Abstract
Sacroiliac joint (SIJ) fusion is a controversial yet last resort operative technique to address SIJ pain. The current study aims to determine the patient outcomes of SIJ fusions, in a single surgeon series utilising an anterior approach with 2 DC plates across the joint and iliac crest autograft.
Retrospective case series involving 11 patients who had 13 SIJ fusions performed over an 8 year period (2002–2010). Patients were identified by electronic key word search from databases at Middlemore hospital and the private sector. Dictated clinic letters and operation notes were reviewed to obtain demographic data and outcomes data including complications. Postoperative radiology reports were reviewed to document radiographic fusion status. Telephone interviews were conducted to measure clinical outcome scores via the Majeed Pelvic Score and the 12-item Short-Form Health Survey (SF-12).
10 out of 11 patients (entailing 12 SIJ fusions) responded and participated in the study, equating to over 90% follow up. 2 cases were managed at Middlemore Hospital, with the remainder in the private sector. All cases but one had a ‘post-traumatic arthritis’ etiology. Diagnosis was made by CT guided local/steroid injection into the joint in conjunction with CT/bone scan/MRI imaging. The Majeed score improved markedly for 9 of 12 SIJ fusions (75%). 10 of 12 patients stated they would have the procedure again. 7 of 12 fusions (58%) had postoperative complications including blood loss, haematoma, nerve injury (including one case of permanent foot drop), non-union, infection of the joint/metal ware, hernia and urinary retention. 5 of 12 fusions (42%) experienced altered sensation over the lateral femoral cutaneous nerve distribution. All except one patient eventually had x-rays or CT scans postoperatively that reported radiographic fusion of the joint.
In appropriately selected patients with SI joint arthrosis, 3/4 patients reported significant improvement in function and pain level after SIJ fusion. Chronic pain (from other sources) and major complications were a feature amongst those failing to benefit. Lateral femoral cutaneous nerve palsy has high incidence with the current operative technique.
