Posterior fusion

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.