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The Surgery: Brief Description
Fixation Surgery: The patient is placed prone on a radiolucent table to allow the use of an image intensifier. The aim is to insert two cannulated screws through the ilium into the sacrum. Once positioning is complete, two Steinmann pins are inserted across the joint under EMG monitoring and image intensification guidance. Once the Steinmann pins are in the appropriate position, incisions are made, the depth of penetration is measured and appropriate-sized 6.6mm cannulated screws are placed across the joint. If the patient’s problem is purely extra-articular, this completes the operation.
Post-op protocol: The patient can stand and ambulate with or without an assistive device the afternoon after the procedure. An assistive device is for patient comfort and is not essential.
Piriformis Release: The piriformis muscle is released by cutting the piriformis tendon at its point of insertion at the superior border of the greater trochanter. This procedure is performed through a small incision (approximately one inch long) along the side of the buttock.
Traditional Fixation/Fusion: The method used to stabilize the SI joint is the same as the fixation. If the patient has intra-articular joint problems, a posterior incision can be made parallel and slightly lateral to the posterior SI spine extending cephalad and parallel to the iliac crest. The lumbrodorsal fascia, as it inserts onto the inner table of the ilium, is identified and stripped from its attachment, exposing the inner table of the ilium. Next, a bone graft is harvested from the inner table, which allows for improved visualization of the ligaments and joint. Then the ligamentous and cartilaginous portion of the joint are removed. Once the bone is decorticated, the bone graft is inserted. The lumbodorsal fascia is re-approximated, and the subcutaneous tissues ans skin are closed.
Fixation/Fusion with the iFuse Implant System®: With the patient in prone position, the procedure is performed through a small incision (approximately one inch long) along the side of the buttock. During the procedure, x-rays provide the surgeon with live imaging to enable proper placement of the triangular shaped, biomechanically rigorous implant designed specifically to stabilize the heavily loaded SI joint. Three to four implants are generally used, depending on the patient’s size. The porous plasma spray coating with an irregular surface supports stable bone fixation/fusion.
Post-op protocol: The patient can get out of bed with assist and an assistive device, walker, or crutches the morning after the surgery. Ambulation should be partial weight bearing on the affected side for short distances.