Pub Date : 2021-09-01DOI: 10.1093/med/9780197607947.003.0022
H. Kalia
This chapter reviews the complications that can occur after minimally invasive surgical fusion of the sacroiliac joint, focusing on infection and neurovascular injuries and their prevention and treatment. The sacroiliac joint has been identified as a potential pain generator in 15% to 30% of chronic low back pain and post-laminectomy syndrome patients. Minimally invasive sacroiliac joint fusion via the lateral approach is effective and better tolerated than the open surgical approach. Most of the current studies have focused on efficacy and patient satisfaction as opposed to the safety profile of the procedure. There is a dearth of literature regarding the safety of minimally invasive sacroiliac joint fusion. Over the past few years, a novel posterior approach to sacroiliac joint fusion has become more common that theoretically is safer and potentially as efficacious as the lateral approach.
{"title":"Complications and their management","authors":"H. Kalia","doi":"10.1093/med/9780197607947.003.0022","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0022","url":null,"abstract":"This chapter reviews the complications that can occur after minimally invasive surgical fusion of the sacroiliac joint, focusing on infection and neurovascular injuries and their prevention and treatment. The sacroiliac joint has been identified as a potential pain generator in 15% to 30% of chronic low back pain and post-laminectomy syndrome patients. Minimally invasive sacroiliac joint fusion via the lateral approach is effective and better tolerated than the open surgical approach. Most of the current studies have focused on efficacy and patient satisfaction as opposed to the safety profile of the procedure. There is a dearth of literature regarding the safety of minimally invasive sacroiliac joint fusion. Over the past few years, a novel posterior approach to sacroiliac joint fusion has become more common that theoretically is safer and potentially as efficacious as the lateral approach.","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":"129241063","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/9780197607947.003.0010
Jacqueline Weisbein
Injections into the sacroiliac joint for both diagnostic and therapeutic purposes have become commonplace. There have been advances in the use of regenerative therapies other than prolotherapy, such as platelet-rich plasma and stem cells. Prior to the introduction of image-guided techniques, blind injections were performed. However, data have consistently shown that without image guidance, injections failed to be accurately placed within the joint. Therefore, the use of image guidance, whether by computed tomography, fluoroscopy, or ultrasound, is imperative to ensure accurate placement of the injectate. This chapter discusses these three types of imaging techniques for sacroiliac joint injections.
{"title":"Imaging techniques for sacroiliac joint injections","authors":"Jacqueline Weisbein","doi":"10.1093/med/9780197607947.003.0010","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0010","url":null,"abstract":"Injections into the sacroiliac joint for both diagnostic and therapeutic purposes have become commonplace. There have been advances in the use of regenerative therapies other than prolotherapy, such as platelet-rich plasma and stem cells. Prior to the introduction of image-guided techniques, blind injections were performed. However, data have consistently shown that without image guidance, injections failed to be accurately placed within the joint. Therefore, the use of image guidance, whether by computed tomography, fluoroscopy, or ultrasound, is imperative to ensure accurate placement of the injectate. This chapter discusses these three types of imaging techniques for sacroiliac joint injections.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"49 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":"134144961","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/9780197607947.003.0009
N. Strand, J. Maloney, Christine L. Hunt
The sacroiliac joint is a common cause of low back pain, and techniques to reduce pain and improve function are of utmost interest to the pain medicine practitioner. As regenerative medicine continues to expand, a thorough understanding of the types of therapies that make up the regenerative medicine toolkit is imperative. This chapter reviews prolotherapy and injections of mesenchymal stem cells, platelet-rich plasma, autologous whole blood, and hyaluronic acid for the treatment of sacroiliac joint–mediated pain. Information on background, mechanisms of action, pharmacology, safety and efficacy, possible side effects, and preparation and administration is provided for each of these regenerative injectants, along with a brief review of clinical trials and published data.
