Robyn Capobianco

Minimally Invasive Sacroiliac Joint Fusion: One-Year Outcomes in 40 Patients

Background. SI joint pain is difficult to diagnose due to overlapping symptoms of the lumbar spine, and until recently, treatment options have been limited. The purpose of this retrospective study is to report on the safety and effectiveness of MIS SI joint arthrodesis using a series of triangular, porous plasma coated implants in patients refractory to conservative care. Methods. We report on the first 40 consecutive patients with one-year follow-up data that underwent MIS SI joint fusion with the iFuse Implant System (SI-BONE, Inc., San Jose, CA) by a single surgeon. Medical charts were reviewed for demographics, perioperative metrics, complications, pain scores, and satisfaction. Results. Mean age was 58 years (range 30–81) and 75% of patients were female. Postoperative complications were minimal and included transient trochanteric bursitis (5%), facet joint pain (20%), and new low back pain (2.5%). There were no reoperations at one year. Mean pain score improved from 8.7 (1.5 SD) at baseline to 0.9 (1.6) at 12 months, a 7.8-point improvement (P < .001). Patient satisfaction was very high. Conclusions. The results of this case series reveal that MIS SI joint fusion using the iFuse Implant System is a safe and effective treatment option in carefully selected patients.

Five-year clinical and radiographic outcomes after minimally invasive sacroiliac joint fusion using triangular implants.

Object : Previous reports of minimally invasive (MIS) sacroiliac (SI) joint fusion for low back, SI joint, and buttock pain secondary to SI joint disorders have shown favorable short- and mid-term outcomes. Herein we present 5-year clinical and radiographic outcomes after MIS SI joint fusion using a series of triangular porous titanium plasma spray (TPS) coated implants. Methods : Consecutive patients treated with MIS SI joint fusion for degenerative sacroiliitis and/or sacroiliac joint disruptions between October 2007 and March 2009 were evaluated. Pain on VAS, an SI joint specific survey and Oswestry Disability Index (ODI) were administered. X-ray and CT scans were obtained to assess the implants. Results : Of 21 patients treated, 17 were available for the study. Mean age was 58 years (range 36-85), 77% were female and 47% had prior lumbar spinal fusion. Pain on VAS improved from 8.3 at baseline to 2.4 at 5 years; 88% of patients reached Substantial Clinical Benefit. Mean ODI score at 5 years was 21.5 (SD 22.7). Patient satisfaction achieved at 12 months was maintained for 5 years (82%). A qualitative review of x-ray and CT imaging showed increased bone density immediately adjacent to all implants, intra-articular osseous bridging in 87% of patients and no evidence of implant loosening or migration. Conclusion : Long-term clinical and radiographic outcomes after MIS SIJ fusion are favorable. Clinical improvements observed at 12 months postoperatively were maintained at 5 years. There was no evidence of long-term complications, implant loosening or migration. Patients who did not achieve large improvements were affected by multiple severe concomitant degenerative conditions of the lumbar spine, pelvis, and/or hip.

One year successful outcomes for novel sacroiliac joint arthrodesis system.

BackgroundSI joint pain can mimic discogenic low back pain or even radicular pain. Patient presentations vary considerably and conditions may include low back, groin, and/or radicular pain, leading to the potential for inaccurate diagnosis and treatment. Despite the large number of patients with SI joint pain, treatment options have been limited to conservative care involving physical therapy and joint injections, radiofrequency rhizotomy, or traditional open SI joint arthrodesis surgery. The purpose of this retrospective study is to evaluate the safety and effectiveness of MIS SI joint arthrodesis via an ileosacral approach in patients refractory to conservative care.MethodsWe report on the first 11 consecutive patients treated with a novel MIS SI joint fusion system by a single surgeon. Medical charts were reviewed for perioperative metrics and baseline pain scores recorded using a 0-10 numerical rating scale.ResultsNinety one percent (91%) of patients were female and the average patient age was 65 years (range 45-82). Mean baseline pain score (SD) was 7.9 (± 2.2). Mean pain score at the 12 month follow up interval was 2.3 (±3.1), resulting in an average improvement of 6.2 points from baseline, representing a clinically and statistically significant (p=0.000) improvement. Patient satisfaction was very high with 100% indicating that they would have the same surgery again for the same result.ConclusionsThe results of this small case series illustrate the safety and effectiveness of minimally invasive SI joint fusion using a series of triangular porous plasma coated titanium implants in carefully selected patients. Larger multi centered studies are warranted.

