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

Rudolf L, Capobianco R - Open Orthop J (2014)

Bottom Line: Pain on VAS improved from 8.3 at baseline to 2.4 at 5 years; 88% of patients reached Substantial Clinical Benefit.Clinical improvements observed at 12 months postoperatively were maintained at 5 years.Patients who did not achieve large improvements were affected by multiple severe concomitant degenerative conditions of the lumbar spine, pelvis, and/or hip.

View Article: PubMed Central - PubMed

Affiliation: Alice Peck Day Memorial Hospital, 17 Alice Peck Day Drive, Suite C, Lebanon, NH 03766, USA.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Plain radiographs showing apparent lucency along the wall of the superior implants on the pelvic AP view (A), but not on the pelvicoutlet view (B). Sagittal view on CT scan (C) confirms the “lucency” as an artifact.
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Figure 4: Plain radiographs showing apparent lucency along the wall of the superior implants on the pelvic AP view (A), but not on the pelvicoutlet view (B). Sagittal view on CT scan (C) confirms the “lucency” as an artifact.

Mentions: A qualitative comparison of 1- and 5-year pelvic plain film radiographs, including AP and outlet views, revealed no change in implant position (Fig. 2). CT scans of the pelvis with axial, sagittal, and coronal reconstructions documented increased bone density circumferentially along three implant walls for all implants on both the iliac and sacral segments. Evidence of osseous bridging across the SI joint was clearly seen on 13 of 15 (87%) of patients (Fig. 3). On x-ray, what appeared to be full-length lucency (absence of bone adjacent to an implant) along the wall of the implant was consistently observed on at least one implant in all patients on AP view. However, this observation was not evident on the outlet view. Upon review of CT imaging, this apparent lucency was confirmed to be an artifact (Fig. 4). Assessment and comparison of CT scans at 1- and 5-years revealed a consistent pattern of artifacts at the corners and periodically along the wall of an implant, which were non-progressive and unchanged in equivalent projections on the axial, sagittal and coronal sections. A small area of true focal lucency was observed on CT scans in 4 patients; along the superior edge of the most cranial implant on the iliac side in 3 patients, and on the superior edge of the most caudal implant on the iliac side in one patient (Fig. 5). Other findings included a regular pattern of sclerotic bone response at the implant entry point in the ilium, on primarily the superior implant (Fig. 6). A detailed explanation of the physics of CT imaging of triangular titanium implants is outside the scope of this manuscript and will be reported separately.


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

Rudolf L, Capobianco R - Open Orthop J (2014)

Plain radiographs showing apparent lucency along the wall of the superior implants on the pelvic AP view (A), but not on the pelvicoutlet view (B). Sagittal view on CT scan (C) confirms the “lucency” as an artifact.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4209504&req=5

Figure 4: Plain radiographs showing apparent lucency along the wall of the superior implants on the pelvic AP view (A), but not on the pelvicoutlet view (B). Sagittal view on CT scan (C) confirms the “lucency” as an artifact.
Mentions: A qualitative comparison of 1- and 5-year pelvic plain film radiographs, including AP and outlet views, revealed no change in implant position (Fig. 2). CT scans of the pelvis with axial, sagittal, and coronal reconstructions documented increased bone density circumferentially along three implant walls for all implants on both the iliac and sacral segments. Evidence of osseous bridging across the SI joint was clearly seen on 13 of 15 (87%) of patients (Fig. 3). On x-ray, what appeared to be full-length lucency (absence of bone adjacent to an implant) along the wall of the implant was consistently observed on at least one implant in all patients on AP view. However, this observation was not evident on the outlet view. Upon review of CT imaging, this apparent lucency was confirmed to be an artifact (Fig. 4). Assessment and comparison of CT scans at 1- and 5-years revealed a consistent pattern of artifacts at the corners and periodically along the wall of an implant, which were non-progressive and unchanged in equivalent projections on the axial, sagittal and coronal sections. A small area of true focal lucency was observed on CT scans in 4 patients; along the superior edge of the most cranial implant on the iliac side in 3 patients, and on the superior edge of the most caudal implant on the iliac side in one patient (Fig. 5). Other findings included a regular pattern of sclerotic bone response at the implant entry point in the ilium, on primarily the superior implant (Fig. 6). A detailed explanation of the physics of CT imaging of triangular titanium implants is outside the scope of this manuscript and will be reported separately.

Bottom Line: Pain on VAS improved from 8.3 at baseline to 2.4 at 5 years; 88% of patients reached Substantial Clinical Benefit.Clinical improvements observed at 12 months postoperatively were maintained at 5 years.Patients who did not achieve large improvements were affected by multiple severe concomitant degenerative conditions of the lumbar spine, pelvis, and/or hip.

View Article: PubMed Central - PubMed

Affiliation: Alice Peck Day Memorial Hospital, 17 Alice Peck Day Drive, Suite C, Lebanon, NH 03766, USA.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus