Percutaneous arthrodesis

What is a percutaneous arthrodesis?

Percutaneous arthrodesis of the facet or sacroiliac joints is a treatment aiming at fusing joints to relieve pain in patients with facet joint or sacroiliac joint syndrome. Arthrodesis is proposed following the failure of more conservative treatments .

Facet joint syndrome is a form of chronic lower back pain. It is characterised by stiffness and pain that increases when twisting and bending backwards. It is frequently caused by osteoarthritis, a type of arthritis that causes joint cartilage to deteriorate. This can also be caused by the joints bearing an unusual amount of weight as well as by repetitive stress injury. Facet joint syndrome is not easy to diagnose because it may be unclear where the source of the pain is located, making it easy for symptoms to be confused with the many other causes of back pain.

In some cases, lower back pain can be the result of painful sacroiliac joint dysfunction, an inflammation of the sacroiliac joint, which is located at the bottom of the spine. Sacroiliac joint pain is complex and can be expressed in one of several forms, such as buttock pain.

Percutaneous arthrodesis treatment is used to stabilise the movement across t he involved joints. The procedure corrects unwanted spinal motion and unstable facet joints.

How does the procedure work?

You will have a local anaesthetic and be mildly sedated for the procedure.

The interventional radiologist will use X-ray guidance to insert facet screws to the affected area of your spine. The joints are temporarily held together with a wire while the screws are fixed in place. A tissue dilator system is introduced along the wire, and then the fusion implants (usually three for one side) are positioned using a pin. Then, under X-ray guidance, the interventional radiologist will drill and shape the area.

Who is eligible for this intervention?

You may be suitable for percutaneous facet fusion:  if you have sacroiliac joint pain (i.e. a positive result on two diagnostic tests and pain relief of at least 75% from a single diagnostic intra-articular injection), and if you have not responded to medical or physical therapy.

What are the risks?

Risks include the screws loosening, disassembling, bending, dislocating or breaking. This may happen straight after the procedure or may be delayed.

Some patients may experience a physiological reaction after surgery and show intolerance to having a foreign object inside their body. Risks also include changes to your spine, changes to your height, infections, bleeding and the growth of the fused bone around the treated area. You may also experience a fracture that does not heal properly, neurological disorders, pain, abnormal sensations and the forming of scar tissue.

Can arthrodesis be proposed for oncologic patients?

Screws can be also used in patients experiencing pain due to fractures (mainly in the pelvic bones) which unsuitable for surgical fixation. The procedure is similar to what has been described above, with two or more screws bridging the fracture line. Some cement may be also added to increase screws anchoring into the target bone. Pain relief is quite fast and sustained over time with more than 90% of patients being pain-free 1 and 6 months after the procedure. The risks are similar to those previously mentioned in the spine and sacro-iliac joints.