Muscle and joint elastic properties during elbow flexion in Duchenne ...
The Symptomatic SI Joint Clinical Examination, … · Understand the prevalence of SI joint pain....
Transcript of The Symptomatic SI Joint Clinical Examination, … · Understand the prevalence of SI joint pain....
The
Symptomatic
SI Joint
Clinical
Examination,
Diagnosis and
Treatment
1
Biagio Mazza, PT
DPT, MPT, OCS, SCS, COMT, CSCS, NSCA-CPT
• MPT - 2001, Rockhurst University, KC, MO
• DPT - 2010, EIM Institute of Health
• APTA Board Certified – Orthopedics and Sports
• Certified Orthopedic Manual Therapist (Spine) – IAOM
• Private Practice Owner: Elite Physical Therapy, KC,MO
• Residence: Prairie Village, KS
• 2 Boys – Anthony 10, Christian 6
• Paid consultant of SI-BONE, Inc. 2
Genne’ DeHenau McDonald PT
• Physical Therapy Degree 1989• Oakland University, Rochester, Michigan
• 26 years clinical experience
• Former Adjunct Faculty and Clinical Lecturer• University of Florida DPT Curriculum
• Former Faculty Herman and Wallace Pelvic Health Institute
• Publications• Musculoskeletal LBP During Pregnancy• Piriformis Syndrome
• Program/Project Manager Medical Affairs SI-BONE
1. Understand the prevalence of SI joint pain.
2. Review anatomy and biomechanics of the SI joint.
3. Review the integrated model of SI joint function.
4. Understand the relationship between the lumbar spine, SI joint and hip.
5. Review subjective history for patient with SI joint pain.
6. Correctly perform SI joint provocation testing
7. Review SI joint rehabilitation.
Course Objectives
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Prevalence of SI Joint Pain
15-30%Component of LBP
22.6%
30.0%
18.5%
27.0%
14.5%
0%
5%
10%
15%
20%
25%
30%
35%
Bernard1987
Schwarzer1995
Maigne1996
Irwin2007
Sembrano2009
32-43%Symptomatic Post-Lumbar Fusion
32% Katz 2003
35% Maigne 2005
43% DePalma 2011
40% Liliang 2011
DePalma – Pain Med 2011
Is the SI Joint truly a problem?
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SIJ & Adjacent Segment Degeneration
75% of post lumbar fusion patients showed SI joint degenerative changes on CT scan five (5) years after lumbar fusion. Ha et al 2008
Lumbar fusion leads to increases in angular motion and increases in joint stress at the sacroiliac joint. Ivanov et al 2008
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Sacroiliac Joint
Articular Surface
Anatomy
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Anterior Ligaments Posterior Ligaments
Anatomy
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Biomechanics
Nutation
Sacral base movement
anteroinferior
Counternutation
Sacral base movement
posterosuperior
Translation
Linear motion; motion in
any one direction
Nutation
Counternutation
Forst 2006
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SI Joint Motion
Multi-planar motion
– Simultaneously rotate and
translate through 3 axes of motion
Motions (<4° in any plane)
– Nutation/Counternutation
• Primary motion
Males: 1 - 2°
Females: 2 - 4°
Sacral Translation
– (A-P motion) up to 1.6mm
Sturesson 1989
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Integrated Model of SI Joint Function
• Describes effective transfer of force and load across the SI joint from the lower extremities to the spine.
Snijders & Vleeming 1993
• Requires a stable core (lumbar spine, pelvis and soft tissues)
• 3 Components of Functional Stability
Passive (form closure)
Active (force closure)
Neuromuscular Control (motor control)
Panjabi 1992
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Form Closure/Structural Integrity: The shape of the sacrum and the integrity of the supporting ligaments
contribute to SI joint stability
Lee 1998, Vleeming 1990a, Vleeming 1990b
The Integrated Model of SIJ Function
Force Closure/Joint Compression: The external dynamic forces created by
contraction of the stabilizing muscles and their fascial and
ligamentous attachments
Lee 1998, Vleeming 1990a, Vleeming 1990b
Motor Control: Nervous system coordination / co-activation of
deep stabilizing muscles (onset, duration, timing)
Snijders 1993, Hodges 1996, Richardson 2002
Components
Core muscles should contract before load reaches the low
back and pelvis to prepare the system for impending load.
