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Sacroiliac Joint Techniques 1st Edition Abdelsayed Md

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SACROILIAC JOINT TECHNIQUES .
SACROILIAC JOINT TECHNIQUES Alaa Abd-Elsayed, MD, MPH, CPE, FASA Medical Director, UW Health Pain Services Medical Director, UW Pain Clinic Division Chief, Chronic Pain Management Department of Anesthesiology University of Wisconsin Madison, Wisconsin United States Atlas of Interventional Pain Management Series .
Elsevier 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 SACROILIAC JOINT TECHNIQUES ISBN: 978-0-323-87754-1 Atlas of Interventional Pain Management Series Copyright © 2024 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Executive Content Strategist: Michael Houston† Senior Content Development Specialist: Malvika Shah Publishing Services Manager: Shereen Jameel Project Manager: Nandhini Thanga Alagu Design Direction: Patrick C. Ferguson Printed in India Last digit is the print number: 9 8 7 6 5 4 3 2 1 .
List of Contributors Hamid R Abbasi, MD, PhD Chief Medical Officer, Inspired Spine Burnsville, Minnesota United States Alaa Abd-Elsayed, MD, MPH, CPE, FASA Medical Director, UW Health Pain Services Medical Director, UW Pain Clinic Division Chief, Chronic Pain Management Department of Anesthesiology University of Wisconsin Madison, Wisconsin United States Ali Arastu, MD University of Chicago Hospital Anesthesia and Critical Care University of Chicago, Hyde Park Chicago, Illinois United States Ryan Budwany, MD, MBA, MPH Pain Medicine Center for Spine and Nerve Charleston, West Virginia United States Ahish Chitneni, DO Department of Rehabilitation and Regenerative Medicine New York-Presbyterian Hospital—Columbia and Cornell New York, New York United States Emmanuel Faluade, MD Department of Anesthesiology, Perioperative Care, Pain Medicine New York University Langone Health New York, New York United States George Girgis, DO Assistant Professor of Anesthesiology Lerner College of Medicine of Case Western Reserve University Staff Pain Management Department Anesthesiology Institute Cleveland Clinic Cleveland, Ohio United states Christopher Haddad John Carroll University Cleveland, Ohio United States Nasir Hussain, MD, MSc Anesthesiology The Ohio State University, Wexner Medical Center Columbus, Ohio United States Meera Kirpekar, MD Assistant Professor Department of Anesthesiology, Perioperative Care, and Pain Medicine NYU Langone New York, New York United States Tariq Malik, MD Associate Professor Anesthesia and Critical Care University of Chicago Chicago, Illinois United States Yeshvant A. Navalgund, MD Assistant Professor Anesthesiology and pain medicine West Virginia University Morgantown, West Virginia United States vi .
List of Contributors vii Evan Parker, MD Pain Management Department Anesthesiology Institute Cleveland Clinic Foundation Cleveland, Ohio United states Divya Patel, MD Department of Anesthesiology, Perioperative Care, Pain Medicine New York University Langone Health New York, New York United States Nicholas R. Storlie Creighton University School of Medicine Omaha, Nebraska United States Timothy J. Woodin, MD The Ohio State University Wexner Medical Center Department of Anesthesiology Columbus, Ohio United States Christine Zaky Loyola University, Chicago Stritch School of Medicine Chicago, Illinois United States John Zaky John Carroll University Cleveland, Ohio United States Sherif Zaky, MD, MSc, PhD Professor of Anesthesiology Ohio University Medical Director of Pain Management Services Firelands Health System Ohio, United States .
Preface The sacroiliac joint is a major contributor to symp- toms of low back pain across a wide range of age groups. Sacroiliac joint pain was described decades ago, but early treatment options were limited to medical therapeutics, steroid injections, and radiofre- quency ablation procedures. Recently, the sacroiliac joint has been identified as an anatomical location amenable to interventional procedures that result in treatment of sacroiliac joint pain syndromes. Novel interventions include neuromodulation and joint fusion. Diverse pain management systems for both neuromodulation and joint fusion serve to broaden the available treatment options available to the interventional pain physician. With these advancements, there remains a need to master surgical techniques and skills to facilitate the safe and efficient performance of these procedures. This atlas provides a comprehensive guide to the traditional and advanced procedures utilized in the treatment of sacroiliac joint pain conditions. The book leverages liberal utilization of high-quality anatomical and radiographic figures to provide a comprehensive guide to performing procedures aimed at alleviating sacroiliac joint pain syndromes. I would like to thank the authors and publisher for their efforts and dedication to writing and producing this atlas that I hope will be guide for physicians all over the world. Alaa Abd-Elsayed, MD, MPH, CPE, FASA viii .
