The National Institute for Health and Care Excellence (NICE) have recently recommended the adoption of the iFuse device for treating chronic sacroiliac joint pain
The case for adopting the iFuse implant system to treat chronic sacroiliac joint pain is supported by evidence that shows using iFuse leads to improved pain relief, better quality of life and less disability compared with non-surgical management.
iFuse should be considered for use in people with a confirmed diagnosis of chronic sacroiliac joint pain (based on clinical assessment and a positive response to a diagnostic injection of local anaesthetic in the sacroiliac joint) and whose pain is inadequately controlled by non-surgical management.
Investment in iFuse costs around £7,100 per person (including the cost of the implant, the implant procedure and associated outpatient attendances). This leads to long-term savings due to reduced steroid injections for these people over a number of years.
NICE estimate that around 2,850 people currently have a confirmed diagnosis of chronic sacroiliac joint pain and around 570 (20 per cent) of these people will have pain that is inadequately controlled by non-surgical management and are therefore eligible for treatment with iFuse. Of these, around 427 people (75 per cent) are expected to be treated with iFuse over years one to three. They also estimate that around 355 people are likely to be newly diagnosed with chronic sacroiliac joint pain each year and around 70 (20 per cent) of these people will be eligible for treatment with iFuse. Of these, around 53 people (75 per cent) are expected to be treated with iFuse. It is assumed that once people with a confirmed diagnosis of chronic sacroiliac joint pain whose pain is inadequately controlled by non-surgical management are treated (the prevalent population), that around 53 people per year (the incident population) will be treated with iFuse.
The iFuse implant system is a titanium implant intended for use in people with chronic sacroiliac joint pain. iFuse is placed across the sacroiliac joint using minimally invasive surgery, where it is intended to stabilise the joint and to correct any misalignment or weakness that can cause chronic pain. The implant is triangular, which is designed to limit movement and spread shear stresses evenly. It has a porous metal coating, which the company claims promotes bone-on-bone growth and encourages joint fusion. Typically, three implants are used per joint, depending on the size of the pelvis.
Chronic sacroiliac joint pain can affect people of any age and usually needs lifelong management. The standard of care is escalating non-surgical management, typically beginning with analgesic therapy (such as non-steroidal anti-inflammatory drugs or opioids) combined with physiotherapy. If these initial treatments are ineffective, invasive procedures may be considered. These include steroid injections into the sacroiliac joint itself and radiofrequency ablation to the nerves that supply the joint. Sacroiliac joint fusion may be considered if the chronic pain continues. This can be done through open surgery or through a minimally invasive procedure, using a device such as iFuse.
Invasive procedures and surgical treatments for chronic sacroiliac joint pain are usually done by spinal surgeons and orthopaedic trauma pelvic surgeons working in specialist centres.
Source: NICE and Device Access