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Form Closure
Osseous Structures – Macro, Micro
Supporting Ligaments
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The Integrated Model of SI Joint Function:
Force Closure – Local Muscles
Local Core Muscles
• Transversus Abdominus
• Multifidus
• Pelvic Floor Muscles
• Diaphragm
– More research being done on other contributing muscles
Local System: contracts prior to upper/lower limb movement regardless of direction Hodges 1997, 2003; Hodges & Richardson 1997; Hodges 1999; Moseley 2002,2003
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The Integrated Model of SI Joint Function:
Force Closure – Global Muscles
Vleeming’s slings:
Large Muscle Groups and their Fascial Connections
– Posterior Oblique System
– Anterior Oblique System
– Deep Longitudinal System
– Lateral System
Global System: Contracts later and is direction dependent
Radebold 2000, 2001; Hodges 2003
Radebold 2000, 2001; Hodges 2003
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Thoracolumbar Fascia & Paraspinal Muscles
Caudal part of the TLF, in combination with efficient paraspinal muscles, plays major role in force closure of SI joint
Macintosh & Bogduk – Spine 1993, Vleeming – Spine 1995
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Motor Control
• Optimal force closure of the SI joint
• Studies showing alteration of muscle activation patterns in low back, groin, and SI joint pain populations– TrA Delayed in LBP Hodges & Richardson 1996
– TrA Delayed in Groin Injuries Cowen 2004
– Altered Motor Control with SI joint Pain O’Sullivan 2002
• Timing, sequence and amplitude of muscle firing– Afferent input from receptors in joints, ligaments, fascia and muscles
– Efferent response of central and peripheral nervous systems Hodges 2003
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Evaluation of the
Patient with
Sacroiliac Joint Pain
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Can we diagnose SI joint pain?
• Common pain patterns from multiple conditions
– Spine (stenosis, facet, spondy, disc herniation, DDD, etc.)
– SI Joint
– Hip (OA, FAI, early AVN, etc.)
– Pelvis (Glut tear, piriformis, pelvic floor)
• Imaging not routinely helpful
• History and Physical Examination
− Provocative maneuvers Laslett 2005, Szadek 2009
− SI joint ROM & Position testing not reliable Freburger 1999, Robinson 2007
• Diagnostic Injection
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Lower lumbar region (72%)
Devin – JAAOS 2012 Vanelderen – Evid Based Med 2010
Lateral hip – common
Thigh and Groin (55%)
Buttock pain (71%)
Lower extremity common (28%)
Groin not uncommon (14%)
Lateral hip & thigh common
Buttock, PSIS (94%)
Devin – JAAOS 2012
Spinal Stenosis
Lower extremity common
Lateral hip – common
Lumbar region common
Buttock common
Knee or below (47%)
Groin uncommon (except L1, L2)
Lumbar Spine – SI Joint – Hip
Pain Referral Patterns
Lumbar pain uncommon
SI JointIsolated
Hip Pathology
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Potential Causes of SIJ Pain: Traumatic
• MVA: Foot on Brake
• Slip and Fall
• Lifting and Twisting
• Traction Injuries
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Potential Causes of SI Joint Pain: Gradual Onset
• Laxity of the SI joint / Pregnancy
• Repetitive Forces on SI joint and
Supporting Structures
• Biomechanical Abnormalities
– Leg length inequality
– Pelvic obliquity/scoliosis
– Iliac crest bone graft
• Adjacent Segment Degeneration
– After lumbar spinal fusion
• Post Infection Degeneration
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Hip and Adjacent Segment (SI Joint)
Hip and SI Joint
76% (25/33) of patients with symptomatic SI joint pathology had at least one abnormal finding on hip radiograph
A significant number met the strict diagnostic criteria for FAI.
42% Hip OA
45% Subchondral cyst
21% Retroversion
12% Lateral CE* angle >40%
47% Coxa profunda
33% Cam impingement
Morgan 2013
* Center Edge
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Positive Subjective
History
Positive SI Joint Provocative
Testing
Lumbar Spine
and
Hip Exam
Positive Response to Intra-articular
Injection
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Elements of the Diagnosis
HISTORY
• When did the pain start?
