Dual fibular allograft dowel technique for sacroiliac joint arthrodesis

摘要

>Study design: Retrospective case series.>Objective: To assess fusion rates in patients with sacroiliac joint (SIJ) pain following a minimally invasive technique using fibular dowel allograft.>Methods: Thirty-seven consecutive patients (mean age: 42.5 years [range, 23–63 years]) with SIJ pain treated with 38 minimally invasive elective SIJ arthrodeses were retrospectively reviewed using chart and x-ray data. The fusion procedure consisted of minimal muscle stripping over the posterior SIJ and insertion of a cranial and caudal fibular dowel graft across the joint following placement of Steinmann pins. Fusion was deemed to be present when bone bridging trabeculae could be seen crossing the SIJ on either oblique x-rays or by computed tomographic scan. Patients were followed-up for a mean of 52 months (range, 24–62 months). Visual Analog Scale (VAS) was used to monitor clinical pain improvement.>Results: Thirty-four patients with SIJ arthrodeses (89.5%) healed and led to substantial improvement in VAS pain scores (preoperative 9.1, postoperative 3.4) (P < .001). This improvement in VAS occurred over a 6-month period and was sustained through subsequent follow-up. Nonunion occurred in four patients with SIJ (10.5%). Each SIJ nonunion was successfully treated by secondary autogenous bone grafting and compression screw fixation.>Conclusions: In patients with primary low back pain attributable to the SIJ, a minimally invasive, dual fibular dowel graft provided high rates of fusion and improved pain scores. rules="all" class="rendered small default_table">>Final class of evidence—treatmentYes> valign="top" align="left" rowspan="1" colspan="1">Study design valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> RCT valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Cohort valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Case control valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Case series valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1">Methods valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Concealed allocation (RCT) valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Intention to treat (RCT) valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Blinded/independent evaluation of primary outcome valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> F/U ≥85% valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Adequate sample size valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1">Control for confounding valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1">>Overall class of evidence valign="top" align="center" rowspan="1" colspan="1">>IV> valign="top" align="left" colspan="2" rowspan="1">The definiton of the different classes of evidence is available on page 63. class="head no_bottom_margin" id="__sec2title">Study Rationale and ContextAlthough early and/or mild sacroiliac joint (SIJ) disease may be treated nonoperatively, severe or unresponsive SIJ disease may require surgical intervention. Fibular allografts may obviate the need for a separate bone donor site and provide sufficient structural support so that additional internal fixation may not be needed. Minimal muscle stripping over the posterior SIJ may provide sufficient exposure of the posterior SIJ for reliable arthrodesis while reducing the morbidity that might occur from a more extensive exposure.