Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0012
A. Antony
This chapter reviews preoperative factors to be considered before performing peripheral nerve stimulation of the sacroiliac joint. When designing a preoperative plan, it is important to consider the type of anesthesia to be administered, anticoagulation management, infection risk, and other relevant medical comorbidities that may complicate the procedure. These factors vary depending on the patient, and in many cases coordination with other specialists is required. Optimization of patient comorbidities, appropriate management of anticoagulation, and planning strategies to minimize infection risk (including the use of perioperative antibiotics) are paramount to ensure the best possible outcomes for the patient undergoing this procedure.
{"title":"Preoperative considerations for peripheral nerve stimulation of the sacroiliac joint","authors":"A. Antony","doi":"10.1093/med/9780197607947.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0012","url":null,"abstract":"This chapter reviews preoperative factors to be considered before performing peripheral nerve stimulation of the sacroiliac joint. When designing a preoperative plan, it is important to consider the type of anesthesia to be administered, anticoagulation management, infection risk, and other relevant medical comorbidities that may complicate the procedure. These factors vary depending on the patient, and in many cases coordination with other specialists is required. Optimization of patient comorbidities, appropriate management of anticoagulation, and planning strategies to minimize infection risk (including the use of perioperative antibiotics) are paramount to ensure the best possible outcomes for the patient undergoing this procedure.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116946862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0020
Cory Ullger, Mogana V. Jayakumar, N. Jassal
Sacroiliac joint pain and dysfunction has increasingly been identified as an important pain generator in patients with chronic back pain or failed back surgery syndrome. It is estimated up to 30% of patients presenting with low back pain will have contributions from a painful sacroiliac joint. Historically, fusion of the joint has been performed with an open posterior or posterolateral approach. Minimally invasive surgical (MIS) approaches were introduced in 2008, and since that time MIS posterior and lateral approaches have become common. Numerous medical device companies have marketed MIS systems, and evidence of safety and efficacy is mounting. This chapter will detail the posterior approaches using fluoroscopic and navigation system guidance. Evidence for safety and efficacy of posterior sacroiliac joint fusion approaches will also be discussed.
{"title":"Posterior fusion","authors":"Cory Ullger, Mogana V. Jayakumar, N. Jassal","doi":"10.1093/med/9780197607947.003.0020","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0020","url":null,"abstract":"Sacroiliac joint pain and dysfunction has increasingly been identified as an important pain generator in patients with chronic back pain or failed back surgery syndrome. It is estimated up to 30% of patients presenting with low back pain will have contributions from a painful sacroiliac joint. Historically, fusion of the joint has been performed with an open posterior or posterolateral approach. Minimally invasive surgical (MIS) approaches were introduced in 2008, and since that time MIS posterior and lateral approaches have become common. Numerous medical device companies have marketed MIS systems, and evidence of safety and efficacy is mounting. This chapter will detail the posterior approaches using fluoroscopic and navigation system guidance. Evidence for safety and efficacy of posterior sacroiliac joint fusion approaches will also be discussed.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"131 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115617596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0021
Usman Latif, Tyler A. Concannon, Andrew G. C. Frazier
This chapter discusses postoperative recommendations, including ambulation, wound care, antibiotic guidelines, and follow-up interval, for patients who have undergone open surgical SIJ fusion versus minimally invasive (MIS) SIJ fusion. Postoperative care varies widely based on the surgical approach. In particular, patients undergoing MIS are less likely to be admitted, ambulate sooner, have a shorter period of less stringent restrictions, and have faster wound healing with fewer complications. These benefits are due to a variety of factors including shorter incision length, less tissue disruption, decreased operating time, and less blood loss. This benefit is most pronounced with approaches that do not involve the use of hardware. Patients undergoing open surgery typically progress through a 4- to 5-month phased plan of progressive physical therapy. In contrast, patients undergoing MIS, particularly percutaneous SIJ fusion with bone allograft, are able to ambulate immediately and have a short period of mild restrictions followed by return to normal activity. The advent of new surgical techniques and less invasive solutions for SIJ fusion is leading the way to an easier postoperative recovery period for patients.
