Becker's ASC Review

26 Executive Briefing S acroiliac joint fusion has historically been an overlooked opportunity for ASCs. That's where SI-BONE's iFuse Implant System® comes into play. Designed to permanently stabilize the sacroiliac (SI) joint through both bony adherence to implants and intraarticular joint fusion, iFuse has been used in over 38,000 minimally invasive procedures since its commercial launch in 2009. Along with evidence from more than 70 peer-reviewed publications, surgeon users of iFuse attest to its positive outcomes. Becker's recently spoke with three surgeons about SI joint pain and why incorporating iFuse procedures was a turning point for their practices and patients. The participating surgeons were: • Gary Dix, MD, Riva Road Surgery Center (Annapolis, Md.) • Troy Lowell, MD, Marion Surgery Center (Ocala, Fla.) • David Baker, MD, Cascade Outpatient Surgery Center (Bellingham, Wash.) Dr. Dix is a paid consultant to SI-BONE, Inc. Note: These responses have been edited for length and clarity. Question: Can you tell us about SI joint pain and dysfunction and why you incorporated minimally invasive SI joint fusion into your practice? Dr. Gary Dix: For a long time, a distinct subset of patients I was seeing, who had been through a variety of conservative and/or surgical treatment modalities, seemed to come back with ongoing pain. They were then sent for further conservative management when there was no obvious spine pathology present. None of them seemed happy with that, either. It started to dawn on me that these patients didn't actually have spine problems, but rather had junctional disease below their previous fusions or adjacent to minor radiographic changes in their spine. Dr. Troy Lowell: So many patients have back pain that's not central, and then they come back with a negative MRI. Until a number of years ago, the medical community was stumped about what to do with them. As it turns out, a lot of these patients had SI problems. When I was a resident and a fellow, it wasn't even mentioned as a disease. Now that I see how common it is, it's really astonishing how little attention was paid to it in the past. [For] surgeons who do keep an awareness of this, it opens up a whole new area of the body to treat and makes them stand out. Q: Why is the iFuse Implant System your product of choice for this procedure, and what differentiates SI-BONE from other companies out there? Dr. David Baker: The iFuse is very consistent in where you can place the implants and generally, in my experience, results in very few complications. That's why we can do the SIJ fusion as an outpatient procedure. I would say the complication rate in my practice is less than 2 percent. iFuse is a system that has good peer review and can actually be reproduced in the private setting. GD: It works. From the very first patient I operated on using this product, the feedback I had was overwhelmingly positive. I realized that to be called somewhat of an expert in this area, I needed to look at competing systems, none of which used the triangular dowel SI-BONE has patented. I performed two or three cases with another system and did not find it to be as useful or beneficial; for example, one of the patients ended up having a nonunion. I've never seen a nonunion in almost 200 SI-BONE cases. Q: How have the awareness-building efforts and resources provided by SI-BONE helped you to incorporate iFuse into your practice and the facility's caseload? TL: SI-BONE has been excellent in trying to get the word out about SI problems. They've given me opportunities to educate the medical community and patients that this exists and there's a treatment for it. The company has also gone through some design changes with the implant. They've changed it so that it's 3D-printed with a lot of nooks and crannies and holes. I believe that the bone's ability to grow into these spaces provides further strength. They haven't just put out an implant and then stopped doing research; they've tweaked it and made it even better. GD: They've created a team of professionals that helps patients with trying to get authorization for the operation from various third-party insurance companies, as part of a comprehensive effort by SI-BONE to gain uniform coverage for the procedure. I became involved in discussions with medical directors of big insurance companies to try and help them understand this wasn't a fly-by- night gimmick, but something that actually benefited patients. We're finally starting to see them coming around as they begin to appreciate the value to their customers. Q: Why do you think iFuse complements the other procedures already offered in your ASC? DB: Patients love that the procedure is minimally invasive and that most patients can go home soon afterward. The cost for the procedure in the ASC is much less than at the hospital, resulting in savings for both the payers and the patients. At our ASC, postoperative pain is very well-controlled with Exparel®, which has negated the need for postoperative opioids. In fact, most patients say they've had very little pain for two days postoperatively. In the two years I've been doing this in the ASC, I've had five patients A game-changer for patients and ASCs: 3 surgeons discuss sacroiliac joint fusion Sponsored by:

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