Posterior SI fusion with allograft if lateral screws didnt work?

[PinchandBurn]

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Do you all know how to identify when it's appropriate to do a percutaneous SI fusion with allograft if when the lateral screws dont work?

Are you looking for "failed fusion" of the si joints? I know i heard the term "haloing'. But what does that mean?

Also , if the lateral screws are placed and pain persists, can you do another 'diagnostic' SI fusion to determine if the pain goes away? Do you have to do it twice before doing the percutaneous posterior fusion? Or will the LCD disallow it like they do for 'fused' levels in the lumbar spine.

 

[BobBarker]

There is not a ncd for si joints. You will have to review if your contractor has an lcd. We don’t. Medicare Advantage plans have their own criteria like a commercial plan would. Haloing is on CT. Black haloing around the hardware shows the screws are loose. You can see it on pedicle screws also.

 

[callmeanesthesia]

In this case I’d follow the Lobel SIJ Fusion Algorithm

Step 1. Don’t

 

[PinchandBurn]

There is not a ncd for si joints. You will have to review if your contractor has an lcd. We don’t. Medicare Advantage plans have their own criteria like a commercial plan would. Haloing is on CT. Black haloing around the hardware shows the screws are loose. You can see it on pedicle screws also.

Anything else to look for?

Suppose there is no hallowing. is it then a "clinical' diagnosis and could you do 1 diagnostic and then go straight to doing a posterior allograft.

 

[BobBarker]

It is up to you. I would exhaust everything prior to doing more surgery. L5/s1 facet, cluneal blocks, everything.

 

[Status Sciaticus]

Do you all know how to identify when it's appropriate to do a percutaneous SI fusion with allograft if when the lateral screws dont work?

Are you looking for "failed fusion" of the si joints? I know i heard the term "haloing'. But what does that mean?

Also , if the lateral screws are placed and pain persists, can you do another 'diagnostic' SI fusion to determine if the pain goes away? Do you have to do it twice before doing the percutaneous posterior fusion? Or will the LCD disallow it like they do for 'fused' levels in the lumbar spine.

what are you treating? Pain or instability?
Could this be FBSS? (I am classifying the SIF as FBSS)