Traditional Sacroiliac Joint Fusion
Starting around the mid-1980’s however, attention was refocused on the sacroiliac joint as a potential source of low back pain, and fusion once again considered as a treatment option.
Numerous surgical techniques have been described, using anterior or posterior approaches, with various types of fixation hardware including plates, screws, and bars.12, 16-20
These procedures generally require a large incision, detachment of surrounding muscles from their bony insertion points, harvesting of bone graft, and preparation of cartilaginous surfaces.
Schutz and Grob described poor outcomes with bilateral sacroiliac joint fusion using a dorsal bilateral interlocking technique in a retrospective study. Of the 17 patients followed up on an average of 39 months, union occurred in only 6 cases. 14 patients reported marked to severe pain at an average of 25.5 months post-operatively, and only 3 patients (18%) expressed satisfaction with the results.15
Buchowski published results for arthrodesis on 20 patients using a modified Smith-Petersen technique with a mean follow up of 5.8 years. The overall fusion rate within 1 year of surgery was 85%. 3 patients (15%) had nonunions requiring revision surgery, with 2 of these patients experiencing deep wound infection which necessitated irrigation and debridement. 60% of the patients indicated they would choose to have the surgery again.21
Waisbrod et al reported on 22 cases of sacroiliac joint arthrodesis with 12 - 55 month follow up. Post-operatively, 11 patients (50%) met the criteria for a satisfactory result: pain reduction ≥50%, no need for analgesics, and resumption of the pre-operative occupation, and had a fully united joint at 12 months. Of the 11 patients with unsatisfactory results, there were 2 nonunions and 1 infection.22
Next page: iFuse Procedure Sacroiliac Joint Fusion
Sacroiliac Joint Anatomy
Sacroiliac Joint Treatment Options
- Belanger Ta and Dall BE.Sacroiliac Arthrodesis Using a Posterior Midline Fascial Splitting Approach and Pedicle Screw Instrumentation: A New Technique. Journal of Spinal Disorders (14) 2: 118–124.
- Smith-Petersen MN, Rogers WA. End-result study of arthrodesis of the sacroiliac joint for arthritis—traumatic and nontraumatic. J Bone Joint Surg 1926;8:118–36.
- Gaenslen FJ. Sacro-iliac arthrodesis: indications, author’s technic and end-results. JAMA 1927;89:2031–5.
- Schutz U, Grob D. Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Acta Orthop. Belg., 2006, 72, 296-308.
- Goldstein A, Phillips T, Sclafani SJA, et al. Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma. 1986; 26:325–333.