Contents 1. Anatomy of the Sacroiliac Joint, 1 John Zaky, Christopher Haddad, and Sherif Zaky 2. Surgical Instruments, 6 Ali Arastu and Tariq Malik 3. Sacroiliac Joint Injection Techniques, 35 Ali Arastu and Tariq Malik 4. Sacral Lateral Branch Nerve Block, 44 Evan Parker, Christine Zaky, and George Girgis 5. Sacroiliac Joint Radiofrequency Ablation, 48 Timothy J. Woodin, Nasir Hussain, and Alaa Abd-Elsayed 6. Peripheral Nerve Stimulation of the Sacroiliac Joint, 57 Ryan Budwany, Alaa Abd-Elsayed, and Yeshvant Navalgund 7. Sacroiliac Joint Posterior Fusion, 62 Alaa Abd-Elsayed and Ahish Chitneni 8. Lateral Sacroiliac Joint Fusion, 71 Hamid R. Abbasi, Alaa Abd-Elsayed, and Nicholas R. Storlie 9. Measuring Outcomes of Improvement, 88 Meera Kirpekar, Emmanuel Faluade, and Divya Patel Index, 99 ix .
spinal joint in the body and is approximately 17.5 cm2 .2 The SIJ is a true diarthrodial joint that is more mobile in youth than later in life. The female pelvis is also more mobile to accommodate pregnancy and parturition.3,4 This joint has at multiple junctures a fibrous joint capsule that contains a thick synovial fluid, cartilaginous surfaces, and numerous ligamen- tous connections. It is different from other synovial joints in that the iliac articulation is made of fibrocar- tilage rather than hyaline cartilage. The sacroiliac joint (SIJ) is a highly complex joint that provides stability and support to the upper body (Fig. 1.1). The specific structure and tight- ness of the fibrous apparatus of the SIJ results in its limited mobility. The importance of the SIJ as a stress reliever between the trunk and lower limbs has been emphasized.1 This joint ensures that the pelvic girdle is not a sold ring of bones that can easily break under routine stresses it might be subject to. The SIJ is known to be the largest axial Chapter 1 Anatomy of the Sacroiliac Joint John Zaky, Christopher Haddad, and Sherif Zaky Sacroliac joint Pubic symphysis Ilium Ilium Sacrum Fig. 1.1 Bony anatomy of the sacroiliac joint. (Source: Waldman SD. Atlas of Interventional Pain Management. 5th ed. Philadelphia: Elsevier; 2021.) 1 .
Sacroiliac Joint Techniques 2 Bony Anatomy There is great variance in shape and size of the bony anatomy of the SIJ among individuals5 (Fig. 1.2). From infancy to adulthood, notable changes in the joint oc- cur.6 The articular surface of the sacrum is generally concave, and the iliac surface is predominantly convex. The SIJ has numerous ridges and grooves compared with a typical synovial joint. This characteristic of the joint minimizes movement, further enhancing stability.7 The ventral aspect of the SIJ frequently has defects that allows fluid in the joint to leak out to the surrounding structures.8 Sacralization, or fusion of the fifth lumbar vertebrae into the body of the sacrum, occurs in about 6% of American adults.9 Fusion between the L5 and S1 ver- tebrae can occur at one or more locations, such as be- tween transverse processes, vertebral bodies, or facet joints. Accessory SIJs have been described as extracap- sular articulations for biomechanical enhancement.10 Fig. 1.2 Fluoroscopic anatomy of the sacroiliac joint. (Source: Waldman SD. Atlas of Interventional Pain Management. 5th ed. Philadelphia: Elsevier; 2021.) .
1 Anatomy of the Sacroiliac Joint 3 Ligaments and Muscles Supporting the Sacroiliac Joint The SIJ is mainly designed to support stability and weight bearing with only small degrees of rotation and translation allowed.7,11 Joint stability is enforced by multiple ligaments that include the anterior sacroiliac ligament (ASL), posterior sacroiliac ligament (PSL), sacrospinous ligament (SSL), sacrotuberous ligament (STL), and interosseous ligament (which is considered the strongest)2,4 (Figs. 1.3 and 1.4). The interosseous sacroiliac ligament encloses the axial joint and fills the spaces dorsal and caudal to the synovial joint. It has the most extensive bony attachment and volume Anterior longitudinal ligament Iliolumbar ligament Anterior sacroiliac ligament Anterior and lateral sacrococcygeal ligaments Iliofemoral ligament Pubofemoral ligament Sacrospinous ligament Arcuate pubic ligament Pubic symphysis Greater sciatic foramen Sacrospinous ligament Sacrotuberous ligament Fig. 1.3 The anterior ligaments of the sacroiliac joint. (Source:Waldman SD. Atlas of Interventional Pain Management. 5th ed. Philadelphia: Elsevier; 2021.) Posterior sacroiliac ligament Greater sciatic foramen Sacrospinous ligament Sacrotuberous ligament Deep posterior sacrococcygeal ligament Lateral sacrococcygeal ligament Ischiofemoral ligament Supraspinous ligament Superficial posterior sacrococcygeal ligament Fig. 1.4 The posterior ligaments of the sacroiliac joint. (Source: Waldman SD. Atlas of Interventional Pain Management. 5th ed. Philadelphia: Elsevier; 202 .
