Sayed Dawood, Khatri Nasir, Rupp Adam, Bovinet Christopher, Azeem Nomen, Li Sean, Josephson Youssef, Pope Jason
Department of Anesthesiology, University of Kansas, Kansas City, KS, USA.
The Spine Center of Southeast Georgia, Brunswick, GA, USA.
J Pain Res. 2022 May 12;15:1411-1420. doi: 10.2147/JPR.S357076. eCollection 2022.
Studies have found that up to one-third of patients with LBP have sacroiliac joint (SIJ) dysfunction as a contributing cause. Historically, the management of SIJ dysfunction has been plagued by ineffectiveness or significant morbidity. In 2008, minimally invasive lateral SIJ fusion was developed. While this procedure is a safe and effective treatment, there is still a significant proportion of patients who will not experience therapeutic success. There is a paucity of data in the literature regarding the management of these patients. Recently, a novel posterior sacroiliac joint fusion device has been developed which minimizes complications compared to lateral approaches and may serve to salvage therapeutic failures in this patient population.
Determine the efficacy and feasibility of a posterior SIJ fusion device as a salvage technique in patients who have not experienced therapeutic success following lateral SIJ fusion.
Multi-center retrospective observational study.
Patients who had previously undergone lateral SIJ fusion and had persistent LBP were evaluated and diagnosed to have persistent primary SIJ pathology. All patients underwent posterior SIJ fusion utilizing a machined allograft transfixing sacroiliac fusion device. Demographic data and patient reported pain scores were collected.
A total of 7 patients who had undergone lateral SIJ fusion were included in the study and underwent posterior SIJ fusion. The mean patient reported pain improvement following posterior fusion was 80% with an average follow-up time of 10 months. Median morphine milliequivalents were 20 pre-procedure and 0 post-procedure.
We were able to show significant reductions in pain scores and opioid consumption, which suggests that minimally invasive posterior SIJ utilizing a novel implant and technique may be a viable treatment option to salvage pain relief in this patient population. Further, the favorable safety profile of this posterior technique uniquely positions it to be an appropriate first-line surgical therapy.
研究发现，高达三分之一的腰痛患者存在骶髂关节（SIJ）功能障碍这一促成因素。从历史上看，骶髂关节功能障碍的治疗一直受到疗效不佳或严重并发症的困扰。2008年，微创外侧骶髂关节融合术问世。虽然该手术是一种安全有效的治疗方法，但仍有相当一部分患者无法获得治疗成功。关于这些患者的治疗，文献中的数据很少。最近，一种新型的骶髂关节后路融合装置已被研发出来，与外侧入路相比，它能将并发症降至最低，并可能有助于挽救这类患者的治疗失败情况。
确定一种骶髂关节后路融合装置作为挽救技术在外侧骶髂关节融合术后未获得治疗成功的患者中的疗效和可行性。
多中心回顾性观察研究。
对先前接受过外侧骶髂关节融合术且持续存在腰痛的患者进行评估，并诊断为持续性原发性骶髂关节病变。所有患者均使用加工同种异体骨固定骶髂关节融合装置进行骶髂关节后路融合。收集人口统计学数据和患者报告的疼痛评分。
共有7例接受过外侧骶髂关节融合术的患者纳入本研究并接受了骶髂关节后路融合术。患者报告后路融合术后疼痛改善的平均比例为80%，平均随访时间为10个月。术前吗啡毫克当量中位数为20，术后为0。
我们能够证明疼痛评分和阿片类药物消耗量显著降低，这表明使用新型植入物和技术的微创骶髂关节后路融合术可能是挽救这类患者疼痛缓解的可行治疗选择。此外，这种后路技术良好的安全性使其独特地成为一种合适的一线手术治疗方法。
