The Sacroiliac joint (SIJ) is the cause of many cases of lower back pain (estimated to be 25%) and yet is clinically difficult to diagnose and treat effectively. There are many differing opinions on how this joint should be treated, with mobilisations; adjustments; soft tissue therapy; steroid injections; acupuncture; electrotherapy; SIJ belts and exercise rehabilitation all playing their part.
If all of the above fails, patients are often left to manage their sacroiliac joint dysfunction with a mixture of medications, relative rest and a few exercises. Surgery to stabilise the joints is rarely performed due to the invasive nature of the technique and its variable outcome.
A new procedure called the ‘iFuse Implant System’ is a minimally invasive technique which uses up to three small titanium rods, implanted across the SI joints to stabilise the sacrum. The titanium rods are triangular in profile which helps to minimise rotation when in place.
The procedure is performed with the patient in a front lying position and either under a general or spinal anaesthetic. A small 2-3cm incision is made on the outer hip and the whole operation takes around an hour to complete. The patient is usually discharged from hospital after just a 1 night stay.
The company behind the procedure – SI-Bone, were originally given clearance to market the system for fixation of long bone and large pelvic fractures in 2008. They were given further permission in 2011 to use the procedure for SI joint fusion.
Whilst this is a relatively new procedure, research is now coming through which shows just how effective this procedure can be. The Open Orthopaedics Journal published a study late last year which looked at 45 patients all treated with this surgery by one surgeon at a private practice. All patients were contacted after a minimum of 24 months post-surgery to assess SIJ pain, satisfaction and work status. Significant improvement were noted in 7 out of 9 areas of daily living and over 80% of patients said they would undergo the same surgery again. Complication rate was low and 13 of the patients had been able to return to work.
SI joint pain should always be initially treated with conservative therapies and in many cases these are successful. However, for those with persistent cases, the iFuse implant system could offer new hope. Whilst further research is required across a wider spectrum of patients and surgeons, the current results are very positive.
Reference: Rudolf, L. Sacroiliac Joint Arthrodesis – MIS Technique with Titanium Implants: Report of the First 50 Patients and Outcomes. The Open Orthopaedics Journal, 2012, 6, 492-499.