Copyright â Springer - 2015
Definition of a Dysfunctional Sacroiliac Joint
Current Education and Societal Commitments for This Condition
Sources of Information for This Textbook
The FDA and Surgery for the Sacroiliac Joint
The Philosophical Approach for the Creation of This Textbook
“Off-Label” Uses of Products
2: Surgical Treatment for the Painful, Stable Sacroiliac Joint: What Does the Literature Tell Us?
Methods Used to Review the Literature
Results of the Literature Review
Minimally Invasive Dorsal Approach
Minimally Invasive Lateral Approach
3: Anatomy and Biomechanics
Biomechanics of the Sacroiliac Joint
4: Biomechanics of the Injured SIJ: Results from an In Vitro Study
Surgical Reconstruction Groups
Variables with Statistical Significance
Conclusions Verses Hypothesis
Clinical Importance of Study Conclusions
5: Pathology of the Sacroiliac Joint Leading to Surgery
Importance of an Accurate Diagnosis
Pathologic Conditions That Responded Positively to Fusion
Degenerative Osteoarthritis (OA)
Case Example of RA Affecting the SIJ
Postpartum SIJ Dysfunction
Aggressive Iliac Bone Graft (IBG) Harvesting
Failed Attempt at Previous SIJ Fusion
LS Fusion, Especially with Instrumentation
Idiopathic Pain in the Normal-ưAppearing SIJ
6: Algorithm for the Diagnosis and Treatment of the Dysfunctional Sacroiliac Joint
Conservative Treatment Prior to Imaging or Injections
Diagnostic Part of the Injection
Injections and Radiating Leg Pain
Intra- Versus Extra-articular Injections
When Injections Are Enough
More Invasive, Complex, and Costly Treatments
A Word About Postoperative Narcotics in the “Chronic Pain Patient”
Restrictions After Fusion of the SIJ
7: Considerations for the Surgeon New to Sacroiliac Joint Surgery
The Borgess Brain and Spine Institute Experience
Important Considerations When Operating on the Dysfunctional SIJ
Three-Dimensional Orientation of the Joint
Considerations When Imaging in the Anterior–Posterior Plane
Location and Importance of the Cluneal Nerves, Sciatic Nerve, and Superior Gluteal Artery
Osteoporosis and Its Ramifications
Patient Demographics and Ramifications for Results
Bilateral Fusion Considerations
Should the Joint Be “Realigned” Before Fusion Surgery?
Fusing Both the Lumbar Spine and the SIJ: Considerations
The Morbidly Obese Patient
Different Approaches for Different Surgeons
8: Lateral Approach, Minimally Invasive
Indications and Current Uses
Lateral Minimally Invasive Approach, Step by Step
Step 2: Intraoperative Image Planning
Step 4: Guide Wire Placement
Step 5: Tubular Retractor Placement
Step 6: Hardware Placement
Step 7: Additional Guide Wire Placement
Complications and Reoperations
9: Posterior Midline Approach
Literature and Historical Review
Relative Indications and Contraindications
Posterior Midline Approach: Step by Step
Step 3: Identification and Separation of the Fascial Layers
Step 4: Exposure of the PSIS
Step 5: Removal of Bone and Posterior Ligaments
Step 6: Placing Cage or Bone Dowel into Longitudinal Axis of the Joint
Step 7: Placing S1 Pedicle Screw
Step 8: Placing Iliac Screw
Step 9: Bone Grafting, Placing Rod, and Compression
Step 10: Tight Closure and Drain
Step 11: Postoperative Management
Complications and Reoperations
Off-Label Uses of Products
Outcomes for the Posterior Midline Approach
Satisfaction and Function Statistics
What Is the Effect of Performing This Procedure Bilaterally?
What Is the Effect of Performing This Procedure Concurrently with a Lumbosacral Fusion?
What Type of Patient Is Least Likely to Benefit from This Procedure?
What Type of Patient Is Most Likely to Benefit from This Procedure?
Salvage Surgery for a Failed Posterior Midline Approach as Described in This Chapter
10: Posterior Lateral into the Longitudinal Joint Axis Approach: Minimally Invasive
Etiology of Procedure and Literature Review
Indications and Contraindications for Procedure
Posterior Lateral into the Longitudinal Axis of the Joint: Minimally Invasive Approach, Step by Step
Step 1: Preoperative Preparation
Step 4: Preparing the Space for the Cage
Step 5: Insertion of Cage
Step 6: Insertion of Second Cage
Step 8: Postoperative Management
Complications and Reoperations
Off-Label Use of Products
Salvage Surgery for a Failed Posterior Lateral into the Longitudinal Axis of the Joint Minimally Invasive Approach Procedure
Satisfaction, Pain, and Functional Statistics
What Is the Effect of Performing This Procedure Bilaterally?
What Is the Effect of Performing This Procedure with a Lumbosacral Fusion?
Method for Using This Approach for Aspiration and Biopsy
11: Posterior Lateral Open Approach for Sacroiliac Joint Arthrodesis
Indications for Open Transiliac Approach
Relative Advantages and Disadvantages of Transiliac Approach vs. Other Open Approaches
Description of Technique of Open Posterior Lateral (Transiliac) Approach to the SIJ
Posterior Lateral Open Approach vs. Minimally Invasive Approaches
12: Posterior Inferior Approach, Minimally Invasive
Surgical Techniques for Fusing the SIJ
Minimally Invasive Surgical (MIS) Techniques
Author’s Experience with Minimally Invasive SIJ Fusions
Posterior Inferior Fusion-Minimally Invasive Surgical (PIF-MIS) Technique of the SIJ
13: The Sacroiliac Joint and Long Lumbosacral Fusions
Implications of Long Fusions to the Sacrum
Effects of Associated Iliac Bone Graft Harvesting
Positive Sagittal Balance, Especially in Elderly Patients
Sacroiliac Joint Fixation with Long Lumbosacral Fusions
14: Postsurgical Rehabilitation
Guidelines for Rehabilitation
Correcting Tissue and Joint Dysfunction
Pain Control and Tissue Remodeling
15: Complications of Sacroiliac Joint Fusion and Salvage Considerations
Complications Specific to SIJ Fusion
The Original Postero Lateral Long Arc Incisional Approach
The Direct Lateral Approach
CT Scanning Considerations
16: Round-Table Discussion, April 2, 2014
Appendix A LITERATURE SEARCH: Sacroiliac Joint Fusion SurgeryOutcomes/Complications
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