iFuse System For Sacroiliac Joint Pain Shows High Success Rate and Patient Satisfaction
With comments by Lead Study author Bradley S. Duhon, MD and SpineUniverse Editorial Board Member Joshua M. Ammerman, MD
The iFuse system for treatment of sacroiliac (SI) joint pain (or dysfunction) was associated with significant improvements in pain, disability, and quality of life at 2-years after surgery in a recent study published in the International Journal of Spine Surgery. The iFuse system showed a high rate of patient satisfaction and was linked to reduced need for opioid medications.
What Is the iFuse System?
The iFuse system is made of titanium (a type of metal) implants (triangular-shaped rods) that attached horizontally across the bones that make up the painful SI joint—the sacrum and part of the pelvis known as the ilium.
The implant procedure takes about 45 minutes to perform, said lead author of the study Bradley S. Duhon, MD, who is Assistant Professor of Neurosurgery at the University of Colorado in Aurora, CO. "The rods are put in place using a minimally invasive approach (a small incision about 1.5 inches long) to limit damage to the surrounding tissues," Dr. Duhon said.
About the Study
In this study 172 people with SI joint dysfunction resulting from degenerative sacroiliitis or SI joint disruption were implanted with the iFuse system. All the patients had low back pain for at least 6 months that did not get better with non-surgical care.
At 2 years after treatment, the patients showed significant improvements in pain, disability, and quality of life (P<0.0001 for all comparisons). For example, on a pain scale ranging from 0-100, with 100 being the worst pain imaginable, average scores fell from 79.8 before surgery to 26 after surgery. Overall, 80% of the surgeries were considered successful by pre-defined criteria.
In addition, all 37 patients who were taking opioids for SI joint or back pain before surgery stopped taking these medications after surgery. In contrast, 7 patients started taking opioids after surgery, including 2 patients who needed surgery on their other SI joint, 1 who had back pain from a fall, and 1 who needed surgery to revise the original iFuse procedure.
A total of 454 adverse events occurred in 153 patients; the majority of these events were not related to the device or procedure. Adverse events were considered severe in 73 patients, and 7 patients needed a surgery to fix their initial implant.
Dr. Duhon said that immediately after surgery, SI joint pain tends to worsen before it gets better, typically reaching low levels by 6 to 12 weeks after surgery.
High Satisfaction Rates
The vast majority of patients were satisfied with the results of the fusion, with 78% reporting that they were very satisfied and 94% saying that they were very or somewhat satisfied. Also, 75% of patients said that they would definitely choose the surgery again given the outcomes, and 88% said they probably or definitely would. Dr. Duhon said these findings are "very encouraging" and are similar to what he sees in his own practice.
The procedure is not appropriate for patients with osteoporosis because of poor bone quality, Dr. Duhon noted.
Commenting on the study, Joshua Ammerman, MD, said that the iFuse system "is a reasonable option to help achieve long-term pain relief for sacroilitis in patients who have failed conservative measures." Dr. Ammerman is a Neurosurgeon at Washington Neurosurgical Associates in Washington, DC, and a member of the SpineUniverse Editorial Board.
What Is SI Joint Pain?
SI joint pain can make normal daily activities like sitting, walking up stairs, and even lying in bed difficult. Unlike other joints in the body that are intended for movement, the SI joints should move less than a centimeter and are held together by a taut band of ligaments to keep it stable. If the joint is injured or the ligaments become stretched or torn, the joint can shift too much and cause pain and inflammation in the joint and surrounding area, including the hips, low back, buttocks, and back of the legs. In addition, the joint can be a source of degeneration, more commonly in patients having received a prior lumbar fusion.
In many patients, SI joint pain can be relieved with physical therapy, nonsteroidal anti-inflammatory medications, lifestyle changes, and joint injections. However, for patients with chronic (ongoing) pain lasting more than 6 months who have not responded to other options, surgery may be helpful.