Over the last few decades, the sacroiliac joint (SIJ) is increasingly being recognized as the etiology of pain in up to 30% of patients presenting with chronic low back and posterior pelvic pain.1,2 Pain from the joint often arises as a result of sacroiliac dysfunction caused by a myriad of conditions including osteoarthritis/joint degeneration, trauma to the SIJ, pregnancy, infection, inflammatory arthritis, and tumor.3 Pain arising from the SIJ has been described as very debilitating with patients reporting Oswestry Disability Index (ODI) scores as high as 50 and poor quality of life.4,5 The seriousness of sacroiliac dysfunction points at the need for efficacious, efficient, and long-lasting therapeutic measures to alleviate its associated symptoms.
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In recent times, there has been a gradual shift away from conventional non-surgical therapies such as the use of opioids and other oral analgesics, physical rehabilitation, radio frequency denervation, and chiropractic methods because of the underwhelming treatment durability and benefit.6–8 To compensate, open surgical fusion of the sacroiliac joint became more common. The wide adoption of open fusion was due in part to the increasing numbers of patients diagnosed with sacroiliac dysfunction and the poor response of patients to the conventional therapeutic approaches.
Through open fusion, surgeons were able to immobilize the joint and eliminate the constant motion that was thought to be the cause of inflammation and the resulting pain.9 It is important to note that open fusion, which is highly invasive and reserved for major lesions such as trauma, infection, and neoplasm, has also been found to lead to poor clinical outcomes, a variety of post-surgical complications, and long recovery periods to immobilize the joint and eliminate the constant motion that was thought to be the cause of inflammation and the resulting pain.8
Newer techniques of open surgical fusion have emerged to reduce many of the complications associated with the procedure and improve its postoperative outcomes. These involve the use of screws and plates to achieve fixation of the joint. Because of the peculiarities of the screws used, which are often fenestrated and rely on bone growth through fenestrations of the screws to achieve any fusion, these techniques often require the use of multiple devices to achieve adequate joint immobilization.
The results of using the plate/screw-type techniques have been mixed with as much as 30% of patients reporting poor results or no effect at all following surgery.to immobilize the joint and eliminate the constant motion that was thought to be the cause of inflammation and the resulting pain.10 The majority of the complications resulting from these techniques have been as a result of the entry of the device into the neuroforamen. Other surgeons have attempted a posterior approach by delivering graft material across the joint in an area of the joint that is not part of the articulation.
In this region of the sacroiliac joint, the bone of the sacrum and the ilium are separated by several millimeters and filled with connective tissue. This area is not an optimal placement of either graft or a fixation device.
With the advent of successful minimally invasive techniques, the role that sacroiliac dysfunction plays in minor trauma, degenerative spine disease, and adjacent level disease in lumbar fusion has become much clearer. Also, it has brought with it the possibility of achieving outcomes superior to open plate and screw techniques.
The Catamaran SI Joint Fixation System utilizes a mini-open posterior inferior approach to the sacroiliac joint. The Catamaran is intended for sacroiliac joint fusion for conditions including sacroiliac joint disruptions and degenerative sacroilitis.
The Catamaran SI Joint Fixation System includes the Catamaran SI Joint Implant and associated surgical instruments. The titanium implant consists of two hollow barrels connected by a bridge. During the procedure, bone graft material is placed in the barrel of the implant to facilitate fusion. This technique allows for direct visualization of the joint, decortication and arthrodesis, and fixation with a single implant.
REFERENCES
- Sembrano JN, Polly Jr How often is low back pain not coming from the back? Spine (Phila Pa 1976). 2009;34(1):E27-E32.
- Schwarzer AC, Aprill CN, Bogduk N. The sacroiliac joint in chronic low back pain. Spine (Phila Pa 1976). 1995;20(1):31-37.
- Polly DW, Swofford J, Whang PG, et al. Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-surgical management for sacroiliac joint dysfunction. Int J spine Surg. 2016;10.
- Cummings J, Capobianco RA. Minimally invasive sacroiliac joint fusion: one-year outcomes in 18 patients. Ann Surg Innov Res. 2013;7(1):12.
- Ledonio CGT, Polly DW, Swiontkowski Minimally invasive versus open sacroiliac joint fusion: are they similarly safe and effective? Clin Orthop Relat Res. 2014;472(6):1831-1838.
- Spiker WR, Lawrence BD, Raich AL, Skelly AC, Brodke Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain. Evid Based Spine Care J. 2012;3(04):41-53.
- Lorio MP, Rashbaum R. ISASS Policy Statement–minimally invasive sacroiliac joint fusion. Int J spine Surg. 2014;8.
- Tran ZV, Ivashchenko A, Brooks L. Sacroiliac joint fusion methodology-minimally invasive compared to screw-type surgeries: a systematic review and meta-analysis. Pain Physician. 2019;22:29-40.
- Moore MR. Diagnosis and surgical treatment of chronic painful sacroiliac dysfunction: the integrated function of the lumbar spine and sacroiliac joint. Integr Funct Lumbar Spine Sacroiliac Joint San Diego, CA. 1995:339-345.
- Schutz U, Grob D. Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Acta Orthop Belg. 2006;72(3):296.
