Sayed Dawood, Balter Kevin, Pyles Stephen, Lam Christopher M
Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Midwest Pain Clinics, Omaha, NE, USA.
J Pain Res. 2021 Oct 14;14:3251-3258. doi: 10.2147/JPR.S326827. eCollection 2021.
BACKGROUND: Sacroiliac joint (SIJ) pathology is a cause of low back pain that may be difficult to diagnose and challenging to treat. Open and minimally invasive (MI) lateral approach fusions have been used to treat sacroiliitis over the past two decades. A novel MI posterior approach SIJ fusion technique utilizes a posteriorly placed transfixing device with single point S1/S2 level or mid-segment SIJ fixation (LinQ procedure). Current efficacy and safety data for this novel procedure are lacking. OBJECTIVE: To review multicenter retrospective 12 months or greater outcomes data in patients receiving the LinQ procedure, with sub-analysis of patients with prior lumbar fusions. METHODS: Patients with sacroiliitis refractory to conservative care with short-term benefit from diagnostic local anesthetic SIJ injections receiving MI posterior approach SIJ fusion with allograft were included from different centers including both academic and private practice. Numeric rating scale (NRS) scores at baseline (pre-procedural) and most recent follow-up were reviewed across three institutions. RESULTS: Of 110 patients who received MI SIJ fusion, 50 patients had sufficient data for evaluation of outcomes at least 12 months post-implant. The average time out from implant at follow-up was 612.2 days for all unique patients. The average NRS was 6.98 pre-fusion and 3.06 at last follow-up. Twenty-four patients had prior lumbar surgery of which 17 had prior lumbar fusions. Average NRS for this subset was 6.85 at baseline and 2.86 at last follow-up with an average follow-up of 613.2 days out from implant. No major adverse events or complications were associated with any of the 50 implants. CONCLUSION: Real-world evidence suggests that MI posterior SIJ fusion with the LinQ procedure is a viable approach for medically refractory sacroiliitis management with long-term efficacy and safety. Further prospective studies are needed to fully evaluate this technique.
背景:骶髂关节(SIJ)病变是下腰痛的一个病因,可能难以诊断且治疗具有挑战性。在过去二十年中,开放和微创(MI)外侧入路融合术已被用于治疗骶髂关节炎。一种新型的MI后入路SIJ融合技术采用后置的固定装置,在S1/S2单水平或骶髂关节中段进行固定(LinQ手术)。目前缺乏关于这种新手术的疗效和安全性数据。 目的:回顾接受LinQ手术患者的多中心回顾性12个月或更长时间的结局数据,并对先前接受过腰椎融合术的患者进行亚分析。 方法:纳入来自不同中心(包括学术机构和私人诊所)的骶髂关节炎患者,这些患者经保守治疗无效,诊断性局部麻醉下骶髂关节注射有短期疗效,接受MI后入路SIJ同种异体骨融合术。在三个机构中回顾了基线(术前)和最近一次随访时的数字评分量表(NRS)评分。 结果:在110例行MI SIJ融合术的患者中,50例患者有足够的数据用于评估植入后至少12个月的结局。所有纳入患者随访时距植入的平均时间为612.2天。融合术前平均NRS为6.98,最后一次随访时为3.06。24例患者曾接受过腰椎手术,其中17例曾接受过腰椎融合术。该亚组患者基线时平均NRS为6.85,最后一次随访时为2.86,距植入的平均随访时间为613.2天。50枚植入物均未发生重大不良事件或并发症。 结论:真实世界证据表明,采用LinQ手术的MI后入路SIJ融合术是治疗药物难治性骶髂关节炎的一种可行方法,具有长期疗效和安全性。需要进一步的前瞻性研究来全面评估该技术。
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