• Prior trauma– A fall on the buttock
– Car accident (T-bone, rear-end, head-on)
– Lift/Twist
– Other
• Prior lumbar fusion– Prior iliac bone graft harvest
• Pregnancy
COMPLAINTS
• Lower back pain
• Sensation of numbness, tingling or weakness
• Pelvis / buttock pain
• Hip / groin pain
• Feeling of leg instability, buckling, or giving way
• Disturbed sleep patterns
• Disturbed sitting patterns (unable to sit for long periods, on one side)
• Pain going from sitting to standing
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History and Complaints
Pain Diagram
• Pain in buttock and posterior thigh
– Usually not midline
– Usually below L5
– At or lateral to PSIS
– Occasionally groin
• Secondary pain in lateral thigh,
groin, and/or lateral calf
Fortin 1999
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History: SI Joint Pain Presentation
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Exacerbating Activities
Unilateral Weight Bearing- Putting on Socks/Shoes
- Ascending/Descending Stairs
- Getting in and out of Car
- Prolonged Walking
(85% of gait cycle is single leg stance)Janda 1983
Sexual Intercourse
Pain with Transitional Motions- Supine to painful side - Sit to stand- Rolling over in bed- Getting in /out of bed
Pain while Stationary- Sitting on affected side- Prolonged standing/sitting
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Relieving Activities
• Bearing weight on unaffected side
• Lying on unaffected side
• Manual or belt stabilization
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Lumbar Spine – Hip – SI Joint
Physical Examination
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Assess Lumbar Spine: Facet Joint Pain
• Incidence 10-15% in patients with chronic LBP Saravanakumar 2008
• Low back pain from the facet joints: radiates down into the buttocks and posterior thigh.
• Clinical Findings – Point tenderness overlying the inflamed facet joints – Loss in spinal muscle flexibility (guarding)– More discomfort leaning backward than forward.
• No history findings or examination maneuver has been found to be unique or specific to this entity Kayser 2008, Cohen 2007, Jackson 1998
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The McKenzie Procedure• More accurate than MRI in:
– Differentiating discogenic from non-discogenic LBP
– Differentiating contained from non-contained discs
(Donelson 1997, 1990)
• Measures patient's symptomatic response to
repeated end-range movements
• Discogenic pain is associated with centralization
with repeated end range movements
(Young 2003, Hancock 2007)
• Most common direction of testing that centralizes
pain is extension
Assess Lumbar Spine: Disc-Related Pain
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These can all be performed quickly in supine before
performing provocative testing
for the SI joint.
Assess Lumbar Spine: Physical Exam
Standard tests to rule out lumbar radiculopathy
• DTRs• Neuro Exam
Passive Straight Leg Raise To rule out lumbar radicular pain + at 35-70°
• Sensitivity 91%• Specificity 26%
Deville 2000
Slump TestTo rule out lumbar disc herniation's
• Sensitivity 84%• Specificity 83%
Majlesi 2008
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Assess Hip: Physical Examination
FABER: For Intra-articular hip pathology (if pain anterior)
• Hip flexion, abduction and ER with overpressure
• 88% sensitive (Martin 2005)
Scour: For Hip OA and other pathologies
• Sensitivity 62% - 91%
• Specificity 43% - 75%(Konin 2006, Magee 2008)
FADIR: For FAI and labral tears:
• Hip flexion, adduction, IR
• Sensitivity = 75%,
• Specificity = 43% (Austin 2008)
FAIR: For Piriformis Syndrome (assure pain is posterior)
• Sensitivity 88%
• Specificity 83% (Fishman, 2002)
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Range of Motion Testing of the Hip (Birrell 2001)
• The most predictive finding for osteoarthritis is decreased range of motion with restriction in internal rotation
• For those patients with one plane of restricted movement, the sensitivity for severe osteoarthritis is 100% and specificity is 42%
• Used to rule in/out osteoarthritis
Femoral Neck Anteversion (FNA) Assessment Compare bilaterally
• If IR is 30 degrees > then external rotation, predictor of FNA (Swanson 1963)
• Trochanteric Prominence Angle Test (TPAT) or Craig test
TPAT predicted the FNA measured intraoperatively, more accurately than either the CT or Magilligan method (Ruwe 1992)
Assess Hip: Physical Examination
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Assess Hip: OA & FAI
• There is a strong association between early hip OA (osteoarthritis) and FAI (femoral acetabular impingement)
• Altman Criteria for Hip OA: – Hip IR > 15 degrees, Pain with Hip IR– Morning stiffness for < 60 min and Age > 50 years OR– Hip IR < 15 degrees, and Hip Flexion < 115 degrees
– (Sensitivity 86 % Specificity 75 %) Altman 1991
• Patients with hip OA often develop osteophytic changes and bony over-growth of the acetabular rim and femoral head
