Introduction

Fig. 1.1

Borgess Brain and Spine Institute (BBSI), Kalamazoo, MI. Used with permission from Borgess Health

Since 1991, BBSI has generated several publications in peer review journals [7–10], created an algorithm for the diagnosis and treatment of the dysfunctional SIJ [11], devised new methods of approach to the SIJ, invented new types of SIJ fixation, and worked with engineers in the cadaver lab to further understand the biomechanics of the ligament injured SIJ (Chap. 4). As a result, the BBSI has become an international referral center for patients with the diagnosis of a dysfunctional SIJ. It should be noted that many of the surgeries and illustrations from BBSI in this textbook represent our posterior oriented surgical experience prior to 2008 and the subsequent development of adequate lateral instrumentation to perform straight lateral minimally invasive fusions. The posterior midline approach was used extensively by us for the treatment of the dysfunctional SIJ for many years as the only other option available was the trauma way of placing two screws laterally across the joint with no real fusion as part of the process. Since the advent of very good lateral fixation devices, the current main operation now being used at BBSI is the minimally invasive lateral approach. As a result of having such a varied surgical history with the SIJ, BBSI is in the unique position of being able to choose between multiple techniques to obtain the desired fusion of the SIJ depending on the individual circumstances of the patient. These different circumstances will be discussed throughout this book, as well as the many varied ways to approach, instrument, and fuse the SIJ.

The authors responsible for the creation of this textbook comprise between them over 80 years of performing surgeries on the dysfunctional SIJ and bring their collected experience of thousands of patients from major referral centers covering all parts of the country. Each author will provide their reasons for using a certain approach and define situations where it is best utilized and possibly where it should be avoided.

The current literature (Chap. 2), published in peer review journals since the 1980s, contains unique information that will also be sited throughout this book by multiple chapter authors.

The Philosophical Approach for the Creation of This Textbook

The philosophical approach to the organization of surgical information in this textbook is to discuss the various previously published techniques along with new techniques in groups according to the approach used to perform them. The approaches are defined by their potential to be invasive and their anatomical locations with reference to the SIJ. So, for example, one of the most utilized surgeries today would be found in the chapter entitled “the lateral approach, minimally invasive.” The emphasis in this book is to provide information on approaches and not specific types of instrumentation to perform those approach-driven procedures. It should be noted here that the anterior approach will not be discussed in this textbook. All the authors agree that this is a very rarely used approach for the dysfunctional SIJ, and only in an extremely unusual circumstance would a surgeon consider using that approach. These types of rare situations would most likely be associated with some acute event or a trauma. In this book, different authors do favor different types of instrumentation, and their bias will show through in their illustrations and images. It is the editors’ expectation that all the writings in this textbook are being provided for general SIJ treatment information and not as a medium for solicitation of devices.

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