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Greater VAS improvement seen with posterolateral vs transgluteal SIJ fusion approach

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Mohammad E. Majd

LOS ANGELES — The posterior oblique approach for unilateral sacroiliac joint fusion may be superior to and have a reduced potential for bleeding that leads to postoperative hematoma compared with the percutaneous transgluteal approach, according to Mohammad E. Majd, MD.

Majd’s retrospective single-cohort analysis of outcomes of the procedures was presented at the North American Spine Society Annual Meeting and was selected as the meeting’s best paper on minimally invasive techniques.

“The posterior oblique approach was a less morbid approach [had a] low complication rate [and] less blood loss. We need further study to increase the power of the study and we could not find any patient-predictive factors to discover like BMI, age, pathology [or] etiology to change the outcome of the surgery,” Majd said.

The IFuse Implant System (SI-Bone) was used in 20 patients who underwent sacroiliac joint (SIJ) fusion with the transgluteal approach. The 30 patients whose SIJ fusion was done posterolaterally received the Rialto SI Fusion System (Medtronic).

VAS pain score improvements following fusion were seen in 80% of the transgluteal group and in 96% of the posterolateral group. Furthermore, results showed the VAS improvements were significant in more patients in the posterolateral group (65%) than in the transgluteal group (45%).

In all, there were four adverse events in the transgluteal group and two patients underwent revisions. There were two adverse events in the posterolateral group, which included one seroma and one infection, but no revisions, Majd said.

“Intraoperative blood loss in both groups was low,” but the amount of blood loss was less in the posterior oblique than in the transgluteal group, he said. – by Susan M. Rapp

Reference:

Majd ME. Paper 38. Presented at: North American Spine Society Annual Meeting; Sept. 26-29, 2018; Los Angeles.

Disclosure: Majd reports he receives royalties from Gold Standard Orthopaedic paid to his institution, consulting fees from Alphatec paid to his institution and is paid for trips/travel by Spine Art.