{"title":"Regenerative medicine therapies for sacroiliac joint disease","authors":"N. Strand, J. Maloney, Christine L. Hunt","doi":"10.1093/med/9780197607947.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0009","url":null,"abstract":"The sacroiliac joint is a common cause of low back pain, and techniques to reduce pain and improve function are of utmost interest to the pain medicine practitioner. As regenerative medicine continues to expand, a thorough understanding of the types of therapies that make up the regenerative medicine toolkit is imperative. This chapter reviews prolotherapy and injections of mesenchymal stem cells, platelet-rich plasma, autologous whole blood, and hyaluronic acid for the treatment of sacroiliac joint–mediated pain. Information on background, mechanisms of action, pharmacology, safety and efficacy, possible side effects, and preparation and administration is provided for each of these regenerative injectants, along with a brief review of clinical trials and published data.","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":"129739664","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/9780197607947.003.0016
Sarafina Kankam, G. Smith, Johnathan H Goree
Sacroiliac joint fusion has become a mainstay of the treatment of low back pain for both surgeons and interventionalists. This chapter discusses proper patient selection for both open and minimally invasive sacroiliac joint fusion techniques. Topics covered are indications and contraindications for surgery as well as imaging modalities that the provider can use to ascertain the integrity of the sacroiliac joint when fusion is being considered. It is important to assess each patient’s psychiatric history and current psychiatric symptoms, weigh the benefits and the risks of the procedure, and then use clinical judgment before proceeding with surgery. A brief overview of the two most common surgical approaches (lateral and posterior), along with survivorship data, is provided. Other patient considerations include bone density, previous lumbar spine surgery, smoking history, and comorbidities such as diabetes mellitus.
{"title":"Patient selection","authors":"Sarafina Kankam, G. Smith, Johnathan H Goree","doi":"10.1093/med/9780197607947.003.0016","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0016","url":null,"abstract":"Sacroiliac joint fusion has become a mainstay of the treatment of low back pain for both surgeons and interventionalists. This chapter discusses proper patient selection for both open and minimally invasive sacroiliac joint fusion techniques. Topics covered are indications and contraindications for surgery as well as imaging modalities that the provider can use to ascertain the integrity of the sacroiliac joint when fusion is being considered. It is important to assess each patient’s psychiatric history and current psychiatric symptoms, weigh the benefits and the risks of the procedure, and then use clinical judgment before proceeding with surgery. A brief overview of the two most common surgical approaches (lateral and posterior), along with survivorship data, is provided. Other patient considerations include bone density, previous lumbar spine surgery, smoking history, and comorbidities such as diabetes mellitus.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"37 2 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":"115642956","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/9780197607947.003.0005
B. Habibi, Mark N Malinowski, Chong H. Kim
There are a variety of anesthetic techniques commonly used for sacroiliac joint (SIJ) procedures. For example, diagnostic SIJ injections do not necessitate anesthesia, while open SIJ fusions require general anesthesia. This chapter, targeted to practitioners performing SIJ procedures, covers the basic elements of these techniques. After a brief discussion of the history of anesthesia in relation to SIJ procedures, each common anesthetic technique is discussed, in order of increasing sedation. Local anesthesia is discussed for intraarticular joint injections, blocks of the nerves innervating the SIJ, and radiofrequency ablations of these same nerves. Monitored anesthesia care is discussed for procedures such as minimally invasive SIJ fusions and the Simplicity radiofrequency ablation technique. The use of neuraxial anesthesia, via either spinal or epidural blocks, is considered for lateral SIJ fusions. Finally, the use of general anesthesia for lateral and open fusions is reviewed.
