At the 11th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference on June 15, Richard Kube, MD, chief executive officer, founder and owner of Prairie Spine & Pain Institute explored sacroiliac joint problems and advances in the treatment of the condition.
1. Symptoms and diagnosis. The symptoms of sacroiliac joint dysfunction include groin pain, buttock pain and paracentral low back pain. Pain in the posterior thigh can travel past the knee. SI joint conditions are commonly misdiagnosed as sciatica. In classic cases, patients will complain of difficulty turning over in bed, inability to put pressure on the affected side and difficulty putting on shoes and clothes.
"One of the most challenging issues of SI joint pain is the complexity of diagnosis," said Dr. Kube. Some of the common diagnostic exams include the Fortin finger test, tenderness in Baer's Point, Yo-Yo Sign, Gaenslen's Test, FABER test, diagnostic SI joint injections and imaging studies. Dr. Kube performs at least three diagnostic tests before administering SI joint injections. He asks his patients to keep a diary of how they experience their pain.
The injections are then done under fluoroscopy. "We want to make sure that we have an accurate diagnosis if we are going to move forward with a more invasive procedure," said Dr. Kube.
2. Non-operative measures. All measures should be exhausted before turning to surgery. Anti-inflammatory drugs and radiofrequency ablation are two non-operative options Radiofrequency ablation, while a viable option, does not reach the ventral aspect of the sacroiliac joint. If this area of the joint is a source of pain, radio frequency ablation may not be an effective treatment. If patients respond well to these measures, they can often be referred to a pain management physician.
3. Surgical treatment. Surgical candidates are patients that have experienced significant pain for at least six months, failed a combination of conservative treatments, are debilitated by pain and have the mental capability for goal direction and reasonable postoperative expectations.
"We begin with the lateral view to decide how we will start and where we will place the implants. Throughout the procedure imaging is crucial. There is a window you absolutely have to hit," said Dr. Kube.
Implants commonly used for SI joint procedures include the iFUSE Implant System, SI-LOK from Globus Medical and SImmetry Sacroiliac Joint Fusion System.
Dr. Kube shared two cases examples of patients he treated with SI joint fusion. The first case was a 29-year old female patient that had SI joint pain for 18 months. She failed conservative treatment. A year after the procedure, on the chronic low back pain Visual Analog Scale the patient had a score of 25. On the leg pain VAS, she had a score of 15. On the Oswestry Disability Index she had a score of six.
In the second case, a 55 year old male suffering from sacroiliac pain due to a bike injury presented with a low back pain VAS score of 80, leg pain VAS score of 38 and ODI score of 50. A year after the procedure, his low back pain VAS score was 25, his leg pain VAS score was 20 and his ODI score was 20.
Dr. Kube first began performing the procedures as a pilot group study of eight to 10 patients. He had the images from these initial procedures examined to ensure fusion was occurring. Of those patients, 90 percent achieved fusion. "The first cut is key to gaining access to the joint and ensuring the remainder of the surgery will go well," said Dr. Kube.
4. Adding SI joint fusion to your practice. When considering the addition of SI joint fusion to your practice, the first step is screening your patients. Decide which patients are candidates and if you have enough to begin regularly performing the procedure. The reimbursement is similar to spinal fusion and the procedure has not yet been denied by PPO insurance plans.
The procedure can be done on an outpatient basis. The postoperative protocol is similar to lumbar fusion. Patients are allowed full weight bearing immediately and can begin sedentary work almost immediately.
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"One of the most challenging issues of SI joint pain is the complexity of diagnosis," said Dr. Kube. Some of the common diagnostic exams include the Fortin finger test, tenderness in Baer's Point, Yo-Yo Sign, Gaenslen's Test, FABER test, diagnostic SI joint injections and imaging studies. Dr. Kube performs at least three diagnostic tests before administering SI joint injections. He asks his patients to keep a diary of how they experience their pain.
The injections are then done under fluoroscopy. "We want to make sure that we have an accurate diagnosis if we are going to move forward with a more invasive procedure," said Dr. Kube.
2. Non-operative measures. All measures should be exhausted before turning to surgery. Anti-inflammatory drugs and radiofrequency ablation are two non-operative options Radiofrequency ablation, while a viable option, does not reach the ventral aspect of the sacroiliac joint. If this area of the joint is a source of pain, radio frequency ablation may not be an effective treatment. If patients respond well to these measures, they can often be referred to a pain management physician.
3. Surgical treatment. Surgical candidates are patients that have experienced significant pain for at least six months, failed a combination of conservative treatments, are debilitated by pain and have the mental capability for goal direction and reasonable postoperative expectations.
"We begin with the lateral view to decide how we will start and where we will place the implants. Throughout the procedure imaging is crucial. There is a window you absolutely have to hit," said Dr. Kube.
Implants commonly used for SI joint procedures include the iFUSE Implant System, SI-LOK from Globus Medical and SImmetry Sacroiliac Joint Fusion System.
Dr. Kube shared two cases examples of patients he treated with SI joint fusion. The first case was a 29-year old female patient that had SI joint pain for 18 months. She failed conservative treatment. A year after the procedure, on the chronic low back pain Visual Analog Scale the patient had a score of 25. On the leg pain VAS, she had a score of 15. On the Oswestry Disability Index she had a score of six.
In the second case, a 55 year old male suffering from sacroiliac pain due to a bike injury presented with a low back pain VAS score of 80, leg pain VAS score of 38 and ODI score of 50. A year after the procedure, his low back pain VAS score was 25, his leg pain VAS score was 20 and his ODI score was 20.
Dr. Kube first began performing the procedures as a pilot group study of eight to 10 patients. He had the images from these initial procedures examined to ensure fusion was occurring. Of those patients, 90 percent achieved fusion. "The first cut is key to gaining access to the joint and ensuring the remainder of the surgery will go well," said Dr. Kube.
4. Adding SI joint fusion to your practice. When considering the addition of SI joint fusion to your practice, the first step is screening your patients. Decide which patients are candidates and if you have enough to begin regularly performing the procedure. The reimbursement is similar to spinal fusion and the procedure has not yet been denied by PPO insurance plans.
The procedure can be done on an outpatient basis. The postoperative protocol is similar to lumbar fusion. Patients are allowed full weight bearing immediately and can begin sedentary work almost immediately.
More Articles on Spine:
How Will the Role of Spine Surgery Evolve? 5 Predictions From Spine Leaders
5 Ideas for Marketing Spine and for Patient Development
Drs. Richard Kube & David Rothbart: 3 Key Considerations for the Transition of Spine to ASCs