One-year outcomes after minimally invasive sacroiliac joint fusion with a series of triangular implants: a multicenter, patient-level analysis

Background Sacroiliac joint (SI) pain is an often-overlooked cause of lower-back pain, due in part to a lack of specific findings on radiographs and a symptom profile similar to other back-related disorders. A minimally invasive surgical (MIS) approach to SI joint fusion using a series of triangular, titanium plasma spray-coated implants has shown favorable outcomes in patients with SI joint pain refractory to conservative care. The aim of this study was to provide a multicenter experience of MIS SI joint fusion using a patient-level analysis. Patients and methods We report a patient-level analysis from 144 patients with a mean of 16 months postoperative follow-up. Demographic information, perioperative measures, complications, and clinical outcomes using a visual analog scale for pain were collected prospectively. Random-effects regression models were used to account for intersite variability. Results The mean age was 58 years, 71% of patients were female, and 62% had a history of lumbar spinal fusion. Mean (95% confidence interval [CI]) operative time was 73 minutes (25.4–118), blood loss was minimal, and hospital stay was 0.8 days (0.1–1.5). At follow-up, mean (95% CI) visual analog scale pain scores improved by 6.1 points (5.7–6.6). Substantial clinical benefit, defined as a decrease in pain by >2.5 points or a score of 3.5 or less, was achieved in 91.9% of patients (95% CI 83.9%–96.1%), and 96% (95% CI 86.3%–98.8%) of patients indicated they would have the same surgery again. Conclusion When conservative measures fail to relieve symptoms resulting from degeneration or disruption of the SI joint, MIS SI joint fusion using a series of triangular, porous, titanium plasma spray-coated implants is a safe and effective treatment option.

A systematic review of minimally invasive sacroiliac joint fusion utilizing a lateral transarticular technique

Background A number of studies have been published regarding minimally invasive surgical (MIS) fusion of the sacroiliac (SI) joint using a lateral transarticular approach. Herein we report a systematic review and meta-analysis to summarize operative measures and clinical outcomes reported in published studies of MIS SI joint fusion. Methods The systematic review was done according to PRISMA standards. PubMed and EMBASE were searched using the terms sacroiliac joint AND fusion. Original peer-reviewed articles in the English language that reported clinical outcomes on at least 5 cases of MIS SI joint fusion using a lateral transarticular approach were included. Random effects meta-analysis (RMA) was performed on selected variables using the DerSimonian and Laird method, including operative measures, VAS SI joint pain ratings (0-10 scale) and Oswestry Disability Index (ODI). Mean and 95% confidence intervals (CI) were calculated and heterogeneity was assessed. Other findings were summarized qualitatively. Results A total of 18 articles met the inclusion criteria. After accounting for overlapping cohorts, 12 unique cohorts from 4 countries were extracted for a total of 432 subjects. The RMA mean (range) was 59 minutes (27-78) for procedure time, 36.9cc (10-70) for estimated blood loss and 1.7 days (range 0-7) for length of stay (LOS). The RMA mean [95% CI] pain score dropped by 5.2 points at 6 months and 5.3 points at 12 months (baseline score of 8.1 [7.8-8.4], 12-month score of 2.7 [2.1-3.3]), and a 24-month score of 2.0(1.4-2.5). ODI decreased by 31 points at 12 months (baseline score of 56.2 [51.0-61.5], 6-month score of 30.7 [21.8-39.6], and 12-month score of 25.1 [12.3-37.9]). Some estimates showed significant variation across studies and between the types of implants used. Other reported outcomes were supportive of the positive effects of SI joint fusion. Conclusion Published studies of MIS SI joint fusion using a lateral transarticular approach confirm its minimally invasive characteristics with minimal blood loss and short operating room times, and show consistent, rapid, sustained and clinically important improvements in patient reported SI joint pain, disability and quality of life scores.

Utility of Intraoperative Neuromonitoring during Minimally Invasive Fusion of the Sacroiliac Joint.

Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement.

Implant survivorship analysis after minimally invasive sacroiliac joint fusion using the iFuse Implant System(

Introduction Surgical revision rate is a key outcome with all permanent implants. The iFuse Implant System® is a permanent implant used to perform minimally invasive sacroiliac joint fusion. The purpose of this study is to determine the surgical revision rate after sacroiliac joint fusion surgery with this system. Methods Using two internal sources of information, revision surgeries were identified and linked to index surgeries. The likelihood of revision surgery was calculated using the Kaplan–Meier life table approach. Predictors of revision were explored. Results Four-year survivorship free from implant revision was 96.46%. Revision rate did not differ by sex and was lower for age >65. In all, 24% of revisions occurred within the first 30 days after surgery; 63.5% occurred within year 1. Implant survivorship has improved annually since the device was introduced in 2009. Conclusion The survivorship rate with this implant is high and improving; the rate is somewhat higher than total hip replacement but lower than that of lumbar spine procedures.