• This would create FAI in and of itself Chibulka 2009, Phillippon 2007
Clinical Presentation• Both may present with positive tests for FABER and FADIR• Both may present with a decrease in hip flexion and internal rotation (ROM)
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Contact between the femoral head-neck junction and the acetabular rim
• Insidious onset 50% of cases Samora 2011
• Symptoms– Persistent insidious deep groin, lateral hip
or buttock pain – Pain increased with prolonged sitting or
standing and hip flexion-type movements– Decreased hip ROM
Two Types • CAM (More common in young males)
– Anterior-superior aspect
• Pincer (More common in females)– Anterior acetabular labrum and chondral
injury in posterior-inferior acetabular rimGanz 2003
Confirmation• Arthroscopy: Gold Standard• MRI
Assess Hip: FAI (Femoral-Acetabular Impingement)
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Assess Hip: Labral Tear Clinical Findings
• Morphological changes in proximal femur or acetabulum lead to abnormal contact during hip flexion Samora 2011
• Clinical Symptoms: anterior groin pain (96-100%), clicking, locking (58%), catching, instability, giving way and/or stiffness Martin 2006, Lewis 2006
– Predisposing factor: Coxa Valga = 87% of cases
• Clinical Sign: FADIR TEST
Method of Injury – Hip external rotation + extension, direct trauma, abnormal loading patterns
MRI – May demonstrate labral tear, but often the bony articular pathology are missed
MRA – Gold standard is magnetic resonance arthrogram Samora 2011
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Piriformis compresses or irritates the sciatic nerve• Incidence: 17.2% among low back pain patient
Chen 2013
Clinical symptoms• A dull ache in the buttock.• Pain down the back of the thigh, calf and foot
(sciatica)• Pain when walking up stairs or inclines.• Increased pain after prolonged sitting.
Clinical Sign• FAIR Test: Reproduction of symptoms when
piriformis muscle is put on stretch.(hip flexion, adduction and internal rotation)
Fishman 2002, Loren 2010
Assess Hip: Piriformis Syndrome
Magnetic Resonance Neurography: Type of MRI that highlights
inflammation and compression of the nerves.
Filler 2005
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Incidence• Common finding on MR imaging in patients
with buttock, lateral hip, or groin pain.Kingzett-Taylor 1999
Clinical Symptoms• Dull lateral hip pain, buttock or groin pain
Clinical Signs
• Focal tenderness at the gluteal insertion
• Weak hip abduction
• Pain with passive and then resisted hip internal rotation with the hip flexed to 90°
Sen 88%, Spec 97.3%
• Pain on one-legged stance for 30 sec or moreSen 100 % Spec 97.3%
Lequesne 2008
Assess Hip:
Gluteus Medius & Minimus Tears
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Point to pain while standing • Able to localize pain with one finger
• Within 1 cm of PSIS (inferomedial)
• Consistent over at least 2 trials
Ask patient to point to location of primary pain
• Below L5: Consider SI joint
• Above L5: Consider lumbar spine etiologies
SI Joint: Physical Exam
Fortin Finger Test
Fortin & Falco 1997
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SI Joint: Physical Exam
Active Straight Leg Raise
To assess functional pelvic stability
• Sensitivity: 87%
• Specificity: 94%Mens 2001
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SI Joint: Provocative Tests
The following five provocative tests, when performed in combination are proven to have a high degree of sensitivity and specificity:
1. Distraction* (Highest PPV**)
2. Thigh Thrust*
3. Compression*
4. FABER
5. Gaenslen’s Maneuver
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Laslett Szadek
3 or more positive tests
Sensitivity 91% 85%
Specificity 78% 76%
Laslett 2005, 2008
Szadek 2009
* Most sensitive of tests
** PPV = positive predictive value
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• Specificity increases when symptoms don’t centralize or peripheralize
with thorough, multidirectional repeated movement assessment
(McKenzie Assessment)
• In some cases a patient may not tolerate having five (5) tests
performed. Therefore, it’s recommended that the three (3) most
sensitive, specific and reliable tests be performed first.
Laslett 2005, Laslett 2008, Szadek 2009
How to Interpret Your Results
1 Positive Test = Suspicion
2 Positive Tests = Fair Confidence
3+ Positive Tests = High Confidence
SI Joint: Specificity of Provocative Tests
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SI Joint: Provocative Tests
Distraction Thigh Thrust
FABER Compression
Gaenslen’s Maneuver
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Assure the tester position is above the patient by lowering table or
standing on a sturdy stool in order to provide adequate force.
Start with light pressure and gradually increase, keeping hands
cupped to minimize local contact pressure (30 second max).
Keep arms straight and lean forward with your upper body to create
gentle steady force.
