Comparative effectiveness of open versus minimally invasive sacroiliac joint fusion

Abstract

Background: The mainstay of sacroiliac joint disruption/degenerative sacroiliitis therapy has been nonoperative management. This nonoperative management often includes a regimen of physical therapy, chiropractic treatment, therapeutic injections, and possibly radiofrequency ablation at the discretion of the treating physician. When these clinical treatments fail, sacroiliac joint fusion has been recommended as the standard treatment. Open and minimally invasive (MIS) surgical techniques are typical procedures. This study aims to compare the perioperative measures and Oswestry Disability Index (ODI) outcomes associated with each of these techniques.

Methods: A comparative retrospective chart review of patients with sacroiliac joint fusion and a minimum of 1 year of follow-up was performed. Perioperative measures and ODI scores were compared using the Fisher's exact test and two nonparametric tests, ie, the Mann-Whitney U test and the Wilcoxon signed-rank test. The results are presented as percent or median with range, as appropriate.

Results: Forty-nine patients from two institutions underwent sacroiliac joint fusion between 2006 and 2012. Ten patients were excluded because of incomplete data, leaving 39 evaluable patients, of whom 22 underwent open and 17 underwent MIS sacroiliac joint fusion. The MIS group was significantly older (median age 66 [39-82] years) than the open group (median age 51 [34-74] years). Surgical time and hospital stay were significantly shorter in the MIS group than in the open group. Preoperative ODI was significantly greater in the open group (median 64 [44-78]) than in the MIS group (median 53 [14-84]). Postoperative improvement in ODI was statistically significant within and between groups, with MIS resulting in greater improvement.

Conclusion: The open and MIS sacroiliac joint fusion techniques resulted in statistically and clinically significant improvement for patients with degenerative sacroiliitis refractory to nonoperative management. However, the number of patients reaching the minimal clinically important difference and those showing overall improvement were greater in the MIS group.

Keywords: arthrodesis; degenerative sacroiliitis; sacroiliac joint; sacroiliac joint disruption.

Figure 1

Postoperative radiograph of a pelvis with a three-hole reconstruction plate spanning the sacroiliac joint. Note: The ‘L’ represents the patient’s left.

Figure 2

Postoperative radiograph demonstrating placement of three fusion implants across the sacroiliac joint.

Figure 3

Plot of ODI scores per patient in open sacroiliac joint fusion group. Abbreviations: SI, sacroiliac; ODI, Oswestry Disability Index, Preop, preoperative; Postop, postoperative

Figure 4

Plot of ODI scores per patient in the MIS SI joint fusion group. Abbreviations: SI, sacroiliac; ODI, Oswestry Disability Index; MIS, minimally invasive surgery; Preop, preoperative; Postop, postoperative.