Opioid Prescription Monitoring in Preoperative and Postoperative Sacroiliac Joint Fusion Patients.

INTRODUCTION: An estimated 15%-25% of patients with chronic low back pain may in fact suffer from sacroiliac (SI) joint dysfunction. SI joint fusion has become a common treatment option for the management of SI joint dysfunction. However, little is known about opioid use prior to and after surgical treatment in this patient population. METHODS: The medical records of 62 patients treated with SI joint fusion at our institution were reviewed in this retrospective study. The Colorado Prescription Drug Monitoring Program (CPDMP) was accessed to gather opioid prescription information for these patients. Only those patients who had received an opioid prescription within 3 months prior to their surgery were included in the study. Patients who had SI joint fusion but underwent another surgical procedure during the 12-month follow-up period were excluded from analysis. Preoperative (6 and 3 months) and postoperative (3, 6, 9, and 12 months) mean morphine milligram equivalents (MME) were collected from the CPDMP database for each patient. Patient demographic and medical comorbidity data were also documented to identify any correlations or potential risk factors for chronic opioid prescribing. Visual analog scale (VAS), Oswestry Disability Index (ODI), and Denver SI Joint Questionnaire (DSIJQ) scores were recorded for each patient to assess clinical outcomes. RESULTS: At 3 months prior to surgery, patients were prescribed an average of 47.2 mean MME/d. At no point postoperatively did the quantity of opioids, measured in MME/d, change significantly from the 3-month preoperative prescription quantities. There was no significant difference in the quantity of opioids received by men vs women, in patients with vs without anxiety and/or depression, or in younger vs older patients. Low body mass index was correlated with decreased opioid prescriptions at 6 months postoperative but became statistically insignificant again by 9 months postoperative.Significant improvements in VAS scores were recorded for all postoperative clinical evaluation timepoints (at 6 weeks and 3, 6, and 12 months) and compared to preoperative scores. By 12 months, VAS scores had decreased from 6.2 to 3.9 (P < 0.001). This change is not only statistically significant but also meets the criteria for minimum clinically important difference in scores. Both the ODI and DSIJQ patient-reported outcomes scores also showed significant improvements at 12 months after surgery (ODI: 48.9 preoperative vs 24.6 postoperative, P = 0.02; DSIJQ: 53.2 preoperative vs 17.4 postoperative, P = 0.014). The ODI improvement also met the minimum clinically important difference criteria. By 6 months postoperatively, there was no significant correlation in VAS or ODI and opioid use. There was no significant correlation between the DSIJQ scores and the daily dose of opioids at any point postoperatively. CONCLUSION: Quantity of opioid prescriptions received by patients with SI joint pain did not change significantly from 3 months preoperatively to any point postoperatively despite significant improvements in all patient-reported outcome measures. This discordance between long-term opioid requirements and positive clinical outcomes is concerning and warrants further investigation.

Mini-open sacroiliac joint fusion with direct bone grafting and minimally invasive fixation using intraoperative navigation.

BACKGROUND: Describe a novel technique for sacroiliac arthrodesis using intraoperative navigation, direct bone grafting, and minimally invasive implants. Report on the outcomes of the first cohort of these patients. METHODS: Institutional review board (IRB) approved, single center, two surgeon, retrospective study. RESULTS: All patients were 18 years or older, primary sacroiliac fusions, and underwent novel technique described. Fifty patients underwent 57 surgeries. Twelve male/38 female patients. All received three sacroiliac implants. Average blood loss 42.8 mL. Average length of stay 1.9 nights. Average follow-up 13.96±13 months. Statistically significant improvements in Visual Analogue Scale (VAS) scores (<0.001) for all time periods 6 weeks, 3 months, 6 months, 12 months compared to preop. Other outcomes scores [Oswestry Disability Index (ODI), and Denver Sacroiliac Joint Questionnaire (DSIJQ)] also showed a general trend for clinical improvement at all postoperative time periods. Of 2/57 (3.5%) complications were identified. No patients required surgical revision within the study window. CONCLUSIONS: Limited open sacroiliac arthrodesis using minimally invasive implants, intraoperative navigation, and direct open bone grafting is safe and demonstrates clinical benefit, similar to other techniques for minimally invasive sacroiliac arthrodesis. There is potential for improved long-term outcomes from increased union rates. KEYWORDS: Sacroiliac dysfunction; minimally invasive sacroiliac fusion; open sacroiliac fusion; navigation.

One-step Minimally Invasive Pedicle Screw Instrumentation Using O-Arm and Stealth Navigation.

STUDY DESIGN: Description of a navigated, single-step, minimally invasive technique for the placement of pedicle screws. OBJECTIVE: To describe a new technique for minimally invasive placement of pedicle screws in the lumbar spine using O-arm and StealthStation navigation in combination. SUMMARY OF BACKGROUND DATA: Minimally invasive surgical techniques are described in the literature as safe and effective methods for pedicle screw instrumentation. These techniques increase radiation exposure and prompt multiple instrument passes through the pedicle. MATERIALS AND METHODS: In total, 35 adult patients (187 screws) underwent lumbar surgery with pedicle screw placement using the 1- (8 patients/48 screws) or 2-step (27 patients/139 screws) technique. Complications associated with instrumentation were noted. Pedicle screw position was evaluated. RESULTS: Of 187 screws placed, 181 (96.8%) were found to be fully contained within the pedicle (grade 1) and 4 (2.1%) had a breach of <2 mm. In the 1-step technique, no screws were malpositioned. One screw at S1 with inadequate fixation was replaced with a screw 1 mm larger in diameter. In the 2-step technique, 2 screws (1.06% overall) were revised due to inferior breach of the pedicle. No neurological sequelae were noted. Also, 1 screw was deemed too long at S1 and was replaced with a shorter screw. None of the revised pedicle screws caused neuromonitoring changes and the breaches were found intraoperatively on 3D imaging. CONCLUSIONS: Using O-arm and StealthStation navigation with minimally invasive surgical technology for placement of posterior spinal instrumentation is safe, effective, and limits radiation exposure.