Chronic Sacroiliac Joint Dysfunction Research Articles

Chronic sacroiliac joint dysfunction and CT-guided percutaneous fixation: a 6-year experience.

Reporting the clinical outcomes, patient satisfaction, and complications following an imaging-guided percutaneous screw fixation in the treatment of sacroiliac joint dysfunction and evaluating the safety and effectiveness of this method. We performed a retrospective study on a prospectively gathered cohort of patients with physiotherapy-resistant pain due to sacroiliac joint incompetence that underwent percutaneous screw fixation, between 2016 and 2022 in our center. A minimum of two screws were used in all patients to obtain fixation of the sacroiliac joint, using percutaneous screw insertion under CT guidance, coupled with a C-arm fluoroscopy unit. The mean visual analog scale significantly improved at 6months of follow-up (p < 0.05). One hundred percent of the patients reported significant improvement in pain scores at the final follow-up. None of our patients experienced intraoperative or postoperative complications. The use of percutaneous sacroiliac screws provides a safe and effective technique for the treatment of sacroiliac joint dysfunction in patients with chronic resistant pain.

34361 Laser hair removal treatment considerations for Ehlers Danlos syndrome

EDS is a clinically and genetically heterogenous group of heritable connective tissue disorders involving a pathogenic disruption of collagen fibrils. Here we present a case of laser hair removal in the setting of EDS (type 6a) in a 29-year-old female phototype 2 patient successfully treated with 755-nm alexandrite laser for aesthetic laser hair removal. Our patient was born with a dislocated hip and diagnosed at age 6 with EDS type 6a with genetic confirmation of PLOD1 positive gene mutation, poor wound healing, chronic sacroiliac joint dysfunction, kyphoscoliosis and bilateral hip dysplasia. She also had a myocardial infarction, right renal artery dissection and iliac artery dissection. She was interested in aesthetic laser hair removal and noted a significant scarring history with numerous hypopigmented scars throughout her extremities with shaving leaving her with scarring on occasion. Given her complex connective tissue disease history with significant morbidity particular consideration was given to planning her laser hair removal treatment sessions for the bikini line. Clinically our patient was phototype 2 with the bikini line containing dark brown terminal hair. To clinically identify endpoints and mitigate potential complications including scarring a test spot was initially performed. The test spot was performed with the alexandrite laser 755 nm, fluence 16 J/cm2, 10-ms pulse duration, 18-mm spot size, dynamic cooling device with 4 total pulses in separate areas. No undesirable endpoints, pigmentary alteration, or scarring was observed and full treatment sessions were initiated with 755-nm 16-18 J/cm2, 10-ms pulse duration, 18-mm spot size, dynamic cooling device with excellent clinical response.

Pilot Study of Sacroiliac Joint Dysfunction Treated with a Single Session of Fascial Manipulation® Method: Clinical Implications for Effective Pain Reduction

Background and Objectives: Sacroiliac joint dysfunction (SIJD) generally refers to pain in the lower back due to abnormal sacroiliac joint movement, either from hypomobility or hypermobility. It is considered to be the principal cause in up to 40% of low back pain cases. In literature, it emerges that the “fascia”, by its anatomical continuity, if altered or densified in different regions of the body with respect to the sacroiliac joint and its surroundings, may have a fundamental role in the genesis of SIJD and low back pain. The purpose of the present study is to evaluate the effectiveness of incorporating a single session of Fascial Manipulation®-Stecco method®, treating the muscular fasciae at distance from the painful region. Materials and Methods: Twenty patients with acute and chronic sacroiliac joint dysfunction (SIJD) were recruited (16 males and 4 females, mean age of 46.6 ± 12.98 years). Patients underwent a predefined assessment protocol, followed by an evaluation of myofascial pain and subsequent manipulation of the fascia at points at least 20 cm away from the posterior inferior iliac spines (PIIS). Each patient underwent three pain evaluations: pre-treatment (t0), post-treatment (t1), and at a 1-month follow-up (t2). For the evaluation in t0, t1 the numerical rating scale (NRS) for the intensity of pain and the algometer for the pain threshold at the PIIS were used; in t2 only the NRS scale. Results: The results obtained by comparing the algometer measurements with the NRS values between t0 and t1 were in both cases statistically significant (p < 0.0001), whereas the comparison between the NRS values at t1 and at t2 was not statistically significant (p > 0.05). Conclusions: A single Fascial Manipulation treatment, even when applied at least 20 cm from the PIIS, can potentially decrease pain around the SIJ. The inclusion of this type of approach in SIJD can allow for improved patient management, better tolerance for other treatments and a more rapid application of pain-free exercise programs.

