Stereotactic navigation-assisted minimally invasive sacroiliac joint fusion in patients with prior pelvic instrumentation: a case series.

BACKGROUND: While many large contemporary series have demonstrated safe and accurate sacroiliac joint (SIJ) fusion in revision settings, few have exclusively focused on non-robotic stereotactic navigation in patients with dense legacy pelvic hardware. SIJ fusion operations are challenging due to existing hardware distorting bony landmarks and reducing implant corridors, often requiring robotic surgery to mitigate these challenges. Our consecutive case series is unique in highlighting that high fusion rates (100% at 12 months) and universal same day discharge is achievable with purely navigation-assisted techniques. This report provides practical guidance for surgeons who may not have access to robotic technology, thereby extending minimally invasive surgery sacroiliac joint fusion (MIS SIJF) to a broader hospital population.

CASE DESCRIPTION: We conducted a retrospective case series of 5 patients who underwent navigation-assisted, MIS SIJF after prior pelvic fixation. All patients underwent successful SIJF with no complications. Operative times averaged 67 minutes for unilateral and 84 minutes for bilateral procedures. All cases achieved same day discharge. At 1-year postoperative follow-up, computed tomography (CT) confirmed fusion in all 5 patients and all patients had complete symptom resolution.

CONCLUSIONS: Stereotactic navigation-assisted MIS SIJF is safe and effective in patients with prior instrumentation. This approach showed accurate implant placement in all cases. This case series suggests that navigation-assisted MIS SIJF can be utilized in hospitals without robotic navigation capabilities, extending advanced care to hospitals where robotic navigation is limited.