PERCUTANEOUS SACRO-ILIAC JOINT FUSION WITH HMA SCREWS: FUNCTIONAL AND RADIOLOGICAL OUTCOME

Abstract

Introduction: Sacroiliac joint (SIJ) is a diarthrodial joint and can often be a source of chronic low back pain complex. We present a percutaneous technique for SIJ fusion and the functional and radiological outcome following the arthrodesis.

Aims and Objectives: To evaluate the functional and radiological outcome following percutaneous technique for SIJ fusion with HMA (Hollow modular anchor-age) screws.

Materials and Methods: 15 consecutive patients operated for SIJ fusion between Sep 2004 and Aug 2007 were included in the study. The diagnosis was confirmed with MRI and diagnostic injections. Pre-operative and post-operative functional evaluation was performed using SF-36 questionnaire and Majeed’s scoring system. Postoperative radiological evaluation was performed using plain radiographs. The Hollow modular anchorage (HMA) screws (Aesculap Ltd, Tuttlingen) packed with bone substitute were implanted percutaneous under fluoroscopic guidance

Results: The study group included 11 females and 4 males with a mean age of 48.7 years. Mean follow-up was 14 months. Mean SF-36 scores improved from 37 to 80 for physical function and from 53 to 86 for general health. The differences were statistically significant (Wilcoxon signed rank test; p < 0.05). Majeed’s score improved from mean 37 preoperative to mean 79 postoperative. The difference was statistically significant (student t test, p< 0.05). 13 had good to excellent results. The remaining 2 patients had improvement in SF-36 from mean 29 to 48. Persisting pain was potentially due to coexisting lumbar pathology. Intra-operative blood was minimal and there were no post operative or radiological complications in any patient.

Conclusion: Percutaneous HMA screws are a satisfactory way to achieve sacro-iliac stabilisation.