Clinical outcomes for minimally invasive sacroiliac joint fusion with allograft using a posterior approach.

IF 2.5 3区医学 Q2 ANESTHESIOLOGY Pain Practice Pub Date : 2024-08-23 DOI:10.1111/papr.13406

Robert Moghim, Chris Bovinet, Max Y Jin, Katie Edwards, Alaa Abd-Elsayed

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Abstract

Background: Sacroiliac joint (SIJ) dysfunction can occur as a result of injury, degeneration, or inflammation. This dysfunction presents symptoms of pain at various locations, including the low back, hips, buttocks, and legs. The diagnosis of SIJ dysfunction is challenging and cannot be achieved solely with imaging studies such as X-rays, MRI, or CT. The current gold standard diagnostic modality is intra-articular SIJ blocks using two differing local anesthetics. Current treatments for SIJ dysfunction may be beneficial for short-term relief but lack long-term efficacy. The purpose of our study was to examine the outcomes of patients who underwent minimally invasive, posterior SIJ fusion using allograft at a single center.

Methods: This was a retrospective study which received exemption from the WCG IRB. Data regarding preoperative and postoperative pain levels, surgical time, complications, and medication usage were obtained retrospectively from patient electronic medical records and prescription drug monitoring program reports. No mapping was completed prior to the procedure. Pain was assessed with the 11-point (0-10) Visual Analogue Scale (VAS) and medication usage was assessed using Morphine Milligram Equivalents (MME). Patients were included if they had been diagnosed with SIJ dysfunction using two intra-articular diagnostic blocks that resulted in at least an 80% decrease in pain and had failed conservative management. Patients with sacral insufficiency fractures were excluded.

Results: VAS scores reduced from 8.26 (SD = 1.09) at baseline to 2.59 (SD = 2.57), 2.55 (SD = 2.56), 2.71 (SD = 2.88), and 2.71 (SD = 2.88) at 3, 6, 9, and 12 months, respectively. MME reduced from 78.21 mg (SD = 51.33) to 58.95 mg (SD = 48.64), 57.61 mg (SD = 47.92), 61.71 mg (SD = 45.64), and 66.29 mg (SD = 51.65) at 3, 6, 9, and 12 months, respectively. All reductions in VAS scores and MME were statistically significant. No adverse events occurred, and the average operating room time was 40.16 min (SD = 6.27).

Conclusion: Minimally invasive, posterior SIJ fusion using allograft is a safe and efficacious method for managing SIJ dysfunction.

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后路微创骶髂关节同种异体移植融合术的临床疗效。

背景：骶髂关节（SIJ）功能障碍可因损伤、退化或炎症而发生。这种功能障碍会导致不同部位的疼痛症状，包括腰部、臀部、臀部和腿部。SIJ 功能障碍的诊断具有挑战性，不能仅通过 X 光、核磁共振成像或 CT 等影像学检查来实现。目前的金标准诊断方法是使用两种不同的局部麻醉剂进行关节内 SIJ 阻滞。目前治疗 SIJ 功能障碍的方法可能有利于短期缓解症状，但缺乏长期疗效。我们的研究旨在考察在一个中心使用同种异体移植进行微创、后路 SIJ 融合术的患者的疗效：这是一项回顾性研究，获得了 WCG IRB 的豁免。有关术前和术后疼痛程度、手术时间、并发症和药物使用情况的数据是从患者电子病历和处方药监控计划报告中回顾性获得的。术前未完成绘图。疼痛采用11点（0-10）视觉模拟量表（VAS）进行评估，用药量采用吗啡毫克当量（MME）进行评估。如果患者通过两次关节内诊断性阻滞确诊为 SIJ 功能障碍，疼痛至少减轻了 80%，且保守治疗无效，则将其纳入治疗范围。骶骨功能不全骨折患者除外：VAS评分从基线时的8.26（SD = 1.09）分别降至3、6、9和12个月时的2.59（SD = 2.57）、2.55（SD = 2.56）、2.71（SD = 2.88）和2.71（SD = 2.88）。在 3、6、9 和 12 个月时，MME 分别从 78.21 毫克（标清 = 51.33）降至 58.95 毫克（标清 = 48.64）、57.61 毫克（标清 = 47.92）、61.71 毫克（标清 = 45.64）和 66.29 毫克（标清 = 51.65）。VAS评分和MME的降低幅度均具有统计学意义。无不良事件发生，手术室平均用时 40.16 分钟（标准差 = 6.27）：结论：使用同种异体移植的微创后路 SIJ 融合术是治疗 SIJ 功能障碍的一种安全有效的方法。

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来源期刊

Pain Practice ANESTHESIOLOGY-CLINICAL NEUROLOGY

CiteScore

5.60

自引率

3.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Pain Practice, the official journal of the World Institute of Pain, publishes international multidisciplinary articles on pain and analgesia that provide its readership with up-to-date research, evaluation methods, and techniques for pain management. Special sections including the Consultant’s Corner, Images in Pain Practice, Case Studies from Mayo, Tutorials, and the Evidence-Based Medicine combine to give pain researchers, pain clinicians and pain fellows in training a systematic approach to continuing education in pain medicine. Prior to publication, all articles and reviews undergo peer review by at least two experts in the field.

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