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    SACROILIAC JOINT TECHNIQUES Alaa Abd-Elsayed, MD,MPH, CPE, FASA Medical Director, UW Health Pain Services Medical Director, UW Pain Clinic Division Chief, Chronic Pain Management Department of Anesthesiology University of Wisconsin Madison, Wisconsin United States Atlas of Interventional Pain Management Series .
  • 7.
    Elsevier 1600 John F.Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 SACROILIAC JOINT TECHNIQUES ISBN: 978-0-323-87754-1 Atlas of Interventional Pain Management Series Copyright © 2024 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Executive Content Strategist: Michael Houston† Senior Content Development Specialist: Malvika Shah Publishing Services Manager: Shereen Jameel Project Manager: Nandhini Thanga Alagu Design Direction: Patrick C. Ferguson Printed in India Last digit is the print number: 9 8 7 6 5 4 3 2 1 .
  • 8.
    List of Contributors HamidR Abbasi, MD, PhD Chief Medical Officer, Inspired Spine Burnsville, Minnesota United States Alaa Abd-Elsayed, MD, MPH, CPE, FASA Medical Director, UW Health Pain Services Medical Director, UW Pain Clinic Division Chief, Chronic Pain Management Department of Anesthesiology University of Wisconsin Madison, Wisconsin United States Ali Arastu, MD University of Chicago Hospital Anesthesia and Critical Care University of Chicago, Hyde Park Chicago, Illinois United States Ryan Budwany, MD, MBA, MPH Pain Medicine Center for Spine and Nerve Charleston, West Virginia United States Ahish Chitneni, DO Department of Rehabilitation and Regenerative Medicine New York-Presbyterian Hospital—Columbia and Cornell New York, New York United States Emmanuel Faluade, MD Department of Anesthesiology, Perioperative Care, Pain Medicine New York University Langone Health New York, New York United States George Girgis, DO Assistant Professor of Anesthesiology Lerner College of Medicine of Case Western Reserve University Staff Pain Management Department Anesthesiology Institute Cleveland Clinic Cleveland, Ohio United states Christopher Haddad John Carroll University Cleveland, Ohio United States Nasir Hussain, MD, MSc Anesthesiology The Ohio State University, Wexner Medical Center Columbus, Ohio United States Meera Kirpekar, MD Assistant Professor Department of Anesthesiology, Perioperative Care, and Pain Medicine NYU Langone New York, New York United States Tariq Malik, MD Associate Professor Anesthesia and Critical Care University of Chicago Chicago, Illinois United States Yeshvant A. Navalgund, MD Assistant Professor Anesthesiology and pain medicine West Virginia University Morgantown, West Virginia United States vi .
  • 9.
    List of Contributorsvii Evan Parker, MD Pain Management Department Anesthesiology Institute Cleveland Clinic Foundation Cleveland, Ohio United states Divya Patel, MD Department of Anesthesiology, Perioperative Care, Pain Medicine New York University Langone Health New York, New York United States Nicholas R. Storlie Creighton University School of Medicine Omaha, Nebraska United States Timothy J. Woodin, MD The Ohio State University Wexner Medical Center Department of Anesthesiology Columbus, Ohio United States Christine Zaky Loyola University, Chicago Stritch School of Medicine Chicago, Illinois United States John Zaky John Carroll University Cleveland, Ohio United States Sherif Zaky, MD, MSc, PhD Professor of Anesthesiology Ohio University Medical Director of Pain Management Services Firelands Health System Ohio, United States .
  • 10.
