Definitive diagnosis of sacroiliac joint dysfunction and indications of minimally invasive sacroiliac joint fixation in the history of surgical treatments

Abstract

Sacroiliac joint (SIJ) dysfunction has been recognized as one of the major causes of low back and buttock pain. Conservative treatments are effective in most patients with SIJ pain due to dysfunction. However, some intractable cases require surgical treatment. Currently, various types of SIJ arthrodesis with minimally-invasive techniques are performed for numerous patients in the USA and Europe, and many surgeons have realized that dealing with SIJ problems could become part of their responsibilities. The most important factor that determines the postoperative outcome is the definitive diagnosis of SIJ dysfunction. According to the diagnostic algorithm of the Japanese Sacroiliac Joint Research Association, the diagnosis of SIJ pain is confirmed when there is more than 70% pain relief after a diagnostic SIJ injection. For minimally-invasive sacroiliac joint fixation, the iFUSE Implant System^® (SI-BONE, Inc., San Jose, CA, USA) is most commonly used in the USA and Europe, and it has been reported to have good results. In a pilot study conducted in Japan, the implant system was found to be superior in terms of simplicity and the minimal invasiveness of the surgical procedure. However, there is a risk of pelvic vascular/nerve injury due to the lateral approach, and long-term results may be unstable in elderly women due to loosening of the implant on the sacral side. Minimally-invasive revision surgery using the same lateral approach is difficult when the implant loosens, so surgery should be performed only for carefully selected cases.