Effectiveness of muscle energy technique as compared to Maitland mobilisation for the treatment of chronic sacroiliac joint dysfunction.

To compare the effectiveness of Muscle Energy Technique (MET) with Maitland mobilisations when using lumbopelvic stability exercises as an adjunct therapy with them in reducing pain and disability in patients with sacroiliac joint dysfunction (SIJD). A randomised controlled trial was conducted at physical therapy departments of Khyber Teaching Hospital, Lady Reading Hospital and Rehab Polyclinic, Peshawar, Pakistan and comprised of data over a to a six-month period from January 2015 to June 2015. Sixty participants (both male and female with an age range of 25-55 years) were randomly assigned to two equal groups of 30 (50%) each by chit-box method. Group-A of 30 patients (experimental group) was treated with Muscle Energy Technique (MET). Group-B of 30 patients (control group) was treated with Maitland Mobilizations at sacroiliac joint. Lumbopelvic stability exercises were given to both groups. The treatment outcomes were measured on the first day and then after 4 weeks (12 sessions) from each subject's pain and disability levels by using Visual Analogue Scale (VAS) for measuring pain and Modified Oswestry Disability Index (MODI) for measuring disability. The paired sample statistics for intra-group analysis of the VAS and MODI showed a significant difference in values i.e. for Group-A, VAS was 16.699 with p-value 0.000 and MODI was 29.125 with p-value 0.000 while for Group-B, VAS was 18.687 with p-value 0.001 and MODI was 28.607 with p-value 0.001. The independent samples test for inter-group analysis of pre-VAS and post-VAS were 0.662 with 0.510 p-value and 1.000 with 0.321 p-value respectively while of pre-MODI and post-MODI were -1.482 with 0.144 p-value and -0.114 with 0.909 p-value respectively This showed an insignificant difference in pain and disability outcomes between the groups. MET and Maitland mobilisations are both effective in treating the chronic sacroiliac joint dysfunction when using lumbopelvic stabilisation exercises as an adjunct therapy with them.

EFFECT OF MUSCLE ENERGY TECHNIQUE IN CHRONIC SACROILIAC JOINT DYSFUNCTION

Objective: The study conducted for evaluating the effectiveness of muscle energy technique in chronic SIJ dysfunction. Methods: 30 patients with chronic sacroiliac joint dysfunction from both genders. Patients were divided into 2 groups 15 in each group .Group A: received muscle energy technique using post isometric relaxation technique to erector spinae, hamstrings, iliopsoas and quadratus lumborum plus conventional treatment program. Group B: control group received conventional treatment program only .Doppler imaging of vibration, palpation meter and visual analogue scale were utilized for evaluating patients (pre and post treatment). Results: The study findings revealed a statistical significant decrease of anterior pelvic tilting angle in group A (p<0.001), also a significant decrease of pain in the 2 groups compared with pre-intervention values(p<0.001) . Conclusion: Muscle energy technique is an effective treatment for decreasing anterior pelvic tilting angle and reducing pain in patients with chronic sacroiliac joint dysfunction. Key words: Muscle energy technique, Doppler imaging of vibration. Palpation meter.

Long-term prospective outcomes after minimally invasive trans-iliac sacroiliac joint fusion using triangular titanium implants

BackgroundMinimally invasive sacroiliac joint fusion (SIJF) has become an increasingly accepted surgical option for chronic sacroiliac (SI) joint dysfunction, a prevalent cause of unremitting low back/buttock pain.ObjectiveThe objective of this study was to report clinical and functional outcomes of SIJF using triangular titanium implants (TTI) in the treatment of chronic SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint (SIJ) disruption at 3 years postoperatively.MethodsA total of 103 subjects with SIJ dysfunction at 12 centers were treated with TTI in two prospective clinical trials (NCT01640353 and NCT01681004) and enrolled in this long-term follow-up study (NCT02270203). Subjects were evaluated in study clinics at study start and again at 3, 4, and 5 years.ResultsMean (SD) preoperative SIJ pain score was 81.5, and mean preoperative Oswestry Disability Index (ODI) was 56.3. At 3 years, mean pain SIJ pain score decreased to 26.2 (a 55-point improvement from baseline, p<0.0001). At 3 years, mean ODI was 28.2 (a 28-point improvement from baseline, p<0.0001). In all, 82% of subjects were very satisfied with the procedure at 3 years. EuroQol-5D (EQ-5D) time trade-off index improved by 0.30 points (p<0.0001). No adverse events definitely related to the study device or procedure were reported; one subject underwent revision surgery at year 3.7. SIJ pain contralateral to the originally treated side occurred in 15 subjects of whom four underwent contralateral SIJF. The proportion of subjects who were employed outside the home full- or part-time at 3 years decreased somewhat from baseline (p=0.1814), and the proportion of subjects who would have the procedure again was lower at 3 years compared to earlier time points.ConclusionIn long-term (3-year) follow-up, minimally invasive trans-iliac SIJF with TTI was associated with improved pain, disability, and quality of life with relatively high satisfaction rates.Level of evidenceLevel II.Clinical relevanceSIJF with TTI.

Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial

BackgroundManual therapy and exercise therapy are two common treatments for low back pain. Although their effects have been discussed in several studies, the superiority of one over the other for patients with sacroiliac joint dysfunction is still unclear. ObjectivesThe aim of this study was to compare the effects of manipulation (M) and stabilization exercises (S) in patients with subacute or chronic sacroiliac joint dysfunction. MethodsThe participants in this randomized controlled trial study were patients with subacute or chronic sacroiliac joint dysfunction for more than 4 weeks and less than 1 year. A total of 40 patients were randomized with a minimization method to the M (n = 20) or S (n = 20) group; 15 patients in each group received treatment. The treatment program lasted 2 week in group M and 4 weeks in group S. Pain and the Oswestry Disability Index (ODI) were recorded before and immediately after the treatment period. ResultsBoth groups showed significant improvement in assessed pain and ODI (P < 0.05). There were no statistically significant differences between groups in post-intervention assessed pain or ODI (P > 0.05). ConclusionsDespite the improvements seen after both manipulation and stabilization exercise therapies in patients with sacroiliac joint dysfunction, there was no significant between-group difference in the treatment effects. This result suggests that neither manual therapy nor stabilization exercise therapy is superior for treating subacute or chronic sacroiliac joint dysfunction.

Efficacy of Mulligan Mobilization Versus Muscle Energy Technique in Chronic Sacroiliac Joint Dysfunction

Background: Sacroiliac joint dysfunction represents 15% of low back pain conditions. Normal sacroiliac joint works as a safeguard and transmits upper body weight into the pelvis and lower extremities. If the SIJ is hypomobile, it cannot effectively absorb forces and other body parts may be overstressed causing musculoskeletal dysfunction. The study conducted by comparing the effectiveness of Mulligan mobilization versus muscle energy technique in chronic SIJ dysfunction.Methods: 45 patients with chronic sacroiliac joint dysfunction from both genders joined the study. They were divided into three groups 15 in each group. Group A: received Mulligan mobilization with movement using posterior and anterior innominate methods plus conventional treatment program. Group B: received muscle energy technique using a post-isometric relaxation technique to erector spinae, hamstrings, iliopsoas and quadratus lumborum plus conventional treatment program. Group C: control group obtained conventional treatment program only. Doppler imaging of vibration, palpation meter, and the visual analogue scale was utilized for evaluating patients (pre and post-treatment).Results: The study findings revealed a statistical remarkable improvement in post-intervention values for sacroiliac mobility in Mulligan mobilization group (p > 0.0001) and a statistically significant decrease of anterior pelvic tilting angle in Mulligan mobilization and muscle energy technique groups (p > 0.0001), also a significant decrease of pain in the 3 groups compared with pre-intervention values (p > 0.0001), additionally, Mulligan mobilization group showed a statistical high detectable difference in right and left sacroiliac mobility more than muscle energy technique and control groups (p > 0.0001).Conclusion: Mulligan mobilization is more effective than muscle energy technique in the treatment of chronic sacroiliac joint dysfunction.

Productivity benefits of minimally invasive surgery in patients with chronic sacroiliac joint dysfunction.

