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Session: Poster session 2 (Odd numbers)
Session starts: Friday 27 January, 10:00
Presentation starts: 10:00

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Nick Kampkuiper (Medisch Spectrum Twente)
Jorm Nellensteijn (Medisch Spectrum Twente)
Edsko Hekman (University of Twente)
Maaike Koenrades (Medisch Spectrum Twente)
Femke Schröder (University of Twente & Medisch Spectrum Twente)

Abstract:
Low back pain is the leading cause of years lived with disability worldwide. In 15-25% of the patients this is caused by sacroiliac (SI) joint dysfunction. When conservative therapy is insufficient, it can be treated with sacroiliac joint fusion (SIJF). This involves stabilisation of the joint with three cannulated implants. Disadvantages of the procedure are radiation exposure, implant loosening, anatomical variations, and the use of solely 2D fluoroscopic guidance. Therefore, it can be challenging to place implants in a stable patient-specific configuration without damaging critical structures. Virtual Surgical Planning (VSP) might be the solution. This study aimed to introduce VSP in SIJF, evaluate the accuracy of the surgical procedure, and determine the surgeon's learning curve. The VSP consists of virtually inserted implants inside a preoperative CT scan and virtual fluoroscopic images of the pelvis with inserted implants that are used during the procedure. In a quantitative accuracy evaluation, three measures were used to assess the 3D deviations of implant placement. In the learning curve analyses the mean 3D deviations per procedure were assessed for 24 consecutive clinical cases. Additionally, the added value based on the surgeon's perspective was discussed. VSP for SIJF was successfully introduced. The results showed relatively low 3D deviations between the implants of approximately 4.8 mm between the apexes, an angular deviation of 4.1°, and 3.9 mm between the entry points, indicating that the surgeon could reproduce the VSP adequately. In the learning curve analysis, however, no trend was visible. The surgeon considers VSP as a valuable addition to SIJF since the surgeon felt better prepared, was more confident, and could perform the surgery more safely. Besides, the surgeon thought that due to VSP longer implants could be used and the duration of the surgery decreased. This study developed and implemented VSP for SIJF into clinical practice. Since in literature no accuracy measures were available for SIJF a comparison was not possible. It was expected that the accuracy would increase when the surgeon becomes more proficient in using VSP. A randomised control trial is recommended to assess the added value of VSP compared to the conventional procedure.