{"title":"Postoperative care","authors":"Usman Latif, Tyler A. Concannon, Andrew G. C. Frazier","doi":"10.1093/med/9780197607947.003.0021","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0021","url":null,"abstract":"This chapter discusses postoperative recommendations, including ambulation, wound care, antibiotic guidelines, and follow-up interval, for patients who have undergone open surgical SIJ fusion versus minimally invasive (MIS) SIJ fusion. Postoperative care varies widely based on the surgical approach. In particular, patients undergoing MIS are less likely to be admitted, ambulate sooner, have a shorter period of less stringent restrictions, and have faster wound healing with fewer complications. These benefits are due to a variety of factors including shorter incision length, less tissue disruption, decreased operating time, and less blood loss. This benefit is most pronounced with approaches that do not involve the use of hardware. Patients undergoing open surgery typically progress through a 4- to 5-month phased plan of progressive physical therapy. In contrast, patients undergoing MIS, particularly percutaneous SIJ fusion with bone allograft, are able to ambulate immediately and have a short period of mild restrictions followed by return to normal activity. The advent of new surgical techniques and less invasive solutions for SIJ fusion is leading the way to an easier postoperative recovery period for patients.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129762465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0004
Lisa R. Kroopf, Kemly Philip, M. Dang, Samara Shipon
There is a relatively high incidence of sacroiliac joint (SIJ) pain and dysfunction among patients undergoing evaluation for low back pain. Low back pain is a leading cause of disability globally. SIJ dysfunction can affect people of varying age ranges, with a higher distribution in several clusters, including pregnant women and adults who have undergone lumbar or lumbosacral fusion surgery. SIJ pain or dysfunction is estimated to account for 15% to 30% of all cases of axial low back pain and is an often underrecognized and undertreated cause of chronic low back pain. This chapter will provide information on the physiologic, psychologic, and physical effects of SIJ pain and how those factors impact the personal, societal, and global burden of disability from SIJ pain. Tools for the evaluation of disability are briefly discussed.
{"title":"Disability associated with sacroiliac joint diseases","authors":"Lisa R. Kroopf, Kemly Philip, M. Dang, Samara Shipon","doi":"10.1093/med/9780197607947.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0004","url":null,"abstract":"There is a relatively high incidence of sacroiliac joint (SIJ) pain and dysfunction among patients undergoing evaluation for low back pain. Low back pain is a leading cause of disability globally. SIJ dysfunction can affect people of varying age ranges, with a higher distribution in several clusters, including pregnant women and adults who have undergone lumbar or lumbosacral fusion surgery. SIJ pain or dysfunction is estimated to account for 15% to 30% of all cases of axial low back pain and is an often underrecognized and undertreated cause of chronic low back pain. This chapter will provide information on the physiologic, psychologic, and physical effects of SIJ pain and how those factors impact the personal, societal, and global burden of disability from SIJ pain. Tools for the evaluation of disability are briefly discussed.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121461750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0018
Kenneth Fiala, J. Martens, A. Abd-Elsayed
Sacroiliac joint fusion surgery is an option for patients whose sacroiliac joint pain has been refractory to conservative pain management. A good candidate for fusion surgery is one who has completed all appropriate nonsurgical management efforts, including physical therapy, intraarticular sacroiliac steroid injections, oral analgesics, and radiofrequency ablation of sacral nerve roots, without experiencing any improvement in pain. This chapter covers candidate selection, the two main surgical approaches used for this fusion surgery (open and minimally invasive), anticoagulation guidelines, and the risk of infection and complications. Before surgery it is very important to make sure the patient understands the risks of the surgery as well as the potential for success.
{"title":"Preoperative considerations","authors":"Kenneth Fiala, J. Martens, A. Abd-Elsayed","doi":"10.1093/med/9780197607947.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0018","url":null,"abstract":"Sacroiliac joint fusion surgery is an option for patients whose sacroiliac joint pain has been refractory to conservative pain management. A good candidate for fusion surgery is one who has completed all appropriate nonsurgical management efforts, including physical therapy, intraarticular sacroiliac steroid injections, oral analgesics, and radiofrequency ablation of sacral nerve roots, without experiencing any improvement in pain. This chapter covers candidate selection, the two main surgical approaches used for this fusion surgery (open and minimally invasive), anticoagulation guidelines, and the risk of infection and complications. Before surgery it is very important to make sure the patient understands the risks of the surgery as well as the potential for success.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121557707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0014
Hunter Hoopes, Mayank Gupta
This chapter focuses on the most commonly used questionnaires and pain assessment scales that are used both clinically and in the research setting, and it compares and contrasts their validity and accuracy. Reliable outcome measures are essential to translate the complex perception of pain into measurable data. Several questionnaires and grading scales have been developed, each with their own inherent advantages and disadvantages. In addition to quantitative measures of pain, this chapter explores what other qualitative measures are useful to understand a patient’s perception of pain, their functional ability, and even potential adverse outcomes. Finally, this chapter demonstrates how some of these measures have already been used in the literature specifically in the context of peripheral nerve stimulation of the sacroiliac joint.