IntroductionSacroiliac joint (SIJ) dysfunction is associated with a marked decrease in quality of life. Increasing evidence supports minimally invasive SIJ fusion as a safe and effective procedure for the treatment of chronic SIJ dysfunction. The impact of SIJ fusion on worker productivity is not known.MethodsRegression modeling using data from the National Health Interview Survey was applied to determine the relationship between responses to selected interview questions related to function and economic outcomes. Regression coefficients were then applied to prospectively collected, individual patient data in a randomized trial of SIJ fusion (INSITE, NCT01681004) to estimate expected differences in economic outcomes across treatments.ResultsPatients who receive SIJ fusion using iFuse Implant System® have an expected increase in the probability of working of 16% (95% confidence interval [CI] 11%–21%) relative to nonsurgical patients. The expected change in earnings across groups was US $3,128 (not statistically significant). Combining the two metrics, the annual increase in worker productivity given surgical vs nonsurgical care was $6,924 (95% CI $1,890–$11,945).ConclusionFor employees with chronic, severe SIJ dysfunction, minimally invasive SIJ fusion may improve worker productivity compared to nonsurgical treatment.

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.

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.

Sacroiliac Joint Fusion Using Triangular Titanium Implants vs. Non-Surgical Management: Six-Month Outcomes from a Prospective Randomized Controlled Trial.

BackgroundSacroiliac (SI) joint pain is a prevalent, underdiagnosed cause of lower back pain. SI joint fusion can relieve pain and improve quality of life in patients who have failed nonoperative care. To date, no study has concurrently compared surgical and non-surgical treatments for chronic SI joint dysfunction.MethodsWe conducted a prospective randomized controlled trial of 148 subjects with SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint disruptions who were assigned to either minimally invasive SI joint fusion with triangular titanium implants (N=102) or non-surgical management (NSM, n=46). SI joint pain scores, Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and EuroQol-5D (EQ-5D) were collected at baseline and at 1, 3 and 6 months after treatment commencement. Six-month success rates, defined as the proportion of treated subjects with a 20-mm improvement in SI joint pain in the absence of severe device-related or neurologic SI joint-related adverse events or surgical revision, were compared using Bayesian methods.ResultsSubjects (mean age 51, 70% women) were highly debilitated at baseline (mean SI joint VAS pain score 82, mean ODI score 62). Six-month follow-up was obtained in 97.3%. By 6 months, success rates were 81.4% in the surgical group vs. 23.9% in the NSM group (difference of 56.6%, 95% posterior credible interval 41.4-70.0%, posterior probability of superiority >0.999). Clinically important (≥15 point) ODI improvement at 6 months occurred in 75% of surgery subjects vs. 27.3% of NSM subjects. At six months, quality of life improved more in the surgery group and satisfaction rates were high. The mean number of adverse events in the first six months was slightly higher in the surgical group compared to the non-surgical group (1.3 vs. 1.0 events per subject, p=0.1857).ConclusionsSix-month follow-up from this level 1 study showed that minimally invasive SI joint fusion using triangular titanium implants was more effective than non-surgical management in relieving pain, improving function and improving quality of life in patients with SI joint dysfunction due to degenerative sacroiliitis or SI joint disruptions.Clinical relevanceMinimally invasive SI joint fusion is an acceptable option for patients with chronic SI joint dysfunction due to degenerative sacroiliitis and sacroiliac joint disruptions unresponsive to non-surgical treatments.

Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach

Background and purpose:Sacroiliac joint pain and dysfunction affect 15–25% of patients reporting low back pain, including reports of spontaneous, idiopathic, traumatic, and non-traumatic onsets. The poor reliability and validity associated with diagnostic clinical and imaging techniques leads to challenges in diagnosing and managing sacroiliac joint dysfunction.Case description:A 35-year-old nulliparous female with a 14-year history of right sacroiliac joint dysfunction was managed using a multimodal and multidisciplinary approach when symptoms failed to resolve after 2 months of physical therapy. The plan of care included four prolotherapy injections, sacroiliac joint manipulation into nutation, pelvic girdle belting, and specific stabilization exercises.Outcomes:The patient completed 20 physical therapy sessions over a 12-month period. At 6 months, the patient’s Oswestry Disability Questionnaire score was reduced from 34% to 14%. At 1-year follow-up, her score was 0%. The patient’s rating of pain on a numeric rating scale decreased to an average of 4/10 at 6 months and 0/10 at 1-year follow-up.Discussion:A multidisciplinary and multimodal approach for the management of chronic sacroiliac joint dysfunction appeared successful in a single-case design at 1-year follow-up.

Minimally invasive arthrodesis for chronic sacroiliac joint dysfunction using the SImmetry SI Joint Fusion system.

Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry® SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed.