gms | German Medical Science

Objective: About one quarter of patients with low back pain suffer from tenderness in the sacroiliac joint (SIJ). Minimally invasive surgical fusion of the SIJ using triangular titanium implants has been recently established as a means of controlling sacroiliac pain. Our aim was to assess the postoperative and short-term (3 month) success rates and complication rates of the procedure after our initial experience.

Methods: SIJ pain was defined as suffering from at least three out of six criteria. These criteria included tenderness on palpation, Gaenslen sign, FABER (flexion, abduction, external rotation) sign, thigh-thrust, distraction and compression of the SIJ. After confirmation of SIJ pain and failed best medical treatment including physiotherapy, two infiltration of the SIJ recess were performed using local aesthetic. In case of pain relief of >50% on two consecutive infiltrations, patients were eligible for SIJ fusion. Fusion was performed under general anaesthesia with three triangular titanium implants inserted through the SIJ under fluoroscopic control. Postoperative computed tomography was used to confirm correct implant position. Subjective outcomes were assessed at discharge and three months postoperatively and graded as worsening, no improvement and improvement.

Results: Eight patients (4 female, 50%) with a mean age of 60 years±16 years underwent nine SIJ fusions at our department, totalling 27 implants. Six patients (75%) reported improvement of symptoms, one (12.5%) unchanged complaints and the remaining one complained of worsening pain (12.5%). CT scans showed insufficient penetration of the SIJ in two implants. Another implant showed a close vicinity to the S1 foramen without violating it. None of these misplacements 3/27 (11%) were considered relevant or requiring surgical revision. In all three affected patients only one implant out of three was misplaced. Clinical outcome evaluation showed that all of the patients harboring suboptimally placed implants were among those with significant symptom improvement.

Conclusion: Our initial experience showed that the use of triangular titanium implants to treat SIJ pain is a safe technique. Implant misplacement rates were within the tolerable range. Patient reported symptom improvement was satisfactory in 75% of cases and showed no tangible association with suboptimal implant position.

Figure 1[Fig. 1] , Figure 2 [Fig. 2]