Single Incision Posteromedial to Ventrolateral (PML) Surgical Technique for Minimally Invasive Sacroiliac Joint Fusion.

Abstract

Sacroiliac joint fusion transfixing procedures place implants across 3 bone cortices. The most studied trajectory is lateral to medial. While the safety and effectiveness of this trajectory have been well documented, concerns of vascular injury involving the branches of the SGA over the lateral ilium have been raised. In heavier patients, a straight lateral-to-medial trajectory frequently requires traversing through a significant amount of soft tissue. While the posterolateral transfixing trajectory decreases the amount of soft tissue dissection, concerns of inferior patient outcomes and biomechanical stability have been published. Herein, we describe a new transfixing procedure for SIJ fusion with implants starting on the dorsal sacrum with a posteromedial to ventrolateral (sacro-alar iliac) implant trajectory. A case video of posteriomedial to ventrolateral SIJ fusion demonstrates the operative technique and is accompanied by a step-by-step description of this technique. Four cases are presented. The posteromedial to ventrolateral operative trajectory allows for minimally invasive bilateral SIJ fusion through a single incision with minimal tissue disruption and avoids branches of the superior gluteal artery.