Patients with sacroiliac joint dysfunction exhibit altered movement strategies when performing a sit-to-stand task

OF BACKGROUND DATA The ability to rise from a chair is a basic functional task that is frequently compromised in individuals diagnosed with orthopedic disorders in the low back and hip. There is no published literature that describes how this task is altered by sacroiliac joint dysfunction (SIJD). PURPOSE The objective of this study was to compare lower extremity biomechanics and the onset of muscle activity when rising from a chair in subjects with SIJD and in healthy persons. STUDY DESIGN Six women with unilateral SIJD and six age-matched healthy controls performed a sit-to-stand task while we measured kinematics, kinetics, and muscle activity. MATERIALS AND METHODS Subjects stood up at a preferred speed from a seated position on an armless and backless adjustable stool. We measured kinematics with a 10-camera motion capture system, ground reaction forces for each leg with force plates, and muscle activity with surface electromyography. Joint angles and torques were calculated using inverse dynamics. Leg-loading rate was quantified as the average slope of vertical ground reaction (VGRF) force during the 500-millisecond interval preceding maximal knee extension. RESULTS Between-leg differences in loading rates and peak VGRFs were significantly greater for the SIJD group than for the control group. Maximal hip angles were significantly less for the SIJD group (p=.001). Peak hip moment in the SIJD group was significantly greater in the unaffected leg (0.75±0.22 N⋅m/kg) than in the affected leg (0.47±0.29 N⋅m/kg, p=.005). There were no between-leg or between-group differences for peak knee or ankle moments. The onset of activity in the latissimus dorsi muscle on the affected side was delayed and the erector spinae muscles were activated earlier in the SIJD group than in the control group. CONCLUSIONS Subjects with SIJD have a greater VGRF on the unaffected leg, generate a greater peak hip moment in the unaffected leg, use a smaller range of motion at the hip joint of the affected leg, and delay the onset of a key muscle on the affected side when rising from a seated position.

Individuals with sacroiliac joint dysfunction display asymmetrical gait and a depressed synergy between muscles providing sacroiliac joint force closure when walking

Walking is often compromised in individuals with low back and hip disorders, such as sacroiliac joint dysfunction (SIJD). The disorder involves reduced coactivation of the gluteus maximus and contralateral latissimus dorsi, which together provide joint stability during walking. The purpose of our study was to compare the kinematics and contributions of selected muscles to identified synergies during walking between healthy individuals and those with SIJD. Six women with unilateral SIJD and six age-matched healthy controls walked on a force-measuring treadmill at 1 m/s while we recorded kinematics and the activity of 16 muscles with surface EMG. Non-negative matrix factorization was used to identify patterns of EMG activity (muscle synergies). Individuals with SIJD exhibited less hip extension and lower peak vertical ground reaction forces on the affected side than the unaffected side. In contrast to controls, the SIJD group also displayed a depressed muscle synergy between gluteus maximus on the affected side and the contralateral latissimus dorsi. The results indicate that individuals with SIJD exhibited both reduced activation of gluteus maximus during a loading synergy present in walking and greater asymmetry between legs when walking compared with age-matched controls.

Manipulation of sensory input can improve stretching outcomes

Abstract The primary purpose of our study was to assess the influence of modulating sensory input with either transcutaneous electrical nerve stimulation (TENS) or self-massage with therapy balls on the maximal range of motion (ROM) about the ankle joint when stretching the calf muscles. We also investigated the influence of these two conditions on the force capacity and force control of plantar flexor muscles. Twenty healthy adults (25 ± 3 yr) performed three sessions of ankle plantar flexor stretching (three stretches of 30 s each): stretching alone (SS), stretching with concurrent TENS (TENS), and stretching after self-massage using therapy balls (SM). TENS was applied for 60 s prior to and during each stretch, and SM was performed for 60 s prior to each of the three stretches. Maximal voluntary contraction (MVC) torque and force steadiness at 20% MVC were recorded before and at 15 min after the final stretch. Ankle dorsiflexion ROM was assessed before, after, and at 5, 10, and 15 min after the last stretch. The increase in ROM was greater after SM (24%) than after SS (13%) and TENS (9%; p < .001). Maximal discomfort level (0–10 VAS) during stretching was similar for all conditions. MVC torque increased after SM only (p < .001, Cohen’s D = 1.5): SM, 16%; SS, –1%; TENS, –3%. Force steadiness did not change. The sensory fibres that contribute to stretch tolerance were engaged by self-massage but not by TENS, resulting in greater increases in flexibility and MVC torque after self-massage.