Low back pain (LBP) is one of the most prevalent, disabling and costly medical conditions affecting modern society. LBP presents a significant challenge to effective treatment due to often multifactorial or unknown etiology. Since the 1980s, the sacroiliac (SI) joint has become increasingly recognized as a common source of LBP. In contrast to other sources of LBP such as internal disc disruption and even psychosocial factors, SI joint pain and degeneration are reliably identified with provocative manual tests and diagnostic injections. Fusion of the SI joint has been shown to provide enduring symptom relief, and minimally invasive techniques developed over the past decade have further reduced the operative risks associated with open fusion surgery. Minimally invasive SI joint fusion surgeries are typically performed by placing rigid implant components across the joint space. The implants provide mechanical fixation while bony fusion develops. Decortication of the SI joint space during the procedure produces a bleeding bone surface that allows for increased availability of autologous mesenchymal stem cells and growth factors at the fusion site. Coupled with the mechanical stability provided by the implant and autologous bone graft, decortication provides an optimal environment for bone growth and subsequent fusion of the joint. This report describes the background of SI joint disease, treatment, and the minimally invasive SImmetry? Sacroiliac Joint Fusion System (Zyga Technology, Inc., Minnetonka, MN, USA), with emphasis on the decortication instrumentation and procedure.
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