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Significant pain relief, decrease in opioid use seen with SI joint fusion system
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Results from a recently published study demonstrated sacroiliac fusion using a new minimally invasive sacroiliac fusion system was safe and linked with significant improvements in patients with regard to pain, disability and opioid use at 6-month follow-up.
Researchers in the Evolusion study evaluated 50 patients who underwent minimally invasive sacroiliac (SI) joint fusion surgery using the SImmetry SI joint fusion system (Zyga Technology). Preoperatively and at 6 months postoperatively, patients were assessed with the VAS SI joint pain scale, Oswestry Disability Index (ODI) and quality of life score, and for opioid use.
Results at 6 months showed VAS pain score significantly reduced from baseline to 6 months from 76.2 to 35.1. There were 72% of patients who attained a minimally clinically important difference (MCID). Investigators noted the mean ODI at 6 months improved from 55.5 to 35.3, with a MCID achieved in 56% of patients. Before the surgery, 33 patients of the 50 patients took opioids. However, at 6 months, opioid use decreased by 55%.
There were few procedural complications, including revision for nerve impingement and revision for ongoing, low back pain. – by Monica Jaramillo
Disclosures: Araghi reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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David W. Polly Jr., MD
The authors have presented initial short-term results from a multicenter prospective cohort study of minimally invasive sacroiliac joint fusion using a trans-iliac sacral approach. This technique involves decortication and bone grafting.
This is the first prospective study that I am aware of with this device and technique. There is no information about patient selection criteria, which is a key component for success in SI fusion. Perhaps this is a limitation of the abstract length. It is also not reported if these patients were cases with isolated, unilateral sacroiliitis and whether they had prior spinal fusion surgery.
The short-term data seems to parallel that of the RCTs and prospective and retrospective cohort studies using porous-coated triangular titanium implants for which there is high-quality evidence. As the authors state, the durability of the intervention requires long-term follow-up.
It is good to see another study demonstrating the value of the intervention, but is unclear if the addition of bone grafting is or is not a key component of success of this intervention. Hopefully, all devices cleared for this indication will present compelling, high-quality data about their utility and outcomes. This emerging data should compel clinicians to look at the SI joint as a potential pain generator and understand that there are now viable, minimally invasive options for surgical treatment when non-surgical management has failed.
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