Safety and effectiveness of minimally invasive sacroiliac joint fusion in women with persistent post-partum posterior pelvic girdle pain: 12-month outcomes from a prospective, multi-center trial.

Robyn Capobianco,Daniel Cher

doi:10.1186/s40064-015-1359-y

Abstract

Postpartum posterior pelvic girdle pain (PPGP) affects nearly 20 % of women who experience back pain in the peripartum period. The sacroiliac joint is a source of this pain in 75 % of women with persistent PPGP. A subset of women will fail to obtain acceptable pain relief from the current array of non-surgical treatment options. The purpose of this study is to assess the safety and effectiveness of minimally invasive sacroiliac (SI) joint fusion in women with chronic SI joint dysfunction whose pain began in the peri-partum period whose symptoms were recalcitrant to non-surgical management. A sub-group analysis of subjects with sacroiliac joint disruption and/or degenerative sacroiliitis enrolled in a prospective, multi-center trial of SI joint fusion was performed. Subjects with PPGP were identified and compared with women without PPGP and with men. Of 172 enrolled subjects, 52 were male, 100 were females without PPGP and 20 females had PPGP. PPGP subjects were significantly younger (43.3 years, vs. 52.8 for females without PPGP and 50.5 for men, p = 0.002). There were no differences in any other demographic or baseline clinical measure. Women with PPGP experienced a significant improvement in pain (−51 mm on VAS), function (−20.6 pts on ODI) and quality of life (SF-36 PCS +10.4, MCS +7.2, EQ-5D +0.31) at 12 months after surgery. These improvements were characteristic of the overall study results; no difference was detected between sub-groups. The sacroiliac joint can be a source of pain in women with persistent PPGP and should be investigated as a pain generator. In this study, women with carefully diagnosed chronic SI joint pain from PPGP recalcitrant to conservative therapies experienced clinically beneficially improvements in pain, disability and quality of life after minimally invasive SI joint fusion using a series of triangular porous plasma spray coated implants.

Highlights

Pelvic girdle pain (PGP) is a term used to describe pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints
PGP can be distinguished from pregnancy related low back pain (PLBP) by its character, intensity, and location; PLBP is mainly described as a “dull ache” in the lumbar region while PGP is mostly described as pain between the posterior iliac crest and gluteal fold that may radiate into the thigh (Gutke et al 2008; Vermani et al 2010)
Of the 120 women, 20 subjects (16.7 % of females, 11.6 % of all subjects) indicated that pain began in the peripartum period (Table 2). This constitutes the population designated as postpartum pelvic girdle pain (PPGP)

Summary

Introduction

Pelvic girdle pain (PGP) is a term used to describe pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints. Hypermobility and ligamentous laxity of the SI joint due to increased levels of estrogen and relaxin appear in the third trimester of pregnancy (Dreyfuss et al 2004). These altered hormonal factors allow the pelvic girdle to slightly expand in order to accommodate parturition. Factors that have been shown to increase the risk of pelvic girdle pain include pre-pregnancy back pain (Sjödahl et al 2013), back flexor weakness (Gutke et al 2008), body mass index (Sjödahl et al 2013), hypermobility, asymmetric SI joint ligament laxity (Damen et al 2001), emotional distress (Bjelland et al 2013), and vaginal delivery (Bjelland et al 2013)

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