Introduction: Sacroiliac joint fusion (SIJF) is an accepted management strategy for sacroiliac joint dysfunction. There is a paucity of long-term data and even less regarding bilateral SIJF.
Methods: A retrospective review was conducted of all patients who underwent primary BSIJF between 7/2020 and 9/2023. All BSIJF were performed using a principles-based approach: joint decortication, bone grafting, compression, and rigid stability. Fusion was assessed by CT at 1 and 2 years. Preoperative outcomes, as well as at 1-year and 2-year follow-up, were recorded for Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Single Assessment Numeric Evaluation (SANE), PROMIS Pain Interference (PI), and PROMIS Physical Function (PF).
Results: BSIJF was performed in 47 patients and 94 joints. 31 patients (70%) were female. Mean age was 54 (range 23 – 80), and mean BMI was 28.9 (range 18.2 - 38.3). Mean follow-up was 27 months (range 13 – 49). 24 patients had previous lumbar spine surgery (PLSS). Radiographs were available for 96% of patients, with a 98% fusion rate. Mean (95% CI) SANE scores were 80% (74-86%) at 1 year and 85% (80-91%) at 2 years. ODI scores improved from 52 (47-57) preoperatively to 33 (27-39) at 1 year and 28 (21-36) at 2 years (both p< 0.001). PROMIS PI and PF scores at 1- and 2-year followups were significantly lower compared to preop (both p< 0.001). NPRS scores were 7.6 (7.1 - 8.0) preoperatively, compared with 3.4 (2.5 - 4.4) at 1 year and 3.4 (1.3 - 5.5) at 2 years. Patients with PLSS had inferior ODI (27 vs. 38, p=0.024) and SANE scores (73% vs. 88%, p=0.007) at 1 year compared with native spines and higher NPRS at 2 years (5.8 vs. 1.7, p=0.031).
Conclusion : Principles-based BSIJF is associated with high rates of fusion with long-term improvement in pain and function. PLSS patients did notably worse.
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