Cognetti Daniel J, Jorgensen Anton Y
Department of Orthopedics, Brooke Army Medical Center, Houston, Texas.
Ortho San Antonio, San Antonio, Texas.
Int J Spine Surg. 2021 Apr;15(2):274-279. doi: 10.14444/8037. Epub 2021 Apr 1.
A retrospective case-series of revision sacroiliac joint (SIJ) fusions.
To provide a technique guide for revision minimally invasive SIJ fusion.
SIJ dysfunction is a prevalent, yet underdiagnosed condition. This disparity exists as a result of diagnostic complexity and lack of a viable surgical treatment option. However, the advent of minimally invasive SIJ fusion has created a resurgence of interest in this debilitating condition. Multiple studies have reported on the increased use of minimally invasive SIJ fusion in recent years, but there is a paucity of literature on management in a revision setting.
A case series of 5 patients from a single academic tertiary referral center over a 3-year period will serve to highlight technical pearls and considerations in SIJ fusion revision. Revision SIJ fusions were identified through a retrospective review of a surgical database and demographic, surgical, and radiographic data were obtained through review of the electronic medical record.
Five patients underwent SIJ fusion revision from 2015 to 2018. There were 3 main modes of failure, with indications for revision including nerve root irritation and SIJ pain recurrence. The mean age at time of revision was 48.8 ± 14.3 years, and the mean follow-up after revision was 2.0 + 0.9 years. Familiarity with SIJ anatomy and use of stereotactic navigation can improve implant position and purchase. Additionally, bone graft and bone morphogenetic protein can be used to fill in old implant tracks and to augment bony ingrowth and ongrowth of new implants.
Increased use of SIJ fusion creates a demand for comprehensive revision strategies and necessitates familiarity with SIJ anatomy. Preoperative planning to determine causes of failure and use of intraoperative navigation are essential to help surgeons better understand the preferential trajectory for each implant.
骶髂关节（SIJ）翻修融合术的回顾性病例系列研究。
为微创SIJ翻修融合术提供技术技术技术学技术指导。
SIJ功能障碍是一种常见但诊断不足的病症。这种差异的存在是由于诊断复杂性和缺乏可行的手术治疗选择。然而，微创SIJ融合术的出现重新引发了人们对这种使人衰弱病症的兴趣。多项研究报告了近年来微创SIJ融合术的使用增加，但关于翻修情况下的治疗的文献却很少。
一个病例系列，包含来自单一学术三级转诊中心的5例患者，为期3年，将突出SIJ融合翻修术中的技术要点和注意事项。通过对手术数据库的回顾性分析确定翻修SIJ融合术病例，并通过查阅电子病历获取人口统计学、手术和影像学数据。
2015年至2018年期间，5例患者接受了SIJ融合翻修术。有3种主要的失败模式，翻修指征包括神经根刺激和SIJ疼痛复发。翻修时的平均年龄为48.8±14.3岁，翻修后的平均随访时间为2.0 + 0.9年。熟悉SIJ解剖结构并使用立体定向导航可以改善植入物的位置和固定。此外，骨移植和骨形态发生蛋白可用于填充旧的植入物通道，并促进新植入物的骨向内生长和骨附着生长。
SIJ融合术使用的增加对全面的翻修策略提出了需求，并且需要熟悉SIJ解剖结构。术前规划以确定失败原因并使用术中导航对于帮助外科医生更好地了解每个植入物的优先轨迹至关重要。
4级。
