Sacroiliac Fusions, The Sacroiliac "Block test" and the IFUSE Technique
The sacroiliac joint is the attachment of the spine to the pelvis. This articulation has very little natural motion and can be affected by various types of trauma. It can also be affected in cases where the mobility of adjacent joints (hip, spine) is reduced. Some common examples are due to prior lumbar fusion, stiff hip (arthritis). the joint can also be affected by prior bone graft harversting from the iliac crest.
The sacroiliac joint can be affected in by inflammatory processes (ankylosing spondylitis, sjogren's syndrome etc.). In these cases associated symptoms and tests will help the rhumatologist establish the diagnosis.
In rare cases no cause can be found. This is called idiopathic sacroiliac dysfunction.
The symptoms are sometimes difficult to differentiate from back pain due to the spine itself. These two pathologies can also coexist.
The diagnosis of sacroiliac dysfuntion is established based on the location and caracteristics of the pain, the physician's physical examination and few studies.
X-rays, MRI, blood tests can be useful but the key test is "the Sacroiliac Block Test" (see below).
The treatment should be started after the diagnosis has been established. It includes three phases:
- Conservative treatment: over the counter pain medication, rest, physical therapy, acupuncture.
- Injections. These are corticosteroid injections. If the injection is efficient it can be repeated in case of relapse. If it is not efficient then repeating it is not indicated.
- Surgical treatment: The IFUSE technique is done minimally invasively as an outpatient. This technique is still new but the results seems promising (see more about the texhnique below).
This test is performed in a surgical suite equipped with fluoroscopy. The test creates a temporary numbing of the joint using a local anesthetic injected in the joint (an anesthetic bock). If a significant relief of pain occurs for two or three hours after the test, while performing somewhat limited activities, on can confirm the diagnosis
If the relief is more modest in nature, the results are more questionable. If there is no relief then the sacroiliac can be eliminated as the main pathology.
A positive test should repeated once for confirmation.IFUSE Technique
This is a new technique for fusion of the sacroiliac joint. In the past such a fusion could only be accomplished through an extensive procedure followed by a long recovery period and uncertain results. IFUSE allows the surgeon to accomplish the thing using a minimally invasive approach.
Below is an animation of the Ifuse technique: