iFuse – Sacro-iliac Joint Fusion

“…up to 25% of all low back pain is related to sacroiliac joint conditions¹.”

Diverse scientific studies show that up to 25% of all low back pain is sacroiliac joint in origin and that the diagnosis of sacroiliac joint disease is frequently overlooked by physicians.

Sacroiliac (SI) joint disorders require appropriate interpretation of a patient’s history, clinical exam results, and imaging studies. Often hip pathology and lumbar pathology coexist with SI joint pathology. During physical examination, patients with SI joint disorders exhibit any/all of the following symptoms:

• Lower back pain (below L5)
• Lower extremity pain (numbness, tingling, weakness)
• Unilateral leg instability (buckling, giving way)
• Disturbed sitting patterns (unable to sit for long periods, on one side)

Diagnosis

Reaction on provocative hip tests (Compression, Thigh Thrust, Distraction, Gaenslen and FABER manoeuvre)

Provocative tests followed by diagnostic intraarticular SIJ injections when indicated are recommended for confirmation of the SI joint as a pain generator

Pain reduction assessment:

• ≥ 50% Positive
• < 50% may have SIJ pain, but consider other pain sources

According to scientific data, it is common for pain from the SI joint to mimic disc or low back pain. To avoid unnecessary lumbar spine surgery, SI joint disorders should be strongly considered in low back pain diagnosis.

Watch the basics of the SI Joint Exam

What is iFuse?

The iFuse Implant System is an innovative, patented, minimally invasive sacroiliac implant system to treat sacroiliac (SI) joint conditions including disruptions and degenerative sacroiliitis. The iFuse Implant System consists of titanium implants and associated surgical instruments.

How does iFuse work?

Typically, patients receive three triangular-shaped titanium implants. Available implant lengths range from 30mm to 70mm in 5mm increments. These implants are delivered to the sacroiliac (SI) joint using a cannulated delivery system designed to protect soft tissue. All this is performed through a 2-3cm incision.

Ideal indications:

The iFuse implant system is ideal for patients with sacroiliac joint conditions. These can appear chronically or due to an injury (e.g. consequently to accidents, post-natal back pain, high workload, etc.)

iFuse benefits

• Triangular implant profile minimizes rotation
• An interference fit between the implant and the adjacent osseous wall
• The iFuse Implant offers a unique advantage for stabilizing and fusing the SI joint as a result of its patented triangular shape and large porous surface area. The triangular shape provides more than 31 times the rotational resistance of a screw which stabilizes the joint while the large porous surface area provides an ideal environment for bony on-growth to support long-term fusion. (see chart)
• Porous surface technology used for decades in other medical applications such as orthopedics and dentistry
• Designed specifically to stabilize and fuse the heavily loaded SI joint
• Rigid titanium construction and implant geometry provide immediate stablilization
• No conflicts with lumbar fusion devices

1 Diagnosis and treatment of sacroiliac joint pain Jonathan N. Sembrano, Mark A. Reiley, David W. Polly, Jr and Steven R. Garfin, Current Orthopaedic Practice Cohen, Steven P. Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment.
Anesth Analg 2005; 101:1440-1453.

Literature

Complete Liste of iFuse publications

       

Stabilization of the sacroiliac joint

Pain in the buttock and sometimes even well above their buttock and higher on the skeleton can origin from the sacroiliac (SI) joint. Like any other joint in the body, the sacroiliac (SI) joint can become arthritic or its support ligaments can become loose or injured by accidents or bed posture. This is especially true with lifting, running, walking or even sleeping on the involved side. In every case the pain can radiate from the back to the leg.

It is important to note that on occasion, patients who have not had symptomatic relief from lumbar spine surgery may actually have had other issues to begin with. This could include the SI joint, the hip, the spine separately or any combination of these three pain generators.

Anatomy

The sacroiliac joint is located in the pelvis, linking the iliac bone (pelvis) to the sacrum (lowest part of the spine above the tailbone). This joint transfers weight and forces between your upper body and legs. It is an essential component for shock absorption to prevent impact forces during walking from reaching the spine

Diagnosis

Diagnostic imaging or other imaging methods (X-ray, CT, MRI) could be useful for the diagnose of the SIJ syndromes.

The most widely used method to accurately determine the cause of SI joint pain is to inject the SI joint with pain medicine. If, following the injection, your pain is decreased a significant amount, then it can be concluded that the SI joint is either the source, or a major contributor, to your lower back pain. If the level of pain does not change after the injection, the SI joint is less likely to be the primary cause.

Treatment Options

Different treatment options can relieve pain. Some patients respond to physical therapy, chiropractic manipulations, use of oral medications, as well as injection therapy. Intermittent use of a pelvic belt may provide symptomatic relief as well. These treatments are performed repetitively, and frequently symptom improvement using these therapies is temporary. Once non-surgical treatment options have been tried and do not provide relief, your surgeon may consider surgery.

Sacroiliac (SI) joint fusion with the iFuse Implant System

A minimally disruptive method to fuse respectively stabilize the SI joint is the iFuse implant system. The procedure involves the insertion of three small titanium implants across the SI joint. This procedure is done through a small incision and takes about one hour. Over the last several years more than 10,000 procedures have been performed and over 700 surgeons have been trained to provide this treatment option for their patients.

Here you can learn more about this minimally disruptive option treating