Stabilize patient on the table to prevent muscle guarding.
Stabilize contralateral ASIS during Thigh Thrust and FABER tests.
If pain is provoked with test, ask patient to identify pain location to
confirm it is their typical pain.
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SI Joint: Provocative Test Tips
• Quadratus Lumborum
• Gluteus Maximus
• Piriformis
• Levator Ani
Travell and Simons 1992
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SIJ Region Pain – Myofascial Causes
Negative
Lumbar and
hip exam
Positive
History
Positive Fortin
Finger Test
and Physical
Exam
Positive Pain
Provocative
Tests
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Justification for SI Joint Injection
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What’s the Reference Standard for Diagnosis?
Diagnostic Injection• Confirm with contrast and
imaging
• Low volume, local anesthetic
• 50-75% pain reduction
Therapeutic Injection• Local anesthetic + corticosteroid
• May provide intermediate or long
term relief
• Results of therapeutic injections
can be unpredictable
Injection Under Fluoroscopy
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• Patient pain diary
• Significant positive clinical response
– 50-75% VAS reduction indicates positive diagnosis of SI joint as pain generator
– Obtain copy of arthrogram to ensure accuracy
• Equivocal or no relief
– < 50% VAS reduction indicates a non-significant clinical response
– May have SI joint pain, but consider other pain sources
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Injection Assessment
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Conservative Treatment
Options for
Sacroiliac Joint Pain
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Conservative Treatment Options
Symptom Management
• Medications (non steroidal anti-inflammatories,
oral steroids, pain medications)
• External SI joint stabilization with belting
• Therapeutic SI joint injections (1-4 per year)
• Physical Therapy
Sembrano 2011
Cohen 2005
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Treat the joint by returning it to its normal relationships so outcomes may be enhanced. Fife 2008
Conservative Treatment Options: Goal
• Optimal SI joint function occurs with the SI Joint in neutral (mid-range) position.
DonTigney 1990, 1994, 1999, 2005; Fujiwara 1999;
Pool-Goudzwaard 2001, 2003; Snijders 1993, 2004; Vleeming 1996
• Treatment goal should be restoration of normal movement and SI joint position.
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Conservative Treatment Options:
Physical Therapy
• Modification of Activities of Daily Living (ADLs)– specific focus on activities that may create or exacerbate symptoms.
• Patient education regarding maintaining optimal alignment
with positioning, posture and body mechanics
• Stabilization Exercise/ Neuromuscular Re-education – Specific focus on timing and engagement of local and global core muscles
Snijders 1993a, 1993b, Hodges 1996, Richardson 2002
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Conservative Treatment Options:
Physical Therapy
• Achieve normal muscle strength balance where
existing deficits (include gluteus medius assessment)Lee 1998, Vleeming 1990, Vleeming 1989
• Achieve normal muscle length balance where existing
imbalances exist – Consideration of muscles that attach to the ilium and sacrum directly and
indirectly, especially limiters of hip internal rotation.Cibulka 1998, Lee 1998, Vleeming 1990, Vleeming 1989
• Adjacent segment joint and soft tissue restriction
mobilization and manipulation as needed *
– Consider the hip structures, lumbar and thoracic regions, knee and ankle
joints.
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• Manual techniques to address myofascial pain
• Balance assessment and training
• Gait training
• Regain or maintain cardiovascular health
• Modalities for pain and muscle spasm
Conservative Treatment Options:
Physical Therapy
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Surgical Treatment Options
for
Sacroiliac Joint Pain
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Smith-Petersen 1926 Campbell 1927 Gaenslen 1927
Bloom 1937 iFuse 2008
Treatment Options: Surgical
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MIS SI Joint Fusion Technologies
Examples of existing
and/or developing
technologies.
The iFuse Implant
System is the only
technology supported
by published clinical
evidence.
