SIJ Fusion with IPS Screws

 ### Case Report: Sacroiliac Joint (SIJ) Fusion Using IPS Screw - A Technical Approach


#### Introduction

Sacroiliac joint (SIJ) dysfunction is a common cause of lower back pain and can significantly impair quality of life. SIJ fusion has emerged as an effective treatment option, especially in patients who do not respond to conservative management. This case report details a successful SIJ fusion using an innovative approach involving the IPS screw system, emphasizing the technical steps and intraoperative considerations.


#### Case Details

**Procedure:** Sacroiliac Joint Fusion  

**Implant Used:** IPS Screw - Titanium  

**Patient Positioning:** Supine


#### Surgical Technique

1. **Patient Preparation and Draping**  

   The patient was positioned supine, and standard draping was applied to maintain a sterile field. The posterior line of the sacrum and the upper border of the S1 vertebra were marked for reference on lateral imaging.


2. **Radiographic Localization**  

   Using fluoroscopy, a full lateral view was obtained by aligning the femoral heads on the same plane. This ensured precise visualization of the SIJ and sacrum anatomy for accurate screw placement.


3. **Skin Incision**  

   A skin incision was made anterior to the marked posterior line of the sacrum. Care was taken to ensure the incision was in line with the planned trajectory of the IPS screw.


4. **Guide Wire Insertion**  

   A single guide wire was directed towards the S1 vertebral body. The position of the guide wire was confirmed using fluoroscopic imaging in three planes: lateral, inlet, and outlet views. This step ensured the guide wire was correctly aligned for optimal screw placement.


5. **Screw Length Measurement**  

   The required screw lengths were measured, resulting in three sizes: 55 mm, 45 mm, and 40 mm. The selection of screw length was based on patient anatomy and the desired fusion segment.


6. **Drilling**  

   Drilling was performed up to the point where the drill just passed through the SIJ. The depth was carefully controlled to avoid over-penetration, which could compromise the surrounding neurovascular structures.


7. **Reaming**  

   A triangular reamer was used to prepare the bony tunnel. One flat surface of the reamer was kept parallel to the upper border of the S1 vertebra for optimal alignment. The reaming was performed until two of the wedge-shaped ends of the reamer passed through the SIJ, creating a well-prepared tunnel for screw insertion.


8. **IPS Screw Insertion**  

   The IPS screw was introduced over the guide wire, ensuring precise placement. The screw was gently advanced using a mallet under continuous fluoroscopic guidance, particularly focusing on the outlet view for confirmation. The screw was impacted until it achieved solid fixation within the sacrum and ilium, effectively bridging the SIJ.


#### Postoperative Outcome

The patient tolerated the procedure well, with no intraoperative complications. Postoperative imaging confirmed the correct placement of the IPS screw with adequate purchase across the SIJ. The patient was mobilized the next day with partial weight-bearing and was advised to follow a rehabilitation program focusing on core strengthening and pelvic stability.


#### Discussion

This case highlights the effectiveness of using an IPS screw for SIJ fusion, providing a minimally invasive approach with robust fixation. Key technical aspects, such as precise radiographic localization, careful drilling and reaming, and controlled screw insertion, were critical to the success of the procedure. The use of a triangular reamer and keeping one surface parallel to the S1 upper border ensured optimal screw alignment, enhancing fusion stability.


#### Conclusion

SIJ fusion using an IPS screw is a viable surgical option for patients with refractory sacroiliac joint pain. This technique offers the advantage of minimal tissue disruption while achieving effective joint stabilization. Further studies and long-term follow-up are recommended to evaluate the durability of this fusion method.


---


This case report presents a detailed technical guide for surgeons looking to implement SIJ fusion using IPS screws, emphasizing the importance of precise imaging and controlled instrumentation for optimal outcomes.

Comments

Post a Comment

Popular posts from this blog

Pelvic fracture management Guideline 2024

Image
**Discussion between Two Professionals on Pelvic Fracture Guidelines** **Dr. A:** "The guidelines for managing pelvic fractures are critical, especially in trauma systems with defined referral pathways. These fractures, especially those involving the pelvic ring, can lead to significant complications like hemorrhage and urological injuries, so we need to ensure these patients are handled by multidisciplinary teams at Major Trauma Centres." **Dr. B:** "Absolutely. The complexity of pelvic fractures, especially when associated with haemodynamic instability, means time is of the essence. For instance, applying a pelvic binder in the correct position immediately—preferably in the prehospital setting—is an essential first step when active bleeding is suspected." **Dr. A:** "Right, and it’s equally important that patients with suspected pelvic fractures and signs of haemodynamic instability be transported directly to Major Trauma Centres. If they arrive at a trauma u...
Read more