    Preface The sacroiliac jointis a major contributor to symp- toms of low back pain across a wide range of age groups. Sacroiliac joint pain was described decades ago, but early treatment options were limited to medical therapeutics, steroid injections, and radiofre- quency ablation procedures. Recently, the sacroiliac joint has been identified as an anatomical location amenable to interventional procedures that result in treatment of sacroiliac joint pain syndromes. Novel interventions include neuromodulation and joint fusion. Diverse pain management systems for both neuromodulation and joint fusion serve to broaden the available treatment options available to the interventional pain physician. With these advancements, there remains a need to master surgical techniques and skills to facilitate the safe and efficient performance of these procedures. This atlas provides a comprehensive guide to the traditional and advanced procedures utilized in the treatment of sacroiliac joint pain conditions. The book leverages liberal utilization of high-quality anatomical and radiographic figures to provide a comprehensive guide to performing procedures aimed at alleviating sacroiliac joint pain syndromes. I would like to thank the authors and publisher for their efforts and dedication to writing and producing this atlas that I hope will be guide for physicians all over the world. Alaa Abd-Elsayed, MD, MPH, CPE, FASA viii .
  • 11.
    Contents 1. Anatomy ofthe Sacroiliac Joint, 1 John Zaky, Christopher Haddad, and Sherif Zaky 2. Surgical Instruments, 6 Ali Arastu and Tariq Malik 3. Sacroiliac Joint Injection Techniques, 35 Ali Arastu and Tariq Malik 4. Sacral Lateral Branch Nerve Block, 44 Evan Parker, Christine Zaky, and George Girgis 5. Sacroiliac Joint Radiofrequency Ablation, 48 Timothy J. Woodin, Nasir Hussain, and Alaa Abd-Elsayed 6. Peripheral Nerve Stimulation of the Sacroiliac Joint, 57 Ryan Budwany, Alaa Abd-Elsayed, and Yeshvant Navalgund 7. Sacroiliac Joint Posterior Fusion, 62 Alaa Abd-Elsayed and Ahish Chitneni 8. Lateral Sacroiliac Joint Fusion, 71 Hamid R. Abbasi, Alaa Abd-Elsayed, and Nicholas R. Storlie 9. Measuring Outcomes of Improvement, 88 Meera Kirpekar, Emmanuel Faluade, and Divya Patel Index, 99 ix .
  • 12.
    spinal joint inthe body and is approximately 17.5 cm2 .2 The SIJ is a true diarthrodial joint that is more mobile in youth than later in life. The female pelvis is also more mobile to accommodate pregnancy and parturition.3,4 This joint has at multiple junctures a fibrous joint capsule that contains a thick synovial fluid, cartilaginous surfaces, and numerous ligamen- tous connections. It is different from other synovial joints in that the iliac articulation is made of fibrocar- tilage rather than hyaline cartilage. The sacroiliac joint (SIJ) is a highly complex joint that provides stability and support to the upper body (Fig. 1.1). The specific structure and tight- ness of the fibrous apparatus of the SIJ results in its limited mobility. The importance of the SIJ as a stress reliever between the trunk and lower limbs has been emphasized.1 This joint ensures that the pelvic girdle is not a sold ring of bones that can easily break under routine stresses it might be subject to. The SIJ is known to be the largest axial Chapter 1 Anatomy of the Sacroiliac Joint John Zaky, Christopher Haddad, and Sherif Zaky Sacroliac joint Pubic symphysis Ilium Ilium Sacrum Fig. 1.1 Bony anatomy of the sacroiliac joint. (Source: Waldman SD. Atlas of Interventional Pain Management. 5th ed. Philadelphia: Elsevier; 2021.) 1 .
  • 13.
    Sacroiliac Joint Techniques 2 BonyAnatomy There is great variance in shape and size of the bony anatomy of the SIJ among individuals5 (Fig. 1.2). From infancy to adulthood, notable changes in the joint oc- cur.6 The articular surface of the sacrum is generally concave, and the iliac surface is predominantly convex. The SIJ has numerous ridges and grooves compared with a typical synovial joint. This characteristic of the joint minimizes movement, further enhancing stability.7 The ventral aspect of the SIJ frequently has defects that allows fluid in the joint to leak out to the surrounding structures.8 Sacralization, or fusion of the fifth lumbar vertebrae into the body of the sacrum, occurs in about 6% of American adults.9 Fusion between the L5 and S1 ver- tebrae can occur at one or more locations, such as be- tween transverse processes, vertebral bodies, or facet joints. Accessory SIJs have been described as extracap- sular articulations for biomechanical enhancement.10 Fig. 1.2 Fluoroscopic anatomy of the sacroiliac joint. (Source: Waldman SD. Atlas of Interventional Pain Management. 5th ed. Philadelphia: Elsevier; 2021.) .
  • 14.