(May 2015)
SI-BONE:
iFuse Implant System®
Globus:
SI-LOK Joint Fixation System
Medtronic:
Rialto Sacroiliac Joint Fusion System
VG Innovations:
SiJoin Posterior Sacroiliac Joint Fusion System
X-spine Systems:
Silex Sacroiliac Joint Fusion System
Zyga Technology:
SImmetry Sacroiliac Joint Fusion System
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iFuse Implant System®
• Unique DesignTriangular shape – minimizes rotation
Interference press fit
Porous TPS coating – large surface area
Specifications• 3X stronger than screw
(iFuse vs. 8.0mm cannulated screw, Mauldin 2009, SI-BONE)
• 31X rotational resistance greater than screw(Torsional Rigidity, iFuse vs. 7.3mm screw, 300191-A, SI-BONE)
• Strength of Experience and Focus17,000+ procedures worldwide (September 2015)
Outstanding training programs
Knowledge in the OR
Reimbursement support
• Clinical Evidence
59
Incision Pin Soft Tissue Protector Measure
Drill Broach Insert Implant Repeat
iFuse Procedure Overview
60
I
IIb
III
IV
Clinical – Other
Biomechanics
...... 2Complaints analysis
Intraoperative neuromonitoring
…....................... 2 RCT (INSITE, 102 iFuse vs. 46 NSM)
... 2Stability achieved & maintained post-cycles
Implant placement technique comparison
…................. 3Prospective, multicenter (SIFI)
Systematic Review
….… 10 Retrospective case series
…............. 3 Open vs. iFuse
Complete References in Bibliography61
iFuse Implant System® Publications
Proprietary and Confidential.
VAS SI Joint Pain
62Complete References in Bibliography
Proprietary and Confidential.
Rapid and Sustained Pain Relief –VAS SIJ Pain
Complete References in Bibliography63Proprietary and Confidential.
Complete References in Bibliography64Proprietary and Confidential.
Post-Operative Considerations
Individual Treatment Plans
Considerations:
• Age
• Weight
• Bone quality
• Associated health factors
Post Surgical Decisions
• Plan for protected weight bearing
• Activity limitations
• Post op rehab plans
• Plan for return to activity
6565
Post-Operative Guidelines
To assist HCPs with Patient Education
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Weight-bearing Status
Post-Operative Swelling Prevention
Precautions and Activity Guidelines
Post-Operative Guidelines and Precautions
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Description of Core Strengthening
Exercises for DVT Prevention combined with basic core
strengthening
Circulation and Stabilization Exercises
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Bed Mobility, Transfers and Stairs
Patient is instructed in maintenance of neutral lumbopelvic mechanics with
movement and utilization of TrA muscle to assist with stabilization
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Post-Operative Physical Therapy Considerations
Review of common musculoskeletal problems affecting the SI joint or affected by chronic SI disorders
Suggested areas to address post-operatively based on best practice and
current evidence
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Post-Operative Considerations
Patient Education: Positioning, Posture and Body Mechanics
Gait Training
Balance Assessment and Training
Timing and Engagement of Core Local/Global Stabilizers
Achieve Normal Muscle Strength and Length Balance
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Post-Operative Considerations
Eliminate Restrictions in Adjacent Structures
• Hip Capsule
• Lumbar and Thoracic Spine / Knee and Ankle Joints
Retraining of Functional Movement Patterns/Motor Control
• With Activities of Daily Living
• With Recreational Activities in Patient Population
Regain / Maintain Cardiovascular Health
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Conclusion
• SI joint can be painful: pathology is prevalent
and underdiagnosed
• SI joint stability depends on a complex
integrated system – Form and Force Closure,
Motor Control
• Must understand the lumbar spine-SI joint-hip
complex and how they interact
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Conclusion
• Diagnosis of SI joint pain
– History
– Physical Examination of spine, hip and SI joint
– Correct Performance of SI joint provocative tests
• Treatment options for SI joint pathology
– Non-surgical management
– Surgical option – MIS SI joint fusion
– Pre and post-operative considerations
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SI-BONE, SI University and iFuse Implant System are registered trademarks of SI-BONE, Inc.
© 2015 SI-BONE, Inc. All rights reserved.
U.S. Patent Nos. 8,202,305; 8,840,623; 8,986,348; and 9,039,743; pending U.S. and foreign patent applications
9228.061815
The iFuse Implant System® is intended for sacroiliac fusion for conditions including
sacroiliac joint dysfunction that is a direct result of sacroiliac joint disruption and
degenerative sacroiliitis. This includes conditions whose symptoms began during
pregnancy or in the peripartum period and have persisted postpartum for more
than 6 months.
There are potential risks associated with the iFuse Implant System. It may not be
appropriate for all patients and all patients may not benefit. For information about
the risks, visit: www.si-bone.com/risks
One or more of the individuals named herein may be past or present SI-BONE
employees, consultants, investors, clinical trial investigators, or grant recipients.
Research described herein may have been supported in whole or in part by SI-
BONE.
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iFuse Implant System – Bibliography
LEVEL I – Randomized Clinical Trial
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LEVEL IIb – Prospective, Multicenter
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Clinical – Other
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Biomechanics
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