Case Study: Sacroiliac Joint Fusion
- 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.
- The patient had severe gluteal spasms and quadriceps weakness.
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
- Sacroiliac (SI joint) arthritis as a result of adjacent segment degeneration
- 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
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.
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.
- 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.
Saint Barnabas Medical Center
Formerly St. Luke’s-Roosevelt
Hospital in Manhattan
Formerly Lenox Hill Hospital