Patient education on iFuse Implant System

1. Lower Back Pain
related to the sacroiliac joint

2. Agenda
• Introduction
• Anatomy of the Spine
• Understanding Lower Back Pain
• Symptoms
• Treatment Options
• Summary and Q&A
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3. Epidemiology
• Up to 85% of all people have lower back
pain (LBP) at some point in life
• 2nd only to common cold in office visits
• 15 million office visits annually
• 5th ranked cause of hospital admission
• Annual direct and indirect costs have reach
$86 Billion
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4. Anatomy - Spine
• 24 vertebrae
– Base of Skull to Pelvis
– Building blocks
• Discs between
vertebrae
– Cushions between
bones
• Protects Spine Cord
• Nerves exit spinal cord
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5. Anatomy – Ligaments
• Strong ligaments encase
each joint
• Allow for about 2-4
millimeters of movement
• If damaged, may have
excessive motion
• Excessive motion may
inflame and disrupt the
joint and surrounding
nerves
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6. Anatomy – Nerve Supply of Pelvis
• Nerves exit Lumbar
Spine & Sacrum
• Provide sensation to
legs
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7. Sacroiliac Joint Problems
Common causes:
• Degenerative disease
• History of trauma
• Pregnancy/childbirth
• Lumbar Fusion
• other unknown reasons.
Disruption due to:
• Injury, traumatic event or repetitive trauma
• or may suffer from sacroiliitis (swelling)
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8. Symptoms
• Back pain - low back
pain
• Buttock pain
• Thigh pain
• Sciatic-like pain
• Difficulty sitting in one
place for too long due
to pain
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9. Diagnosing
• SI Joint – being “rediscovered”
• Not usually part of LBP work-up
• Often misdiagnosed or not evaluated
• Physicians are not trained to look for it
• Proper Diagnosis important
– Pain can mimic discogenic or radicular low
back pain
– potentially leading misdiagnosis and lumbar
surgery
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10. Diagnosing - Imaging
• Plain film, CT scan, & MRI maybe order
– Often misleading
– One study, CT scans were negative in 42% of
symptomatic SI joints1
– MRI has not been proven to have positive
correlation
1. Elgafy H, Semaan HB, Ebraheim NA, et al. Computed tomography findings in patients with sacroiliac pain. Clin Orthop Relat Res. Jan 2001;112
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11. Diagnosing - Imaging
• International Association for the Study of Pain
(IASP) criteria for diagnosis of SI joint pain:1
– Pain is present in the region of the SI joint.
– Stressing the SI joint by performing clinical
tests that are selective for the joint reproduces
the patient’s pain.
– Selectively infiltrating the putatively
symptomatic joint with local anesthetic
completely relieves the patient of pain.
1. Merskey H, Bogduk N. Classification of chronic pain. In: Merskey H, Bogduk N. Descriptions of Chronic Pain Syndromes and Definition of Pain
Terms. 2nd ed.8
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12. Diagnosing – Physical Therapy
Distraction Test
• The sacroiliac joint is stressed by the
examiner, attempting to pull the joint apart
Compression Test
• The two sides of the joint are forced together.
Pain may indicate that the sacroiliac joint is
involved.
Gaenslen's Test
• lay on a table, one leg drops over the edge
and the supported leg is flexed. In this
position, sacroiliac joint problems will cause
pain because of stress to the joint.
Patrick's Test
• The leg is brought up to the knee, and the
knee is pressed on to test for hip mobility.
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13. Diagnosis – SI Injections
SI Joint Injections:
• Gold standard
• Confirm or deny SI Joint is
source of pain
• 20-30 minutes after the
procedure, you will move
your back to try to provoke
your usual pain.
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14. Conservative Treatment
• Non Steroid Anti-Imflamatory Drugs (NSAIDS)
• Chiropractic Manipulation
• Physical Therapy
• Loosen/Stretch for hypomobility
• Strengthen for hypermobility
• Pelvic Belt
• Steroid injections
• Others: RF ablation, etc.
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15. Conservative Treatment – SI Belts
SI Belts:
• Wraps around the hips
• Hold the sacroiliac joint
tightly together
• Reduce motion to reduce
pain
• Goal: Decrease joint
mobility
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16. Conservative Treatment
Physical Therapy
• Lumbar stabilization program:
strengthening abdominals
and buttock muscles
• Improve flexibility in lower
extremity musculature
• Lower back stretches
• Goal: Decrease mobility
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17. Conservative Treatment – SI Injections
Treatment:
• Same procedure as diagnosis
• Includes Corticosteroid in
injection
– Reduce your inflammation
– May provide months of relief
• Treats symptoms, not joint
mobility
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18. Treatment – Radiofrequency Ablation
“Burns” small nerves that provide sensation to
SI joint
• In theory, this treatment:
– Destroys any sensation
– Makes joint essentially numb
• Not always successful
– Temporary, nerves regenerate.
• Treats symptoms, not joint mobility
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19. Surgical Treatment – iFuse Implant
• Decrease mobility of SIJ
– Same rationale as SI Belt
• Minimally Invasive
– Small incision
• Doesn’t require bone for
fusion
• Potential for less OR
time
• Restore Quality of Life
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20. Surgical Treatment – iFuse Implant
• 3 or 4 pins a cross SIJ
• High success rate: 90%
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21. Conclusion
• SIJ is underdiagnosed
• Have your physician examine SI Joint,
diagnosis to confirm or rule out
• If SI Joint is diagnosed, treatment goals:
– Reduce symptoms
– Decrease mobility of SIJ joint
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