Deer Timothy R, Rupp Adam, Budwany Ryan, Bovinet Christopher J, Chatas John W, Pyles Stephen T, Azeem Nomen, Li Sean, Naidu Ramana, Antony Ajay, Hagedorn Jonathan M, Sayed Dawood
The Spine & Nerve Centers of the Virginias, Charleston, WV, USA.
Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, KS, USA.
J Pain Res. 2021 Sep 2;14:2709-2715. doi: 10.2147/JPR.S325059. eCollection 2021.
BACKGROUND: Sacroiliac joint (SIJ) pain is a common cause of low back pain, a problem experienced by two-thirds of adults in the United States population. Traditionally, the management of persistent SIJ-related pain has involved conservative therapies (physical therapy, topical medications, oral anti-inflammatory medications), interventional therapies (SIJ steroid injections or ablation), and surgery (SIJ fusion; open and lateral approach). Recent advancements in technology have paved the way for SIJ fusion via a posterior approach, which aims to minimize complications and enhance recovery. OBJECTIVE: The purpose of this study is to introduce the concept of the posterior approach to SIJ fusion as a feasible adjunct and salvage technique for patients with inadequate pain relief from other minimally invasive surgical procedures, and to validate its efficacy through a retrospective multicenter data analysis. DESIGN: Multicenter retrospective observational study. METHODS: Patients with refractory SIJ pain were treated by interventional pain physicians at one of the eight different pain management centers. All patients underwent posterior SIJ fusion via the LinQ sacroiliac fusion procedure. Demographical data were collected, in addition to patient-reported pain relief. RESULTS: A total of 111 patients were included in the study and underwent posterior SIJ fusion for refractory SIJ-related pain following the use of spinal cord stimulation (SCS), interspinous spacer (ISS), intrathecal drug delivery (IDDS), and/or minimally invasive lumbar decompression (MILD). Overall, the mean patient reported pain relief following posterior SIJ fusion was 67.6%. In patients with a history of failed back surgery syndrome, the mean patient reported pain relief was 76.5%. CONCLUSION: In this retrospective case series of patients with continued intolerable pain following SCS, ISS, IDDS, or MILD, a novel posterior SIJ fusion device provided significant pain relief in a salvage manner. These early results suggest that this intervention may be a therapeutic option to consider in these patients.
背景：骶髂关节（SIJ）疼痛是下腰痛的常见原因，在美国三分之二的成年人都经历过这一问题。传统上，持续性SIJ相关疼痛的治疗方法包括保守治疗（物理治疗、局部用药、口服抗炎药）、介入治疗（SIJ类固醇注射或消融）和手术（SIJ融合术；开放和外侧入路）。技术的最新进展为通过后路进行SIJ融合术铺平了道路，该方法旨在将并发症降至最低并促进恢复。 目的：本研究的目的是介绍后路SIJ融合术的概念，作为一种可行的辅助和挽救技术，用于那些因其他微创手术未能充分缓解疼痛的患者，并通过回顾性多中心数据分析验证其疗效。 设计：多中心回顾性观察研究。 方法：难治性SIJ疼痛患者在八个不同的疼痛管理中心之一接受介入疼痛科医生的治疗。所有患者均通过LinQ骶髂融合手术进行后路SIJ融合。除了患者报告的疼痛缓解情况外，还收集了人口统计学数据。 结果：本研究共纳入111例患者，在使用脊髓刺激（SCS）、棘突间间隔器（ISS）、鞘内药物递送（IDDS）和/或微创腰椎减压（MILD）后，因难治性SIJ相关疼痛接受了后路SIJ融合术。总体而言，患者报告后路SIJ融合术后的平均疼痛缓解率为67.6%。有腰椎手术失败综合征病史的患者，患者报告的平均疼痛缓解率为76.5%。 结论：在这个回顾性病例系列中，对于SCS、ISS、IDDS或MILD后仍持续存在难以忍受疼痛的患者，一种新型的后路SIJ融合装置以挽救性方式提供了显著的疼痛缓解。这些早期结果表明，这种干预措施可能是这些患者可考虑的一种治疗选择。
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