Frank Phillips, MD Midwest OrthopedIcs at Rush Chic-ago, FL
De novo sources of SI joint dysfunction include inflammation, postpartum pain, or a new onset of chronic low back pain with or without trauma. In this edition of the Sentinel Newsletter Mark Reiley shares an interesting article on sacral dysplasia as a de novo source of low back pain. He recommends including oblique plain X-rays of the pelvis and axial CT scans of the pelvis as part of the process of diagnosing SI joint disease. In my practice, I order a low back MRI that extends through the sacrum, I take close notes ofpatient complaints and history, perform provocative testing using 5 or 6 provocative tests with the highest sensitivities and specificities, and I have a minimum of 2 diagnostic SI joint blocks performed to rule out false positives. When reviewing surgical options, the iFuse is an ideal minimally invasive option for fusing the SI joint due to its unique design and ability to stabilize the joint.
Bengt Sturesson shares a very interesting case study on a patient who suffered for years after a traumatic injury before he was diagnosed with SI joint dysfunction. His diagnostic work-up is exhaustive and his method detailed in order to get to the point of MIS surgery as an option. This iFuse patient had considerable success and at six months this patient was off medication and was able to return to work.
This month’s featured publication is a review article in Current Orthopedic Practice by Jonathan Sembrano, Mark Reiley, David Polly, J r, and Steven Garfin. This article makes several key points about diagnosis and treatment of the SI joint: the SI joint is a significant component of low back pain, most spine care providers are ‘reluctant or unaware’ of the SI joint as a cause of low back pain, and differential diagnosis of low back pain including the SI joint is essential to get effective treatment. When reviewing surgical options, the iFuse is a clear first choice due to its ability to stabilize and fuse the joint.
The Sentinel is published by SI-BON, Inc. and features case studies, surgical tips and clinical reports related to sacroiliac (SI) joint diagnosis and minimally invasive surgical (MIS) treatment relevantto its product, the iFuse Implant System®.
SI-BONE, Inc. is a leading spinal medical device company dedicated to the development oftools and products for diagnosing and treating patients with low back issues related to sacroiliac (SI) joint pathology. The company has developed, and is manufacturing and marketing, less invasive approaches using implants for the treatment of SI joint pathology.
SI-BONE received clearance in November 2008 from the Food and Drug Administration (FDA) to market its iFuse Implant System. The CE mark for European commercialization was obtained in November 2010. The iFuse provides immediate post-operative stabilization and accomplishes the goal of traditional SI joint fusion through an MIS approach. Clinical publications have identified the SI joint as a pain generator for up to 22 percent of low back pain patients. In addition, DePalma, Pain Medicine 2011, identified the SI joint as a pain generator in low back pain in 40 to 61% of post-lumbar fusion patients, so-called ‘failed back surgery’ patients.1 Effective treatment of the SI joint is a significant unmet clinical need and, when conservative therapy fails, iFuse may provide an option.
In response to increasing awareness of SI joint disruption and degenerative sacroiliitis as debilitating symptom generators, SI-BONE, Inc. developed an innovative, patented implant to treat the SI joint. The company is also embarking on a prospective multicenter study to document acute and long-term clinical outcomes in patients who are proven to be refractory to prior therapies.
The iFuse Implant System is a commercially available device in the U.S. intended for treatment of conditions including sacroiliac joint disruptions and degenerative sacroiliitis. The iFuse procedure uses a minimal incision for delivery and implantation of small, titanium implants. The implants are coated with a porous plasma spray that acts as an interference surface, designed to help decrease implant motion. These implants have substantial thickness and sophisticated metallurgy and are able to produce a much stronger construct than that of conventional pins or screws used to surgically fix boney structures. The SI-BONE implant technology has been used successfully in over 2,000 MIS SI joint cases to-date.
Find out more at http://www.si-bone.com