Sacroiliac Joint Pain Robert Limoni MD Orthopedic Surgery and Sports Medicine Baycare Clinic 1 Myth 1 The Si Joint Doesnt Cause Pain 2 Prevalence of SI Joint Pain 1530 Component of chronic LBP ID: 751942
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Surgical Treatment Options for Sacroiliac Joint Pain Robert Limoni MDOrthopedic Surgery and Sports Medicine Baycare Clinic
1Slide2
Myth #1The Si Joint Doesn’t Cause Pain2Slide3
Prevalence of SI Joint Pain15-30%Component of chronic LBP32-43%Symptomatic Post-Lumbar Fusion32% Katz 200335% Maigne 200543% DePalma 201140% Liliang 2011DePalma – Pain Med 2011
Is the SI Joint truly a problem?
3Slide4
Myth #2 The SI joint Doesn’t Move4Slide5
SI Joint MotionMulti-planar motion Simultaneously rotate and translate through 3 axes of motionMotions (<4° in any plane)Nutation / CounternutationPrimary motionMales: 1 - 2°Females: 2 - 4°Sacral Translation (A-P motion) up to 1.6mmSturesson 19895Slide6
mechanicsstandingsitting6Slide7
Myth #3If the xray is normal, the joint is not abnormal7Slide8
Mechanism of osteoarthritishipknee8This Photo by Unknown Author is licensed under
CC BY-NC
This Photo
by Unknown Author is licensed under
CC BY-SASlide9
Mechanisms of degenerationDegeneration in the footThe Butt Bunion9This Photo by Unknown Author is licensed under CC BY-NC-SASlide10
Myth #4Patients with SI problems are crazy!10Slide11
iFuse Implant System® Publications1154October 2017RCT (INSITE, iMIA)…...…………………. 8
I
Prospective, Multicenter
…………………...
6
II/IIb
Comparison
…………….….
5
III
Retrospective Case Series
….……….
17
IV
Systematic Review, Meta-analysis
………….
3
Reviews
Cost-effectiveness, Productivity, etc.
……….
5
Economics
Complications, Survivorship, etc.
…...
7
Other
Stability, Implant Placement, etc.
…
3
BiomechanicsSlide12
12Complete References in BibliographySlide13
13Complete References in BibliographySlide14
14Complete References in BibliographySlide15
Myth # 5Fusion of a joint requires denuding all cartilage and penetration of the subchondral plate15Slide16
Unique Patented DesignTriangular shape (minimizes rotation) Interference press fit (immediate stabilization)Porous titanium surface (promotes bony ongrowth/ingrowth for long-term fusion)* Strength of Experience29,000+ procedures worldwide (November 2017)Clinical EvidenceiFuse Implant™, available since 2009,is the ONLY device for treatment of SI joint dysfunction supported by multiple prospective clinical studies including 2 RCTsMore than 50 peer-reviewed publications16
iFuse Implant System
®
* MacBarb G, et al. Int J Spine Surg. 2017:11;116-28.Slide17
iFuse-3D™Same proven triangular shape1st 3D-printed implant for the SI jointDemonstrates Substantial Bone Ongrowth, Ingrowth, and Through Growth1Porous surface mimics cancellous boneSelf-harvesting technologyAbility to apply graft material17
MacBarb G, et al.
Int J Spine Surg
. 2017:11;116-28.Slide18
MIS SI Joint Fusion TechnologiesExamples of existing and/or developing technologies.iFuse Implant is the ONLY SI joint fusion technology supported by multiple prospective clinical publications, including2 Randomized Controlled Trials. (May 2017)
SI-BONE:
iFuse Implant System
®
Globus:
SI-LOK Joint Fixation System
Medtronic:
Rialto Sacroiliac Joint Fusion System
VG Innovations:
SiJoin Posterior Sacroiliac Joint Fusion System
X-spine Systems:
Silex Sacroiliac Joint Fusion System
Zyga Technology:
SImmetry Sacroiliac Joint Fusion System
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Myth #6Si Fusions are for Neurosurgeons19Slide20
IncisionPin
Soft Tissue Protector
Measure
Drill
(
optional with
sharp-tip broach)
Broach
Insert Implant
Repeat
iFuse Procedure Overview
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History and Exam of the SI Joint21Slide22
Exacerbating ActivitiesUnilateral Weight BearingPutting on Socks/ShoesAscending/Descending StairsGetting in and out of CarProlonged Walking(85% of gait cycle is single leg stance) Janda 1983 Sexual Intercourse
Pain with Transitional Motions
Supine to painful side
Sit to stand
Rolling over in bed
Getting in /out of bed
Pain while Stationary
Sitting on affected side
Prolonged standing/sitting
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Active provocative tests23This Photo by Unknown Author is licensed under CC BY-SAThis Photo by Unknown Author is licensed under
CC BY-SASlide24
SI Joint: Physical ExamActive Straight Leg RaiseTo assess functional pelvic stabilitySensitivity: 87%Specificity: 94%Mens 2001
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DistractionThigh Thrust
Compression
FABER
Gaenslen’s
3 of 5 positive tests
provides discriminative power
for diagnosing SI joint pain
Szadek –
J Pain
2009
Laslett –
J Man Manip Ther
2008
SI Joint Provocative Tests passive
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SI Joint: Provocative TestsThe following five provocative tests, when performed in combination are proven to have a high degree of sensitivity and specificity:Distraction
*
(Highest PPV**)
Thigh Thrust
*
FABER
Compression
*
Gaenslen’s Maneuver
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Laslett
Szadek
3 or more positive
tests
Sensitivity
91%
85%
Specificity
78%
76%
Laslett 2005, 2008
Szadek 2009
* Most sensitive tests
** PPV
= positive predictive value
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Point to pain while standing Able to localize pain with one fingerWithin 1 cm of PSIS (inferomedial)Consistent over at least 2 trialsAsk patient to point to location of primary painBelow L5: Consider SI jointAbove L5: Consider lumbar spine etiologies
SI Joint: Physical Exam
Fortin Finger Test
Fortin & Falco 1997
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Thank you!28