Sacroiliac joint dysfunction is common, and while most cases can be managed non-surgically, minimally invasive fusion has emerged as an effective option when conservative treatments fail.
Minimally invasive techniques offer significant benefits, including reduced collateral tissue damage, post-operative pain, blood loss, and hospital stay. However, traditional minimally invasive sacroiliac joint fusion methods often overlook key fusion principles, such as complete removal of cartilage and fibrous tissue to expose raw bone within the joint, close apposition of joint surfaces, and stabilization until fusion is achieved.
The objective of this study is to outline the surgical technique for SIJ fusion augmented by endoscopic SIJ debridement and direct bone grafting and to analyze data related to the initial clinical series in which it was implemented to assess the feasibility and safety of this procedure.
Methods:
A retrospective review of a prospectively maintained database was performed of all consecutive patients who underwent minimally invasive sacroiliac joint fusion with endoscopic decortication, by a single surgeon, since the introduction of the technique in July 2024. The diagnosis, operative time, blood loss, implants, number of screws, length of hospital stay, complications, and demographic variables including sex, age, and comorbidities were recorded. Clinical outcomes were assessed with visual analogue scale (VAS) leg pain, VAS back pain, Oswestry Disability Index (ODI), Roland‐Morris Disability Questionnaire (RMDQ) and EuroQol-5 Dimensions Questionnaire (EQ5D) for Quality of Life. Clinical outcomes were collected pre-operatively and post-operatively at 12 weeks and 9 months. Post-operative CT imaging was only performed where clinically indicated and when available was assessed for evidence of graft material within the sacroiliac joint at the site of decortication.
Results:
Results
Since the introduction of the technique in July 2024, consecutive patients undergoing minimally invasive sacroiliac joint fusion with adjunctive endoscopic decortication and direct bone grafting were identified from a prospectively maintained database. Demographic characteristics, comorbidities, operative variables, implant configuration, length of hospital stay, and perioperative complications were recorded. The procedure was successfully completed in all cases using an ultra-minimally invasive approach. Clinical outcomes, including VAS back pain, VAS leg pain, Oswestry Disability Index (ODI), Roland–Morris Disability Questionnaire (RMDQ), and EuroQol-5 Dimensions (EQ-5D), showed significant improvement preoperatively and at 12 weeks and 9 months postoperatively. Early follow-up demonstrated improvements in pain, disability, and quality-of-life measures, with no major procedure-related complications observed. Postoperative CT imaging, when clinically indicated and available, confirmed the presence of graft material within the sacroiliac joint at the site of endoscopic decortication.