{"title":"Types of anesthesia for different sacroiliac joint interventions","authors":"B. Habibi, Mark N Malinowski, Chong H. Kim","doi":"10.1093/med/9780197607947.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0005","url":null,"abstract":"There are a variety of anesthetic techniques commonly used for sacroiliac joint (SIJ) procedures. For example, diagnostic SIJ injections do not necessitate anesthesia, while open SIJ fusions require general anesthesia. This chapter, targeted to practitioners performing SIJ procedures, covers the basic elements of these techniques. After a brief discussion of the history of anesthesia in relation to SIJ procedures, each common anesthetic technique is discussed, in order of increasing sedation. Local anesthesia is discussed for intraarticular joint injections, blocks of the nerves innervating the SIJ, and radiofrequency ablations of these same nerves. Monitored anesthesia care is discussed for procedures such as minimally invasive SIJ fusions and the Simplicity radiofrequency ablation technique. The use of neuraxial anesthesia, via either spinal or epidural blocks, is considered for lateral SIJ fusions. Finally, the use of general anesthesia for lateral and open fusions is reviewed.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"159 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":"116237249","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/9780197607947.003.0007
Ben K Homra, Y. Eshraghi, M. Guirguis
The posterior sacral network is a complex meshwork of lateral branches of the dorsal sacral rami that innervate the posterior aspect of the sacroiliac joint. Pain arising from this joint can be diagnostically targeted using either a fluoroscopic or ultrasound technique to determine if the patient would benefit from radiofrequency ablation of the lateral branches. Injecting local anesthetic near the dorsal foramina using these techniques will temporarily block the transmission of pain by the lateral branches from the sacroiliac joint. This chapter covers the anatomy of the posterior sacral network, discusses the details of the two techniques for lateral branch blocks and evidence for their utility, provides information about the risks and contraindications associated with the techniques, and concludes by discussing the implications of the procedure.
{"title":"Lateral branch blocks","authors":"Ben K Homra, Y. Eshraghi, M. Guirguis","doi":"10.1093/med/9780197607947.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0007","url":null,"abstract":"The posterior sacral network is a complex meshwork of lateral branches of the dorsal sacral rami that innervate the posterior aspect of the sacroiliac joint. Pain arising from this joint can be diagnostically targeted using either a fluoroscopic or ultrasound technique to determine if the patient would benefit from radiofrequency ablation of the lateral branches. Injecting local anesthetic near the dorsal foramina using these techniques will temporarily block the transmission of pain by the lateral branches from the sacroiliac joint. This chapter covers the anatomy of the posterior sacral network, discusses the details of the two techniques for lateral branch blocks and evidence for their utility, provides information about the risks and contraindications associated with the techniques, and concludes by discussing the implications of the procedure.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"36 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":"116020085","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/9780197607947.003.0011
Jessica B Jameson
Sacroiliac joint pain is a very common cause of low back pain. Treatments such as physical therapy, medications, transcutaneous electrical nerve stimulation, and nerve blocks or injections can often improve symptoms. However, when these techniques are unsuccessful, consideration should be given to peripheral nerve stimulation as a long-term solution for chronic sacroiliac joint pain. Case reports over the previous decade have indicated that peripheral nerve stimulation can be useful in treating sacroiliac joint pain. This chapter provides an overview of this technique. The topics include the patient selection process (including the importance of obtaining a psychological evaluation), contraindications, and instruments used during the procedure.
{"title":"Patient selection and instruments used for peripheral nerve stimulation of the sacroiliac joint","authors":"Jessica B Jameson","doi":"10.1093/med/9780197607947.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0011","url":null,"abstract":"Sacroiliac joint pain is a very common cause of low back pain. Treatments such as physical therapy, medications, transcutaneous electrical nerve stimulation, and nerve blocks or injections can often improve symptoms. However, when these techniques are unsuccessful, consideration should be given to peripheral nerve stimulation as a long-term solution for chronic sacroiliac joint pain. Case reports over the previous decade have indicated that peripheral nerve stimulation can be useful in treating sacroiliac joint pain. This chapter provides an overview of this technique. The topics include the patient selection process (including the importance of obtaining a psychological evaluation), contraindications, and instruments used during the procedure.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"35 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":"125943665","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/9780197607947.003.0015
Meghan Hughes, A. Abd-Elsayed
This chapter will look at complications of peripheral nerve stimulation (PNS) by stratifying them into three distinct categories: hardware-related complications (lead migration or fracture, connection issues, and premature battery depletion), biologic complications (infection), and programming or therapy-related complications. Today, the complications related to current PNS procedures are rare and minor. Hospital admission is exceedingly unlikely. Every new device on the market is working not only to improve performance but also to mitigate risks such as lead migration and infection. Also included in this chapter is background information about how the procedure and the hardware have evolved over the years, leading to improved performance and fewer complications.