{"title":"Outcome measures and outcomes of peripheral nerve stimulation of the sacroiliac joint","authors":"Hunter Hoopes, Mayank Gupta","doi":"10.1093/med/9780197607947.003.0014","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0014","url":null,"abstract":"This chapter focuses on the most commonly used questionnaires and pain assessment scales that are used both clinically and in the research setting, and it compares and contrasts their validity and accuracy. Reliable outcome measures are essential to translate the complex perception of pain into measurable data. Several questionnaires and grading scales have been developed, each with their own inherent advantages and disadvantages. In addition to quantitative measures of pain, this chapter explores what other qualitative measures are useful to understand a patient’s perception of pain, their functional ability, and even potential adverse outcomes. Finally, this chapter demonstrates how some of these measures have already been used in the literature specifically in the context of peripheral nerve stimulation of the sacroiliac joint.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"497 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133401045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0003
Nicholas Canzanello, Jonathan M. Hagedorn
The diagnosis of sacroiliac joint dysfunction is often difficult and requires a thoughtful and thorough workup to uncover. A proper diagnosis is required so that appropriate treatment can be provided for the chronic pain patients suffering from sacroiliac joint dysfunction. This chapter discusses the symptoms of sacroiliac joint dysfunction (including inciting factors, location, and inflammatory etiologies), the components of a physical examination (including detailed explanations of several physical examination maneuvers, as well as their reliability), the utility of diagnostic injections, the imaging techniques that are useful in this setting (radiography, ultrasound, computed tomography, magnetic resonance imaging), and laboratory evaluation that might be required in this setting (bloodwork).
{"title":"Diagnostic evaluation of sacroiliac disease","authors":"Nicholas Canzanello, Jonathan M. Hagedorn","doi":"10.1093/med/9780197607947.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0003","url":null,"abstract":"The diagnosis of sacroiliac joint dysfunction is often difficult and requires a thoughtful and thorough workup to uncover. A proper diagnosis is required so that appropriate treatment can be provided for the chronic pain patients suffering from sacroiliac joint dysfunction. This chapter discusses the symptoms of sacroiliac joint dysfunction (including inciting factors, location, and inflammatory etiologies), the components of a physical examination (including detailed explanations of several physical examination maneuvers, as well as their reliability), the utility of diagnostic injections, the imaging techniques that are useful in this setting (radiography, ultrasound, computed tomography, magnetic resonance imaging), and laboratory evaluation that might be required in this setting (bloodwork).","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122141669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0019
G. Acker, Jonathon Belding, Chong H. Kim
Sacroiliac joint pain and dysfunction has increasingly been identified as an important pain generator in patients with chronic back pain or failed back surgery syndrome, and it is estimated to account for 15% to 30% of low back pain cases. Historically, fusion of the joint has been performed with an open posterior or posterolateral approach. Minimally invasive surgical (MIS) approaches were introduced in 2008, and since that time MIS posterior and lateral approaches have become common. Numerous medical device companies have marketed MIS systems, and evidence of their safety and efficacy is mounting. This chapter will detail lateral MIS approaches using fluoroscopic and navigation system guidance, as well as the posterolateral open approach, also known as the modified Smith-Petersen approach. Evidence for safety and efficacy of lateral sacroiliac joint fusion will also be discussed.
{"title":"Lateral fusion","authors":"G. Acker, Jonathon Belding, Chong H. Kim","doi":"10.1093/med/9780197607947.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0019","url":null,"abstract":"Sacroiliac joint pain and dysfunction has increasingly been identified as an important pain generator in patients with chronic back pain or failed back surgery syndrome, and it is estimated to account for 15% to 30% of low back pain cases. Historically, fusion of the joint has been performed with an open posterior or posterolateral approach. Minimally invasive surgical (MIS) approaches were introduced in 2008, and since that time MIS posterior and lateral approaches have become common. Numerous medical device companies have marketed MIS systems, and evidence of their safety and efficacy is mounting. This chapter will detail lateral MIS approaches using fluoroscopic and navigation system guidance, as well as the posterolateral open approach, also known as the modified Smith-Petersen approach. Evidence for safety and efficacy of lateral sacroiliac joint fusion will also be discussed.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"275 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115819809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0013
Kris Ferguson, A. Abd-Elsayed
This chapter will detail the surgical recommendations and step-by-step approaches for both trial stimulation and permanent implantation of peripheral nerve stimulation to treat sacroiliac joint pain. It also provides a brief history of this procedure, which has evolved from being a procedure that required careful, open dissection of the target nerve to a sleek treatment requiring only image guidance and a minimally invasive percutaneous approach. A trial stimulation period typically ranges from 7 to 14 days; steps for the trial simulation procedure include preparation, target point identification, and lead insertion. Additional topics for the permanent implantation procedure include tunneling and pocket dissection.
{"title":"Peripheral nerve stimulation trial and implantation","authors":"Kris Ferguson, A. Abd-Elsayed","doi":"10.1093/med/9780197607947.003.0013","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0013","url":null,"abstract":"This chapter will detail the surgical recommendations and step-by-step approaches for both trial stimulation and permanent implantation of peripheral nerve stimulation to treat sacroiliac joint pain. It also provides a brief history of this procedure, which has evolved from being a procedure that required careful, open dissection of the target nerve to a sleek treatment requiring only image guidance and a minimally invasive percutaneous approach. A trial stimulation period typically ranges from 7 to 14 days; steps for the trial simulation procedure include preparation, target point identification, and lead insertion. Additional topics for the permanent implantation procedure include tunneling and pocket dissection.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131168294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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