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Minimally Invasive Sacroiliac Joint Fusion Provides Fast Recovery

Outpatient surgery improves quality of life

Sacroiliac Joint Fusion

A novel approach to sacroiliac joint fusion is available at Lehigh Valley Health Network (LVHN) for people with sacroiliitis or sacroiliac joint dysfunction. The outpatient procedure involves inserting a small bone allograft into the joint using minimally invasive instrumentation, providing people with long-lasting benefits, quicker recovery and fewer complications than traditional sacroiliac joint fusion.

“Since I joined LVHN in 2020, my goal for the network has been to bring the latest minimally invasive spinal techniques and procedures to patients,” says interventional pain medicine physician Nirmal Shah, DO, who performed the first procedures for LVHN at Lehigh Valley Hospital (LVH)–Cedar Crest, LVH– Hecktown Oaks and LVH–Muhlenberg. “Patients today prefer surgeries with no overnight stays, quick recoveries and no long-term restrictions.”

Conditions treated

“Sacroiliac joint dysfunction may be caused by age-related degeneration or may result from previous lumbar spinal fusion surgery, which places additional stress on the joint,” Dr. Shah says. “About 30 percent of low back pain originates from the sacroiliac joint.”

Dr. Shah says that advanced imaging and provocative testing during a physical examination are keys for pinpointing the sacroiliac joint as the source of low back pain. He recommends individuals try conservative measures first, such as aquatic therapy, physical therapy or chiropractic therapy, followed by topical agents or anti-inflammatory pain medications. Anti-inflammatory injections may provide relief for up to 90 days. If pain continues to persist for at least six months, fusion may be a good option.

A new approach

The new technique involves using minimally invasive instrumentation. The surgeon makes a small incision in the person’s back and inserts a single bone allograft the size of an almond directly into the sacroiliac joint. Individuals are under local anesthesia and deep sedation during the procedure. The allograft contains a bridging window filled with demineralized bone matrix to enable fusion.

In contrast, traditional sacroiliac joint fusion involves a lateral, open approach under general anesthesia to place the instruments for joint stabilization. The surgeon accesses the sacroiliac joint by moving muscles and ligaments to the side while avoiding major primary nerves and blood vessels.

Outpatient benefits

Outpatient sacroiliac fusion is ideal for people who do not respond to conservative measures or those who are not good candidates for general anesthesia – either due to comorbidities or their own preferences.

“Patients go home the same day with an exercise program that we increase after their post-op visit,” Dr. Shah says. “We typically clear patients to return to all activities about six weeks later.”

Joint fusion
Picture 1 – A dilator wedge instrument is placed into the sacroiliac joint. After applying a rasp and broaching the inner walls of the sacroiliac joint, the allograft implant (LinQ) is placed into the joint with the orthobiologics on lateral fluoroscopic view. There is a large graft window within the implant to allow bridging of the sacroiliac joint.
Picture 2 – An allograft implant (LinQ) is seeded into the left sacroiliac joint near the fulcrum or midpoint of the sacroiliac joint.
Picture 3 – An allograft implant (LinQ) is positioned into the right sacroiliac joint via a posterior approach to avoid major nerves and blood vessels

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