Willis WH, Hill RJ. A more precise diagnosis for low-back pain. Spine (Phila Pa 1976). 1979;4:102–109.
Kurmann A, Vorburger SA, Candinas D, Beldi G. Operation time and body mass index are significant risk factors for surgical site infection in laparoscopic sigmoid resection: a multicenter study. Surg Endosc. 2011;25:3531–3534.
Lorio MP, Polly DW Jr, Ninkovic I, Ledonio CG, Hallas K, Andersson G. Utilization of minimally invasive surgical approach for sacroiliac joint fusion in surgeon population of ISASS and SMISS membership. Open Orthop J. 2014;8:1–6.
Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine (Phila Pa 1976). 1996;21:1889–1892.
Pull ter Gunne AF, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine (Phila Pa 1976). 2009;34:1422–1428.
Rudolf L. Sacroiliac joint arthrodesis-MIS technique with titanium implants: report of the first 50 patients and outcomes. Open Orthop J. 2012;6:495–502.
Rudolf L. MIS fusion of the SI joint: does prior lumbar spinal fusion affect patient outcomes? Open Orthop J. 2013;7:163–168.
Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976). 1995;20:31–37.
Sembrano JN, Polly DW Jr. How often is low back pain not coming from the back? Spine (Phila Pa 1976). 2009;34:E27–E32.
Skramm I, Saltyte Benth J, Bukholm G. Decreasing time trend in SSI incidence for orthopaedic procedures: surveillance matters! J Hosp Infect. 2012;82:243–247.
Slinkard N, Agel J, Swiontkowski MF. Documentation of outcomes for sacroiliac joint fusion: does prior spinal fusion influence the outcome? Eur Spine J. 2013;22:2318–2324.
Slipman CW, Lipetz JS, Plastaras CT, Jackson HB, Vresilovic EJ, Lenrow DA, Braverman DL. Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. Am J Phys Med Rehabil. 2001;80:425–432.
Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome. Spine (Phila Pa 1976). 1996;21:2251–2254.
Slipman CW, Sterenfeld EB, Chou LH, Herzog R, Vresilovic E. The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome. Arch Phys Med Rehabil. 1998;79:288–292.
Spiker WR, Lawrence BD, Raich AL, Skelly AC, Brodke DS. Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain. Evid Based Spine Care J. 2012;3:41–53.
Wise CL, Dall BE. Minimally invasive sacroiliac arthrodesis: outcomes of a new technique. J Spinal Disord Tech. 2008;21:579–584.