Sacroiliac Joint San Francisco Bay Area
Interestingly, surgical treatment of the sacroiliac joint was introduced in the mid-1920s by Smith-Petersen about a decade prior to the first reported lumbar microdiscectomy for disc herniation, which was reported in 1934. The fates of those two procedures have been quite different. Lumbar discectomy has become an extraordinarily common procedure, probably the number-one spinal procedure performed in the United States. On the other hand, sacroiliac fusion for almost a century has been on the outskirts of spinal surgery, with only recent evolution of the surgical technique and understanding of the pathophysiology of sacroiliac joint dysfunction. The latest twist in the history of sacroiliac surgery came around 2009 with the introduction of minimally invasive transiliac fusion utilizing the iFuse device from SI-BONE, a local company based on San Jose, California. This has allowed us to perform the sacroiliac fusion with much less damage to the surrounding soft tissues, minimize postoperative need for mobilization, and speed up the recovery. There are more than 30 articles detailing the usage of the iFuse device and highlighting its safety and efficacy. Sacroiliac fusion seems to be extraordinarily powerful to address confirmed sacroiliac dysfunction that is refractory to conservative management. This is in stark contrast to conservative management of sacroiliac disorders, which really has minimal capacity to change the pain or dysfunction of the patient. We were part of the SIFI clinical trial, a single-arm, multicenter prospective surgical trial of the iFuse procedure to treat sacroiliac joint dysfunction and arthropathy. This has been reported in several publications. Also, we were part of the LOTUS and PROSPER retrospective studies involving sacroiliac fusion patients, both of which have recently reported in peer-reviewed publications. Overall, sacroiliac joint issues are extraordinarily common in spine practice, and at least half seem to be related to prior lumbar fusion. We now do have a very potent, safe, and efficacious way to address those patients who fail to respond to conservative management.