CPT® Code 0334T

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1. Indications

The sacroiliac joint stabilization procedure is indicated for patients experiencing significant pain and dysfunction due to various underlying conditions affecting the sacroiliac joint. These indications include:

• Trauma: Injuries to the sacroiliac joint that result in instability or pain.
• Infection: Inflammatory processes caused by infections that compromise joint integrity.
• Cancer: Tumors affecting the sacroiliac region that may lead to joint instability or pain.
• Spine instability: Conditions that result in instability of the spine, contributing to sacroiliac joint dysfunction.

2. Procedure

The procedure for sacroiliac joint stabilization involves several key steps, which can vary based on the chosen technique—either percutaneous or minimally invasive. Each step is designed to ensure proper stabilization of the joint while minimizing tissue damage.

• Step 1: The patient is placed under general anesthesia and positioned prone on the operating table, which is equipped for intra-operative imaging, such as fluoroscopy or CT scanning. The surgical site, specifically the buttocks area, is thoroughly prepped and draped to maintain a sterile environment.
• Step 2: For the percutaneous technique, a small incision is made over the sacroiliac joint. A guide wire is then advanced to the surface of the ilium, specifically over the inferior portion of the sacroiliac joint. This wire serves as a pathway for subsequent instruments.
• Step 3: Progressively larger cannulated dilators are passed over the guide wire until a sleeve or trocar can be docked into position on the ilium. This step is crucial for creating a channel for the implant.
• Step 4: A reamer is utilized to create an open channel through the ilium, across the joint, and into the sacral bone. This channel is essential for the placement of the implant and involves the removal of cartilage and tissue.
• Step 5: A hollow core implant, which may be filled with bone graft or a bone morphogenetic protein (BMP) soaked carrier, is inserted into the channel and secured in place. Typically, additional implants (usually a total of three) are placed along the sacroiliac joint in a similar manner.
• Step 6: After the implants are secured, the sleeve or trocar is removed, and the incision is closed.
• Step 7: In the minimally invasive technique, a small incision is made in the skin, and the gluteal fascia is dissected. The gluteal muscle is split longitudinally to expose the ilium.
• Step 8: A pin is placed extending through the ilium, across the sacroiliac joint, and into the sacrum to stabilize the joint. Sizing is performed to determine the appropriate length of the implant.
• Step 9: A drill and triangular broach are used to prepare the bone for the implant. The first implant is placed into the prepared bone channel, and this process is repeated for two additional levels along the sacroiliac joint, resulting in the placement of two more implants.
• Step 10: The operative site is irrigated to ensure cleanliness, and the incision is closed in layers to promote optimal healing.

3. Post-Procedure

Post-procedure care for patients undergoing sacroiliac joint stabilization typically involves monitoring for any immediate complications and managing pain. Patients may be advised to follow specific rehabilitation protocols to facilitate recovery and restore function. The expected recovery period can vary based on individual circumstances and the extent of the procedure performed. Follow-up appointments are essential to assess the healing process and the effectiveness of the stabilization. Patients should be informed about signs of potential complications, such as increased pain, swelling, or signs of infection, and instructed to report these to their healthcare provider promptly.