Becker's ASC Review

27 Executive Briefing that were taking narcotic pain medications preoperatively for over two years — none of the five required opioids after their procedure. TL: The iFuse Procedure only requires about a 1-inch incision or less, the blood loss is usually less than 100 cubic centimeters, it usually only takes about 45 minutes, and based upon my experience, the complication rate is low. CMS reimbursement is sufficient for my practice. From my experience, it can be a valuable addition to the set of services offered by the surgery center. Q: What processes and criteria did you establish for appropriate patient selection? DB: The most important thing is to be highly selective of the patients. They have to be medically fit; if they don't meet the health criteria, they're not an appropriate candidate. In fact, I've done an 80-year-old patient in the ASC because she was very healthy and had very good support at home. So, her age was really not a factor; it's how healthy the patients are. GD: For me, the key is confirming the diagnosis. Once you start to recognize the primary complaints and the nuances of how they present, it's easier to separate these patients out from those with lumbar spine or hip pathology, with whom they're often confused. I like to know that they have a very compelling history. I also look for patients who've had previous lumbar fusions, because sacroiliitis can present from junctional breakdown, once the lumbosacral segment has been fused. The gold standard for confirming the diagnosis is two separate fluoroscopically-guided injections into the SI joint with local anesthetic and steroid. If these provide significant short-term relief on each occasion, that clinches it. Q: What are some key preparatory steps and best practices for integrating this procedure? TL: The most important thing would be that the pain location is exactly where the SI joint is. No. 2 would be that they have been ruled out for any lumbar complaints, because lumbar problems can cause very similar symptoms. No. 3 would be that they respond in a physical exam more appropriately to an SI problem than a lumbar problem. DB: Using a long-acting local anesthetic and preparing the patient preoperatively are best practices. My staff goes through how the procedure is going to be done, what they can expect postoperatively and when they're going to follow up. Q: How has integrating iFuse impacted your facility, patients and practice? GD: SI joint fusion has helped strengthen my practice, given the generally positive outcomes that result from the surgery. People who have had a successful result will tell their friends and family, who will then seek me out for their SI joint and low back problems. The other thing that has been eye-opening is the amount of pain relief my patients have experienced after surgery. One of the earliest patients I operated on was a woman who had fallen off her horse, landed on her tailbone and been in debilitating pain for 5 years. Being one of the first folks to have a SI joint fusion, she paid out of pocket. She did very well, and about three months later, gave me a phone call. She said, 'I'm talking to you on the back of my horse. I haven't been able to ride him for five years, and I'm up in the saddle again right now.' That was very rewarding for me. It speaks to the fact that this is an amazing operation when done on the right people. Based on my experience, it has the potential to change lives dramatically. Over 100 health plans, including all Medicare Administrative Contractors, Tricare, UnitedHealthcare, 30-plus BCBS plans, and other large commercial health plans cover SI joint fusion, many exclusively with the triangular iFuse Implant System. The procedure is performed in all three sites of service, depending on the condition and health of the patient. SI-BONE estimates that over 30 million American adults have chronic lower back pain. Studies have shown that 15% to 30% of patients with chronic lower back pain have pain stemming from a dysfunctional SI joint. SI-BONE's experience in both clinical trials and commercial settings indicates that iFuse could be beneficial for at least 30 percent of patients who are properly diagnosed and screened for surgery by trained healthcare providers. This article was sponsored by SI-BONE, Inc. The views expressed by the surgeons interviewed for this article are theirs alone. The iFuse Implant System® is intended for sacroiliac joint fusion for conditions including sacroiliac joint dysfunction that is a direct result of sacroiliac joint disruption and degenerative sacroiliitis. This includes conditions whose symptoms began during pregnancy or in the peripartum period and have persisted postpartum for more than six months. The iFuse Implant System is also intended for sacroiliac fusion to augment immobilization and stabilization of the sacroiliac joint in skeletally mature patients undergoing sacropelvic fixation as part of a lumbar or thoracolumbar fusion. There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit. For information about the risks, visit: www.si-bone.com/risks. n SI-BONE is a medical device company that pioneered the iFuse Implant System, a minimally invasive surgical system for fusion of the sac- roiliac joint to treat sacroiliac joint dysfunction. The iFuse Implant, commercially available since 2009, is the only SI joint fusion device sup- ported by multiple prospective clinical studies showing improved pain, patient function and quality of life resulting from treatment. There are over 65 peer-reviewed publications supporting the safety, durable effectiveness, and biomechanical and economic benefits unique to the iFuse Implant (www.si-bone.com/results). This body of evidence has enabled multiple government and private insurance payors to establish coverage of the SI joint fusion procedure exclusively when performed with the iFuse Implant System. The iFuse Implant System is intended for sacroiliac fusion for conditions including sacroiliac joint dysfunction that is a direct result of sacro- iliac joint disruption and degenerative sacroiliitis. This includes conditions whose symptoms began during pregnancy or in the peripartum period and have persisted postpartum for more than 6 months. The iFuse Implant System is also intended for sacroiliac fusion to augment immobilization and stabilization of the sacroiliac joint in skeletally mature patients undergoing sacropelvic fixation as part of a lumbar or thoracolumbar fusion. There are potential risks associated with the iFuse Implant System. It may not be appropriate for all patients and all patients may not benefit.

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