{"title":"Complications of peripheral nerve stimulation for sacroiliac pain","authors":"Meghan Hughes, A. Abd-Elsayed","doi":"10.1093/med/9780197607947.003.0015","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0015","url":null,"abstract":"This chapter will look at complications of peripheral nerve stimulation (PNS) by stratifying them into three distinct categories: hardware-related complications (lead migration or fracture, connection issues, and premature battery depletion), biologic complications (infection), and programming or therapy-related complications. Today, the complications related to current PNS procedures are rare and minor. Hospital admission is exceedingly unlikely. Every new device on the market is working not only to improve performance but also to mitigate risks such as lead migration and infection. Also included in this chapter is background information about how the procedure and the hardware have evolved over the years, leading to improved performance and fewer complications.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"34 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":"124012859","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/9780197607947.003.0001
Mark N Malinowski, A. Swain, Chong H. Kim
The sacroiliac joint, a multiplanar joint located in the dorsal complex of the pelvis, is one of the most important joints in the human to ensure upright and bipedal stability. The joint has been the subject of study for many years, but due to the presence of anatomic variability, challenges remain when analyzing its biomechanics in both normal and pathologic states. The joint is well vascularized and heavily innervated, making it a clinically significant structure with respect to primary, autoimmune, and traumatic disease processes. The chapter describes the gross anatomy of this joint as well as its embryologic origins, variability, and proposed movements as it relates to the joint’s potential for pathogenicity. This information will be useful to clinicians during diagnosis and radiographic evaluation of the patient with low back pain.
{"title":"Anatomy of the sacroiliac joint","authors":"Mark N Malinowski, A. Swain, Chong H. Kim","doi":"10.1093/med/9780197607947.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0001","url":null,"abstract":"The sacroiliac joint, a multiplanar joint located in the dorsal complex of the pelvis, is one of the most important joints in the human to ensure upright and bipedal stability. The joint has been the subject of study for many years, but due to the presence of anatomic variability, challenges remain when analyzing its biomechanics in both normal and pathologic states. The joint is well vascularized and heavily innervated, making it a clinically significant structure with respect to primary, autoimmune, and traumatic disease processes. The chapter describes the gross anatomy of this joint as well as its embryologic origins, variability, and proposed movements as it relates to the joint’s potential for pathogenicity. This information will be useful to clinicians during diagnosis and radiographic evaluation of the patient with low back pain.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"8 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":"122179359","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/9780197607947.003.0006
Luay Mrad, Akshat Gargya, Rany T. Abdallah
Intraarticular injection of the sacroiliac joint is a commonly performed procedure in interventional pain practice for the management of chronic low back pain due to sacroiliac joint inflammation or dysfunction. It can also be done as a diagnostic procedure to detect the source of low back pain. It is preferred to perform this procedure under image guidance using either fluoroscopy or ultrasound. Ultrasound-guided injection of the sacroiliac joint is preferred in pregnant patients to avoid exposure and risk of complications from radiation. Ultrasound is also beneficial in avoiding vascular injury; however, this imaging modality has less accuracy than fluoroscopy. This chapter describes the steps used to successfully perform two approaches, providing information about the necessary equipment, patient positioning, and anesthesia.
{"title":"Intraarticular injections (ultrasound-guided and fluoroscopic-guided approaches)","authors":"Luay Mrad, Akshat Gargya, Rany T. Abdallah","doi":"10.1093/med/9780197607947.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780197607947.003.0006","url":null,"abstract":"Intraarticular injection of the sacroiliac joint is a commonly performed procedure in interventional pain practice for the management of chronic low back pain due to sacroiliac joint inflammation or dysfunction. It can also be done as a diagnostic procedure to detect the source of low back pain. It is preferred to perform this procedure under image guidance using either fluoroscopy or ultrasound. Ultrasound-guided injection of the sacroiliac joint is preferred in pregnant patients to avoid exposure and risk of complications from radiation. Ultrasound is also beneficial in avoiding vascular injury; however, this imaging modality has less accuracy than fluoroscopy. This chapter describes the steps used to successfully perform two approaches, providing information about the necessary equipment, patient positioning, and anesthesia.","PeriodicalId":131285,"journal":{"name":"Sacroiliac Joint Pain","volume":"56 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":"130234375","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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