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. 2021 Apr;15(2):274-279.
doi: 10.14444/8037. Epub 2021 Apr 1.

Minimally Invasive Sacroiliac Fusion Revision: A Technique Guide

Daniel J Cognetti  1 , Anton Y Jorgensen  2
Affiliations

Minimally Invasive Sacroiliac Fusion Revision: A Technique Guide

Daniel J Cognetti et al. Int J Spine Surg. 2021 Apr.

Abstract

Study design: A retrospective case-series of revision sacroiliac joint (SIJ) fusions.

Objective: To provide a technique guide for revision minimally invasive SIJ fusion.

Summary of background data: SIJ dysfunction is a prevalent, yet underdiagnosed condition. This disparity exists as a result of diagnostic complexity and lack of a viable surgical treatment option. However, the advent of minimally invasive SIJ fusion has created a resurgence of interest in this debilitating condition. Multiple studies have reported on the increased use of minimally invasive SIJ fusion in recent years, but there is a paucity of literature on management in a revision setting.

Methods: A case series of 5 patients from a single academic tertiary referral center over a 3-year period will serve to highlight technical pearls and considerations in SIJ fusion revision. Revision SIJ fusions were identified through a retrospective review of a surgical database and demographic, surgical, and radiographic data were obtained through review of the electronic medical record.

Results: Five patients underwent SIJ fusion revision from 2015 to 2018. There were 3 main modes of failure, with indications for revision including nerve root irritation and SIJ pain recurrence. The mean age at time of revision was 48.8 ± 14.3 years, and the mean follow-up after revision was 2.0 + 0.9 years. Familiarity with SIJ anatomy and use of stereotactic navigation can improve implant position and purchase. Additionally, bone graft and bone morphogenetic protein can be used to fill in old implant tracks and to augment bony ingrowth and ongrowth of new implants.

Conclusions: Increased use of SIJ fusion creates a demand for comprehensive revision strategies and necessitates familiarity with SIJ anatomy. Preoperative planning to determine causes of failure and use of intraoperative navigation are essential to help surgeons better understand the preferential trajectory for each implant.

Level of evidence: 4.

Keywords: SI; SIJ; arthrodesis; minimally invasive; revision; sacroiliac joint fusion; technique guide.

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Conflict of interest statement

Disclosures and COI: Anton Y. Jorgensen, MD, is a paid consultant for SI-Bone.

Figures

Figure 1
Figure 1
Three modes of failure in index sacroiliac joint (SIJ) fusion necessitating revision. (A) Violation of foramina causing radiculopathy. (B) Implant loosening about sacral aspect of implant. (C) Implant spanning the ligamentous portion of the SIJ.
Figure 2
Figure 2
(A) Lateral graphic of the sacroiliac joint showing the posterior/dorsal ligamentous portion of the joint and the anterior/ventral cartilaginous portion of the joint. (B) Oblique graphic highlighting the narrow ventral true cartilaginous portion of the joint that is the target for implant placement. Image courtesy of Visible Body.
Figure 3
Figure 3
Removal of loose implant with tubular retractor, screw removal set, and osteotomes.
Figure 4
Figure 4
Inlet (A), outlet (B), lateral (C) fluoroscopic views after navigation assisted placement of newly revised triangular implants with comparison to previously placed contralateral circular implants, highlighting the more ventral triangular implants. The ventral trajectory crosses the cartilaginous portion of the joint.
Figure 5
Figure 5
Axial and coronal postoperative computed tomography scans localized over the revised cephalad (A), middle (B), and caudal (C) navigated triangular implants, with previously placed contralateral circular implants. Red arrows: old implant tracts.
Figure 6
Figure 6
Computed tomography scan demonstrating interosseous bridging anterior to the implant across the cartilaginous portion of the sacroiliac joint.
See this image and copyright information in PMC

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