Sacroiliac Pain: Structural Causes of Pain Referring to the SI Joint Region.

BACKGROUND: The currently reported incidence of primary sacroiliac joint (SIj) pathology ranges from 15% to 30%. The differential diagnosis of SIj region pain includes pain generated from the lumbar spine, the SIj, and the hip joint. The origins of SIj dysfunctions are controversial and pain generation from this joint has been questioned. PURPOSE: Retrospectively analyze the relative incidence of lumbar spine, SIj, and hip joint etiologies in patients complaining of ≥50% SIj region pain. STUDY DESIGN: This is a retrospective cohort case series. METHODS: Inclusion criteria: chief complaint SIj pain (≥50% of overall complaint). In total, 124 patients charts were reviewed from a single spine surgeon's clinic. All patients were evaluated by the same 2 practitioners and all cases were reviewed for clinical examination findings, diagnostic tests performed, final diagnosis, treatment, and clinical follow-up. RESULTS: After complete diagnostic workup, 112 (90%) had lumbar spine pain, 5 (4%) had hip pain, 4 (3%) had primary SIj pain, and 3 (3%) had an undetermined source of pain upon initial diagnosis. SIj pain generation was confirmed via fluoroscopy-guided diagnostic injections. Following designated treatment, 11 (9%) patients returned to clinic at an average of 2.4 years complaining of continued/recurrent SIj region pain. Further investigation revealed 6 patients had confirmed pain generation from the lumbar spine, 3 patients had confirmed pain generation from the SIj, and 2 patients had undetermined sources of pain. CONCLUSIONS: The SIj is a rare pain generator (3%-6%) in patients complaining of ≥50% SIj region pain and is a common site of referral pain from the lumbar spine (88%-90%). Clinicians ought to quantify areas of pain (via percent of overall complaint) when interviewing their patients complaining of low back pain to distinguish potential pain generators. Recommended breakdown of areas of interest include axial low back, SIj region, buttock/leg, groin/anterior thigh.

Navigation accuracy comparing non-covered frame and use of plastic sterile drapes to cover the reference frame in 3D acquisition.

BACKGROUND: Advancements in surgical navigation technology coupled with 3-dimensional (3D) radiographic data have significantly enhanced the accuracy and efficiency of spinal fusion implant placement. Increased usage of such technology has led to rising concerns regarding maintenance of the sterile field, as makeshift drape systems are fraught with breaches thus presenting increased risk of surgical site infections (SSIs). A clinical need exists for a sterile draping solution with these techniques. Our objective was to quantify expected accuracy error associated with 2MM and 4MM thickness Sterile-Z Patient Drape® using Medtronic O-Arm® Surgical Imaging with StealthStation® S7® Navigation System. Camera distance to reference frame was investigated for contribution to accuracy error. METHODS: A testing jig was placed on the radiolucent table and the Medtronic passive reference frame was attached to jig. The StealthStation® S7® navigation camera was placed at various distances from testing jig and the geometry error of reference frame was captured for three different drape configurations: no drape, 2MM drape and 4MM drape. The O-Arm® gantry location and StealthStation® S7® camera position was maintained and seven 3D acquisitions for each of drape configurations were measured. Data was analyzed by a two-factor analysis of variance (ANOVA) and Bonferroni comparisons were used to assess the independent effects of camera angle and drape on accuracy error. RESULTS: Median (and maximum) measurement accuracy error was higher for the 2MM than for the 4MM drape for each camera distance. The most extreme error observed (4.6 mm) occurred when using the 2MM and the 'far' camera distance. The 4MM drape was found to induce an accuracy error of 0.11 mm (95% confidence interval, 0.06-0.15; P<0.001) relative to the no drape testing, regardless of camera distance. Medium camera distance produced lower accuracy error than either the close (additional 0.08 mm error; 95% CI, 0-0.15; P=0.035) or far (additional 0.21mm error; 95% CI, 0.13-0.28; P<0.001) camera distances, regardless of whether a drape was used. CONCLUSIONS: In comparison to the 'no drape' condition, the accuracy error of 0.11 mm when using a 4MM film drape is minimal and clinically insignificant.

Recombinant human bone morphogenetic protein-2-augmented transforaminal lumbar interbody fusion for the treatment of chronic low back pain secondary to the homogeneous diagnosis of discogenic pain syndrome: two-year outcomes.

STUDY DESIGN: A retrospective observational study. OBJECTIVE: To assess clinical outcomes, perioperative complications, revision surgery rates, and recombinant human bone morphogenetic protein-2 (BMP-2)-related osteolysis, heterotopic bone, and unexplained postoperative radiculitis (BMPP) in a group of patients treated with BMP-2-augmented transforaminal lumbar interbody fusion (bTLIF) for the homogeneous diagnosis of discogenic pain syndrome (DPS) and to put forth the algorithm used to make the diagnosis. SUMMARY OF BACKGROUND DATA: There is a paucity of literature describing outcomes of TLIF for the homogeneous diagnosis of DPS, an old but controversial member of the lumbar degenerative disease family. METHODS: The registry from a single surgeon was queried for patients who had undergone bTLIF for the homogeneous diagnosis of DPS, which was made via specific diagnostic algorithm. Clinical outcomes were determined by analyzing point improvement from typical outcome questionnaires and the data from Patient Satisfaction and Return to Work questionnaires. Independent record review was used to assess all outcomes. RESULTS: Eighty percent of the cohort (36/45) completed preoperative and postoperative outcome questionnaires at an average follow-up of 41.9 ± 11.9 months, which demonstrated significant clinical improvement: Oswestry Disability Index = 16.4 (P < 0.0001), 12-Item Short Form Health Survey physical component summary score = 10.0 (P < 0.0001), and a Numeric Rating Scale for back pain = 2.3 (P < 0.0001). The median patient satisfaction score was 9.0 (10 = complete satisfaction), and 84.4% (27/32) of the cohort were able to return to their preoperative job, with or without modification. There were 3 perioperative complications, 4 revision surgical procedures, and 11 cases of benign BMPP. There were no incidents of the intraoperative dural tears or nerve root injury, and litigation involvement (11/36, P > 0.17), preoperative depression (15/36, P > 0.19) or prior discectomy/decompression (14/36, P < 0.37) was not a predictor of outcomes. CONCLUSION: Although limited by retrospective design and small cohort, the results of this investigation suggest that bTLIF is a reasonable treatment option for patients who experience DPS and affords high patient satisfaction. A larger study is needed to confirm these findings. LEVEL OF EVIDENCE: 4.