Feature
Managing pain with SI joint fusion and nerve ablation
By Junjian Huang, MD, and Douglas Beall, MD, FSIR A
s an IR at the University of Alabama at Birmingham, my practice focuses on interventional spine and pain
intervention. Many of these procedures are done using basic fluoroscopy and US guidance. However, IRs have imaging knowledge and capabilities far exceeding what has traditionally been available to other specialties. Using these skills, we are able to make procedures safer and faster for patients. Extension of our skillset into the musculoskeletal system and pain management space is a natural
12 IRQ | SPRING 2024
step. There is high demand for these procedures, making this space “blue water,” or a ripe opportunity, for our specialty. Douglas Beall, MD, FSIR, has been at the forefront of expansion in this space and shared insight on how he approaches sacroiliac (SI) joint instability and percutaneous fusion.
Junjian Huang, MD: How did you get started with percutaneous SI joint fusion? Douglas Beall, MD, FSIR: I began working with percutaneous SI joint fusion by treating sacral traumatic
fractures. I would span them with 7.0 mm partially threaded screws, often combined with bone cement depending on the density of the bone. These screws had a tendency to loosen and back out. This caused us to change to fully threaded screws, which held better but still did not predictably stay in place without occasionally backing out. The sacral fractures often involved the SI joint, and fusion of the joint was a routine way of treating patients with pelvic ring injuries.
These strategies had a significant overlap with the treatment of sacral insufficiency fractures that were seen almost exclusively in patients with severe osteoporosis and were treated very effectively with sacroplasty.1 Sacroplasty was used for some sacral fractures and could be combined with screw fixation when the sacral fracture gap was large due to fracture displacement or an oligotrophic nonunion fracture.
SI joint fusion was also used in patients with chronic pelvic instability, which
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