    1 Anatomy ofthe Sacroiliac Joint 3 Ligaments and Muscles Supporting the Sacroiliac Joint The SIJ is mainly designed to support stability and weight bearing with only small degrees of rotation and translation allowed.7,11 Joint stability is enforced by multiple ligaments that include the anterior sacroiliac ligament (ASL), posterior sacroiliac ligament (PSL), sacrospinous ligament (SSL), sacrotuberous ligament (STL), and interosseous ligament (which is considered the strongest)2,4 (Figs. 1.3 and 1.4). The interosseous sacroiliac ligament encloses the axial joint and fills the spaces dorsal and caudal to the synovial joint. It has the most extensive bony attachment and volume Anterior longitudinal ligament Iliolumbar ligament Anterior sacroiliac ligament Anterior and lateral sacrococcygeal ligaments Iliofemoral ligament Pubofemoral ligament Sacrospinous ligament Arcuate pubic ligament Pubic symphysis Greater sciatic foramen Sacrospinous ligament Sacrotuberous ligament Fig. 1.3 The anterior ligaments of the sacroiliac joint. (Source:Waldman SD. Atlas of Interventional Pain Management. 5th ed. Philadelphia: Elsevier; 2021.) Posterior sacroiliac ligament Greater sciatic foramen Sacrospinous ligament Sacrotuberous ligament Deep posterior sacrococcygeal ligament Lateral sacrococcygeal ligament Ischiofemoral ligament Supraspinous ligament Superficial posterior sacrococcygeal ligament Fig. 1.4 The posterior ligaments of the sacroiliac joint. (Source: Waldman SD. Atlas of Interventional Pain Management. 5th ed. Philadelphia: Elsevier; 202 .
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    Orchard Damerel. The TromlettDiamonds. The Wooing of May. A Tragic Honeymoon. A Proctor’s Wooing. Fortune’s Gate. Bonnie Maggie Lauder. Mary Unwin. Mrs. Dunbar’s Secret. By JOHN STAFFORD.—Doris and I. By R. STEPHENS.—The Cruciform Mark. By R. NEILSON STEPHENS. Philip Winwood. By R. A. STERNDALE.—The Afghan Knife. By R. L. STEVENSON.—The Suicide Club. By FRANK STOCKTON. The Young Master of Hyson Hall. By SUNDOWNER. Told by the Taffrail. By ANNIE THOMAS.—The Siren’s Web. By BERTHA THOMAS.—The Violin-Player. By FRANCES E. TROLLOPE. Like Ships upon Sea. Anne Furness. Mabel’s Progress. By ANTHONY TROLLOPE. The Way we Live Now. Frau Frohmann. Marion Fay. Scarborough’s Family. The Land-Leaguers.
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    By IVAN TURGENIEFF,c. Stories from Foreign Novelists. By MARK TWAIN. Choice Works. Library of Humour. The Innocents Abroad. Roughing It; and The Innocents at Home. A Tramp Abroad. The American Claimant. Adventures of Tom Sawyer. Tom Sawyer Abroad. Tom Sawyer, Detective. Pudd’nhead Wilson. The Glided Age. Prince and the Pauper. Life on the Mississippi. The Adventures of Huckleberry Finn. A Yankee at the Court of King Arthur. Stolen White Elephant. £1,000,000 Bank-note. By C. C. F.-TYTLER.—Mistress Judith. By SARAH TYTLER. What She Came Through. Buried Diamonds. The Blackhall Ghosts. The Macdonald Lass. Witch-Wife. Sapphira. Mrs. Carmichael’s Goddesses. Rachel Langton. A Honeymoon’s Eclipse. A Young Dragon. By ALLEN UPWARD.
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    The Queen againstOwen. By ALBERT D. VANDAM. A Court Tragedy. By E. A. VIZETELLY.—The Scorpion. By F. WARDEN.—Joan, the Curate. By CY WARMAN.—Express Messenger. By A. WERNER. Chapenga’s White Man. By WILLIAM WESTALL. For Honour and Life. A Woman Tempted Him. Her Two Millions. Two Pinches of Snuff. Nigel Fortescue. Birch Dene. The Phantom City. A Queer Race. Ben Clough. The Old Factory. Red Ryvington. Ralph Norbreck’s Trust. Trust-money. Sons of Belial. Roy of Roy’s Court. With the Red Eagle. Strange Crimes (True Stories). By ATHA WESTBURY. The Shadow of Hilton Fernbrook. By C. J. WILLS.—An Easy-going Fellow. By JOHN STRANGE WINTER. Cavalry Life: and Regimental Legends.
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