Dual fibular allograft dowel technique for sacroiliac joint arthrodesis

 

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ABSTRACT

Study design: Retrospective case series.

Objective: To assess fusion rates in patients with sacroiliac joint (SIJ) pain following a minimally invasive technique using fibular dowel allograft.

Methods: Thirty-seven consecutive patients (mean age: 42.5 years [range, 23–63 years]) with SIJ pain treated with 38 minimally invasive elective SIJ arthrodeses were retrospectively reviewed using chart and x-ray data. The fusion procedure consisted of minimal muscle stripping over the posterior SIJ and insertion of a cranial and caudal fibular dowel graft across the joint following placement of Steinmann pins. Fusion was deemed to be present when bone bridging trabeculae could be seen crossing the SIJ on either oblique x-rays or by computed tomographic scan. Patients were followed-up for a mean of 52 months (range, 24–62 months). Visual Analog Scale (VAS) was used to monitor clinical pain improvement.

Results: Thirty-four patients with SIJ arthrodeses (89.5%) healed and led to substantial improvement in VAS pain scores (preoperative 9.1, postoperative 3.4) (P < .001). This improvement in VAS occurred over a 6-month period and was sustained through subsequent follow-up. Nonunion occurred in four patients with SIJ (10.5%). Each SIJ nonunion was successfully treated by secondary autogenous bone grafting and compression screw fixation.

Conclusions: In patients with primary low back pain attributable to the SIJ, a minimally invasive, dual fibular dowel graft provided high rates of fusion and improved pain scores.

• REFERENCES

• 1 Salaff F, Stancati A, Silvestri CA et al. 2004; Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain 8 (4) 283-291
  CrossrefPubMedGoogle Scholar
• 2 Ostelo RW, Devo RA, Stratford P et al. 2008; Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimial important change. Spine (Phila Pa 1976) 33 (1) 90-94
  CrossrefPubMedGoogle Scholar
• 3 Ostelo RW, deVet HC. 2005; Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol 19 (4) 593-607
  CrossrefPubMedGoogle Scholar
• 4 Routt Jr MLC, Kregor PJ, Simonian PT et al. 1995; Early results of percutaneous iliosacral screws placed with the patient in a supine position. J Orthop Trauma 9 (3) 207-214
  CrossrefPubMedGoogle Scholar
• 5 Tonetti J, Carrat L, Lavalleé S et al. 1998; Percutaneous iliosacral screw placement using image guided techniques. Clin Orthop Relat Res (354) 103-110
  PubMedGoogle Scholar
• 6 van den Bosch EW, van Zwienen CM, van Vugt AB. 2002; Fluoroscopic positioning of sacroiliac screws in 88 patients. J Trauma 53 (1) 44-48
  CrossrefPubMedGoogle Scholar
• 7 Buchowski JM, Kebaish KM, Sinkov V et al. 2005; Functional and radiographic outcomes of sacroiliac arthrodesis for the disorders of the sacroiliac joint. Spine J 5 (5) 520-528 ; discussion 529
  CrossrefPubMedGoogle Scholar
• 8 Belanger TA, Dall BE. 2001; Sacroiliac arthrodesis using a posterior midline fascial splitting approach and pedicle screw instrumentation: a new technique. J Spinal Disord 14 (2) 118-124
  CrossrefPubMedGoogle Scholar

• REFERENCES EDITORIAL PERSPECTIVE

• 1 Ashman B, Hermsmeyer J, Norvell DC. 2010; Chronic sacroiliac joint pain: fusion versus denervation as treatment options. EBSJ 1 (3) 35-44
  PubMedGoogle Scholar
• 2 Dreyfuss P, Dreyer SJ, Cole A et al. 2004; Sacroiliac joint pain. J Am Acad Orthop Surg 12 (4) 255-265
  PubMedGoogle Scholar