Inspired Spine

Background Chronic lower back pain is a significant global health issue, leading to disability and a substantial economic burden. A considerable number of cases are associated with the sacroiliac joint (SIJ), especially among patients with a history of lumbar fusions. Despite various treatments, persistent SIJ pain often requires surgical intervention, with minimally invasive techniques becoming the standard due to their benefits over open surgery. This study examines the clinical outcomes of a novel minimally invasive SIJ fixation technique using the Trident™ system. Methodology The study retrospectively reviewed 39 patients who underwent SIJ fusion with the Trident™ system across four surgical sites by a single surgeon. Strict inclusion and exclusion criteria ensured a homogeneous patient population. The procedure involved placing hollow fenestrated screws in a tri-pronged fashion across the SIJ to achieve fusion. The Oswestry Disability Index (ODI) was used to measure functional outcomes, and statistical analyses were conducted to assess the efficacy of the procedure. Results The study found statistically significant improvements in most ODI categories postoperatively. Subgroup analyses revealed that patients with bilateral SIJ fusions showed the greatest improvement, while those with unilateral fusions without prior lumbar surgery showed the least improvement, though still significant. The results suggest that the Trident™ system is effective in improving patient outcomes. Conclusions Evidence indicates that the novel SIJ fixation technique could influence future standards of care for SIJ-related chronic low back pain. The Trident™ Screw System's minimally invasive approach to SIJ fusion is effective in improving functional outcomes for patients with chronic SIJ-related lower back pain. The technique's efficacy, demonstrated through significant ODI improvements, supports its potential as a valuable treatment option.

Sacroiliac joint (SIJ) dysfunction has been increasingly recognized as the underlying pathology responsible for a significant percentage of cases of chronic lower back pain and radiculopathy. Diagnosis of SIJ dysfunction involves multiple provocation tests followed by serial injections of anesthetic, with significant alleviation of pain indicating that the SIJ is the pain generator. One documented complication of SIJ injections is extravasation of injected material from the SIJ capsule, resulting in unintended symptoms. We report the case of a patient who reported experiencing an orgasm following each of her three diagnostic SIJ injections. We hypothesize that this unusual symptom was caused by extravasation of injected material ventrally to the nearby pudendal nerve, a nerve responsible for sensory innervation of the perineum and a mediator of sexual arousal and orgasm.

BackgroundDegenerative deformities of the spine have traditionally been treated with extensive open surgeries. However, these open procedures are associated with a high degree of surgical morbidity. In this study, we explore whether clinical improvement in patients with spinal deformities can be achieved using a new minimally invasive surgery (MIS) called oblique lateral lumbar interbody fusion (OLLIF). OLLIF is a MIS single surgeon procedure in which the disc is approached through Kambin’s triangle. OLLIF can achieve correction of spinal deformities through careful cage placement.PurposeThe purpose of this study is to establish the safety and efficacy of using OLLIF to correct spinal deformities and to collect early outcome data. Collected data includes perioperative outcomes, patient reported outcomes, and radiographic outcomes.Study Design/SettingThis study is a retrospective review of 37 OLLIF surgeries in 36 patients with symptomatic degenerative spinal deformity. Collected perioperative data included surgery time, blood loss, and hospital stay. Follow-up was conducted at least 150 days post surgery. We recorded complications and patient reported outcomes such as Oswestry Disability Index (ODI) and pain scale. Imaging was conducted pre- and post-surgery. Fusion rates and changes in Cobb angle were also measured.ResultsA total of 37 surgeries that treated 100 vertebral levels were performed. For two and three level procedures, respectively, the mean blood loss was 83 and 178 ml, the average surgery time was 74 and 158 minutes and the average hospital stay was 2.6 and 3.3 days. The patients ambulated within 24 hours in all but two cases. The patients reported pain improvements on the ten-point pain scale from 8.3 to 3.7 (p<0.001) and on the ODI from 53% to 32%. Cobb angles decreased from 16° to 9.3° (p<0.001), amounting to 2.5° of correction per level of surgery. Detailed imaging was reviewed by independent radiologists for 24 cases and 100% interbody fusion was achieved along with 71% right posterolateral and 74% left posterolateral fusion. There were three cases of mild nerve irritation/neuropraxia and no infections.ConclusionsOLLIF is a safe and effective MIS technique to correct adult degenerative scoliosis. Unlike alternative procedures, OLLIF is technically less complex than comparable procedures and can safely be used from the thoracolumbar junction to S1.DisclosuresH. Abbasi: None.

ObjectivesBetween 1998 and 2008 the number of spinal fusions in the U.S. increased 2.4 fold and the cost per fusion increased 3.3 fold, leading to a 7.9 fold increase in the cost burden of spinal fusions to the U.S. health care system. OLLIF is a new minimally invasive procedure for fusions of the Lumbar spine that can be employed safely and effectively from T12-L1 to L5- S1. OLLIF approaches the disk space through Kambin's triangle. OLLIF does not requiring direct visualization but instead relies on bilateral fluoroscopic imaging and electrophysiological monitoring. OLLIF reduces surgery times and hospital stay compared to TLIF. The purpose of this study is to evaluate the preoperative cost of OLLIF compared to TLIF.Materials and MethodsThe study population are 69 OLLIF patients and 58 open TLIF controls. All patients underwent full course of conservative therapy. Indications were Degenerative Disk Disease, Disk Herniation, Listhesis, Stenosis (except Osteogenic Stenosis). This is a retrospective cohort study. All surgeries were single surgeon procedures and all TLIF cases were completed before the surgeon started performing OLLIF. We recorded surgery time, length of stay and infection rates. Perioperative outcomes were monetized by using a multiplier approach. OR Time was monetized at $ 83.51/minute and hospital stay at $ 2197/day. Infection rate was monetized relative to a 2.4% infection rate for open procedures.ResultsOLLIF cuts surgery times and hospital stay in half relative to TLIF (59/132 min, 4.7/2.3 days respectively). When these differences are monetized, OLLIF reduces the average cost per surgery relative to TLIF by $11,834 per surgery, with higher cost reductions for multi-level procedures. In over 500 OLLIF procedures to date, there have been no deep infections requiring drainage and only a single superficial infection (0.2%). We estimate that thereduction in infections saves an additional $316 per surgery, for a total cost reduction of $12,150.DiscussionIn 2008, there were 207,495 lumbar fusions in the U.S. [1]. By saving $12,150 per surgery relative to the current standard of care, OLLIF could reduce U.S. healthcare expenditures by over $2.5bn. We are currently conducting a detailed study of the costs of OLLIF relative to TLIF. This study will include direct health care costs such as provider visits, injections, diagnostic tests, medication, and devices, as well as indirect health costs and productivity losses due to disability.ConclusionsOLLIF is a new MIS spinal fusion that reduces perioperative costs relative to open surgery and could potentially reduce U.S. healthcare expenditures by $2.5bn per year, through the preoperative cost savings alone. A comprehensive cost analysis is under way.DisclosuresH. Abbasi: None.