Case Study: Sacroiliac Joint Fusion
HISTORY
- The patient is a 68-year-old male, British banker, with diabetes and severe sacroiliac pain after a prior spinal fusion. He had terrible difficulty negotiating uneven terrain and difficulty with prolonged sitting.
PHYSICAL EXAM
- The patient had severe gluteal spasms and quadriceps weakness.
PREOPERATIVE IMAGING
AP and lateral X-rays, showing severe SI (sacroiliac joint) arthritis and L3-4 adjacent segment degeneration in the setting of a prior L4-S1 decompression and fusion
DIAGNOSIS
- Sacroiliac (SI joint) arthritis as a result of adjacent segment degeneration
SURGERY
- MIS (minimally invasive surgery) SI (sacroiliac) fusion with percutaneous screws and L3-4 XLIF (extreme lateral interbody fusion) with lateral plate
- One hour of operative time
- 20 cc blood loss
POSTOPERATIVE IMAGING
AP fluoroscopic images showing three screws across the right and left SI (sacroiliac) joints placed through a minimally access tubular retractor under fluoroscopic guidance with preservation of the gluteal muscles.
POSTOPERATIVE IMAGING
AP and lateral X-rays showing three screws across the right and left SI (sacroiliac ) joints and L3-4 interbody cage and plate placed through a muscle splitting corridor through the iliopsoas muscle (hip flexor), avoiding muscle stripping of the posterior lumbar musculature.
OUTCOMES
- The patient was discharged home four hours after surgery on mild oral pain medications.
- In a patient with his characteristics (diabetic and high-level banker), correct diagnosis and MIS surgery allowed us to perform two different surgeries in the same sitting. MIS surgery via a lateral approach avoided massive muscle stripping and increasing scar formation in classic revision spine surgery. MIS surgery for the sacroiliac joint avoided gluteal muscle stripping.
- The patient was able to sit and return to his job the following day.
- Note that in a patient with this complex picture, correct diagnosis and surgical planning are critical for optimal results.
Hospital Affiliations
Mt. Sinai
Saint Barnabas Medical Center
Lenox Hill
Formerly St. Luke’s-Roosevelt
Hospital in Manhattan
Livingston, NJ
Formerly Lenox Hill Hospital
in Manhattan
Outpatient Surgery Centers
Malo Surgery Center
201 Route 17 North 12th floor
Rutherford, NJ 07070
Phone: 201-549-8890
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Midtown Surgery Center
305 East 47th St.
New York, NY 10017
Phone: 212-751-2100
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Advanced Spine Surgery Center
855 Lehigh Ave,
Union, NJ 07083
Phone: 908-557-9420
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Denville Surgery Center LLC
3130 Route 10 West
Denville, NJ 07834
Phone: 973-328-3475
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