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Objective: Reoperations for spinopelvic failure after adult spinal deformity (ASD) surgery are common. We sought to determine the added costs of ASD surgery attributable to reoperations for spinopelvic construct failures., Methods: We constructed a Markov process model to calculate the expected discounted 5-year costs of spinopelvic construct failures after ASD surgery. The Nationwide Inpatient Sample (NIS) was queried to estimate the number of ASD surgeries. Model inputs were based on literature review and expert opinion. ASD surgery was defined as thoracolumbar fusion of 4 or more levels with pelvic fixation. The following pelvic fixation failures were included: 1) rod fracture or pseudarthrosis from L4-S1, 2) iliac screw failure or set plug dislodgment, 3) iliac screw prominence, and 4) sacroiliac (SI) joint pain. The number of patients undergoing ASD surgery annually in the US was determined using a commercial claims database., Results: The net present value 5-year cost per patient for spinopelvic complications was $35,265, equal to 29% of index surgery costs. Given an estimated 27,580 cases annually in the US, the additional cost to address spinopelvic complications reach nearly $1 billion over 5-years. A sensitivity analysis showed that these costs were most sensitive to the rate of rod fracture/pseudarthrosis, iliac screw prominence, and reoperation., Conclusion: A conservative estimate of the cost of spinopelvic failures after ASD surgery is substantial, nearly $1 billion over 5-years. We propose a method of capturing spinopelvic fixation failures for use in future clinical studies and cost analyses., Competing Interests: Dr Daniel Cher and Dr Robyn Capobianco are employees of SI-BONE. SI-BONE manufactures devices used in spine surgery. The manuscript does not discuss these devices. Dr Daniel Sciubba reports personal fees from DePuy, Medtronic, Stryker, Nuvasive, Baxter, and SI Bone, outside the submitted work. Dr David Polly reports personal fees from SI Bone and Globus, during the conduct of the study; grants from Medtronic and MizuhoOSI, outside the submitted work. In addition, Dr David Polly has patents US 11,571,245 B2. February 7, 2023, US 11,234,830 B2. February 1, 2022, and US 11,369,419 B2. June 28, 2022 with royalties paid to SI Bone. The authors report no other conflicts of interest in this work., (© 2023 Zuckerman et al.)

Competing Interests: AK reports consulting fees and royalties from a non-study device from SI-BONE, GD reports teaching honoraria from SI-BONE, Inc., JC has nothing to disclose, MT reports consulting fees from CoreLink, WJ reports consulting fees from Abbott Labs and Boston Scientific, DS has nothing to disclose, AB has a contract for teaching or speaking engagements on behalf of SI-BONE, JS reports consulting fees from SI-BONE. RC and WR are employees of a device manufacturer. The authors report no other conflicts of interest in this communication.

Background: Distraction arthrodesis (DA) and stabilization of the sacroiliac (SI) joint by placing standalone structural allograft (SA) into the joint from a posterior trajectory has recently been introduced as a surgical procedure for chronic SI joint pain refractory to non-operative care., Methods: Retrospective case series of patients with recurrent and/or persistent pain after placement of one or more interpositional/intraarticular standalone SAs between the ilium and sacrum using a posterior procedure to treat SI joint pain/dysfunction. Patients subsequently underwent surgical revision with porous titanium fusion implants using a lateral transfixing procedure. The demographic, clinical, and radiographic features of these cases are described., Results: Data were available for 37 patients. The average (SD) age was 57 (13) years, 62% were female, and the average BMI was 31 (5.4). On average, two SA implants were placed per joint; 46% of cases were bilateral. At follow-up, two common themes were identified: lucencies around the implants and suboptimal implant position. None of the cases showed radiographic fusion of the SI joint prior to revision. One patient had an inflammatory reaction to the SA. All patients presented for revision due to either continued (49%) or recurrence (51%) of pain. In one revision case, the SA was forced ventrally, resulting in a sacral fracture, which was treated conservatively without sequelae., Conclusions: The popularity of standalone SA for SI joint stabilization/fusion with a posterior procedure is increasing. This case series demonstrates that clinical failures from this procedure may require surgical revision. The proposed fusion strategy (DA) for these products is unproven in the SI joint, and, therefore, properly conducted prospective randomized clinical trials with long-term clinical and radiographic follow-up are important to establish the safety and efficacy of this approach. In the meantime, the placement of lateral titanium implants appears to be an effective revision strategy., Competing Interests: AK reports consulting fees from SI-BONE; in addition, Dr Andy Kranenburg has a patent Torq implant with royalties paid to SI Bone. GD reports teaching honoraria from SI-BONE, Inc., JC has nothing to disclose, MT reports consulting fees from CoreLink, WJ reports consulting fees from Abbott Labs and Boston Scientific, DS has nothing to disclose, AB has contract for any teaching or speaking engagements on behalf of SI Bone, JS reports consulting fees from SI-BONE. RC and WR are employees of a device manufacturer., (© 2022 Kranenburg et al.)

Introduction: Surgical revision rate is a key outcome with all permanent implants. The iFuse Implant System(®) is a permanent implant used to perform minimally invasive sacroiliac joint fusion. The purpose of this study is to determine the surgical revision rate after sacroiliac joint fusion surgery with this system., Methods: Using two internal sources of information, revision surgeries were identified and linked to index surgeries. The likelihood of revision surgery was calculated using the Kaplan-Meier life table approach. Predictors of revision were explored., Results: Four-year survivorship free from implant revision was 96.46%. Revision rate did not differ by sex and was lower for age >65. In all, 24% of revisions occurred within the first 30 days after surgery; 63.5% occurred within year 1. Implant survivorship has improved annually since the device was introduced in 2009., Conclusion: The survivorship rate with this implant is high and improving; the rate is somewhat higher than total hip replacement but lower than that of lumbar spine procedures.

Background: Sacroiliac joint (SI) pain is an often-overlooked cause of lower-back pain, due in part to a lack of specific findings on radiographs and a symptom profile similar to other back-related disorders. A minimally invasive surgical (MIS) approach to SI joint fusion using a series of triangular, titanium plasma spray-coated implants has shown favorable outcomes in patients with SI joint pain refractory to conservative care. The aim of this study was to provide a multicenter experience of MIS SI joint fusion using a patient-level analysis., Patients and Methods: We report a patient-level analysis from 144 patients with a mean of 16 months postoperative follow-up. Demographic information, perioperative measures, complications, and clinical outcomes using a visual analog scale for pain were collected prospectively. Random-effects regression models were used to account for intersite variability., Results: The mean age was 58 years, 71% of patients were female, and 62% had a history of lumbar spinal fusion. Mean (95% confidence interval [CI]) operative time was 73 minutes (25.4-118), blood loss was minimal, and hospital stay was 0.8 days (0.1-1.5). At follow-up, mean (95% CI) visual analog scale pain scores improved by 6.1 points (5.7-6.6). Substantial clinical benefit, defined as a decrease in pain by >2.5 points or a score of 3.5 or less, was achieved in 91.9% of patients (95% CI 83.9%-96.1%), and 96% (95% CI 86.3%-98.8%) of patients indicated they would have the same surgery again., Conclusion: When conservative measures fail to relieve symptoms resulting from degeneration or disruption of the SI joint, MIS SI joint fusion using a series of triangular, porous, titanium plasma spray-coated implants is a safe and effective treatment option.