MVZ Wirbelsäulenzentrum München-Taufkirchen, Eschenstr. 2, Taufkirchen b. München, D-82024, Munich, Germany.
Department of Neurosurgery, "Heart and Brain" University Hospital, Pleven, BG-5800, Bulgaria.
Acta Neurochir (Wien). 2024 Nov 18;166(1):462. doi: 10.1007/s00701-024-06357-8.
The sacroiliac joint (SIJ) is a common source of chronic low back pain. Published cohorts have reported favorable outcomes after SIJ fusion. We report the 12-month follow-up from SIJ fusion of the so far largest single-center and single-surgeon group.
Over 15,000 outpatients were evaluated for chronic low back and leg pain, of whom 3,477 underwent SIJ blocks. 541 patients were stringently selected to undergo SIJ fusion with triangular titanium implants (TTI). 483 patients had a follow-up of 12 months. Patients were seen every 3 months and completed visual analog scale (VAS) and Oswestry Disability Index (ODI) ratings.
Mean age of all patients was 61 years, and the majority (65%) were women. 44% had undergone prior lumbar fusion and 10% had a spinal cord stimulator (SCS) in place at the time of SIJ surgery. 26% underwent non-simultaneous bilateral SI joint fusion. At 12 months, the proportion of patients with clinically important improvements in pain (≥ 2 points) was very high (100%). The proportion with substantial improvement (≥ 4 points) was 98%. Similarly, improvement in ODI was high, with nearly 99% having an improvement of ≥ 15 points by month 12. The proportions of patients with VAS ≤ 2 or ODI ≤ 15 was also high (92.8% and 48.9%).
In our clinical practice, SIJ fusion with TTI produces significant improvement in pain and disability. The most important factor for achieving these clinical results may be the very stringent multistep selection of patients for surgery, which is described in detail, as well as the highly standardized and streamlined surgical procedure and the particular postoperative management.
骶髂关节（SIJ）是慢性下腰痛的常见来源。已发表的队列研究报告称，SIJ 融合后结果良好。我们报告了迄今为止最大的单中心和单外科医生组的 SIJ 融合 12 个月随访结果。
超过 15000 名门诊患者因慢性下腰痛和腿痛接受评估，其中 3477 名患者接受了 SIJ 阻滞。严格选择 541 名患者进行三角钛植入物（TTI）SIJ 融合。483 名患者进行了 12 个月的随访。患者每 3 个月接受一次检查，并完成视觉模拟量表（VAS）和 Oswestry 残疾指数（ODI）评分。
所有患者的平均年龄为 61 岁，大多数（65%）为女性。44%的患者曾接受过腰椎融合术，10%的患者在 SIJ 手术时已放置脊髓刺激器（SCS）。26%的患者进行了非同期双侧 SI 关节融合。在 12 个月时，疼痛有临床意义改善（≥2 分）的患者比例非常高（100%）。有显著改善（≥4 分）的患者比例为 98%。同样，ODI 也有很大改善，近 99%的患者在第 12 个月时改善≥15 分。VAS≤2 或 ODI≤15 的患者比例也很高（92.8%和 48.9%）。
在我们的临床实践中，TTI 融合 SIJ 可显著改善疼痛和残疾。实现这些临床结果的最重要因素可能是对手术患者进行了非常严格的多步骤选择，以及详细描述的高度标准化和简化的手术程序和特殊的术后管理。
