Chronic Sacroiliac Joint Pain Research Articles

Catamaran SI Joint Fusion System(R) MAINSAILTM Study: a prospective, single-arm, multi-center, post-market study of six-month clinical outcomes and twelve-month radiographic findings

ABSTRACT Background Minimally invasive surgical techniques for sacroiliac joint (SIJ) fixation have the potential to reduce risk and improve patient outcomes, but evidence remains limited. This interim analysis presents initial findings from an ongoing prospective study evaluating the safety and efficacy of the Catamaran System. Methods The primary endpoint of success at 6 months was defined as a ≥20 mm improvement in SIJ pain (Visual Analog Scale, VAS), no neurologic worsening, absence of device-related serious adverse events (SAEs), and no surgical reintervention. Secondary endpoints included 6 month evaluation of the Oswestry Disability Index (ODI), patient satisfaction, and 12 month radiographic CT fusion, performed by an indpendent radiologist. Results Thirty-three consecutive patients (mean age: 58.9 years; %-females: 76%; Body Mass Index: 30.5) were treated across six U.S. clinical sites. At the primary endpoint of 6 months, 80% of patients met the criteria for success, with no device-related SAEs and no surgical reintervention reported. VASSIJ-Pain significantly decreased from preoperative levels (mean: 80.9 mm) to 6 months postoperatively (31.1 mm; p < 0.001). Mean ODI scores also showed a significant improvement from preoperative values (51.9%) to 6 months postoperatively (29.6%, p < 0.01). Patients reported high satisfaction rates throughout all follow-ups, with 93.3% of patients being satisfied at 6 months. Conclusion In patients diagnosed with chronic SIJ pain, minimally invasive inferior-posterior delivery of the Catamaran implant was safe and effective in relieving pain and reducing disability.

Treatment of chronic sacroiliac joint pain using Conventional Radiofrequency (CRF) and Pulsed Radiofrequency (PRF): A randomized control study.

Objective: To determine the effectiveness of conventional radiofrequency (CRF) and pulsed radiofrequency (PRF) in treatment of chronic sacroiliac joint pain. Study Design: Randomized Controlled Trial. Setting: Shaikh Zayed Hospital, Lahore. Period: 2nd August 2022 to 10th February 2023. Methods: A total sample of 60 patients with SIJ pain was screened for this study. This sample was divided equally but randomly into both study groups; conventional radiofrequency (CRF) and pulsed radiofrequency (PRF). Pre-procedure general information on Visual analogue score (VAS) and revised Oswestry Disability Index (ODI) were used to measure the main outcome variables; pain score and physical disability index. Post-procedure information on these two outcome variables was also recorded after 1, 3 and 6 months duration. Paired samples t-test and independent samples t-test was used to assess the effectiveness of these two treatment methods for SIJ pain treatment. Results: The mean pain score in the conventional radiofrequency (CRF) group was reduced to 3.02 ± 0.9 from 8.02 ± 1.13 which is more substantial and statistically significant than pulsed radiofrequency where it was 4.2± 1.31 from 7.98 ± 1.20. Similarly, the conventional radiofrequency (CRF) group showed better performance on average scores of the ODI index (20.2± 6.9) as compared to pulsed radiofrequency (31.2± 8.9) in reducing physical disability in SIJ patients. Conclusion: This study concludes that the existing conventional radiofrequency (CRF) method of treatment can be effectively used in treatment of SIJ with its slight complications.

Successful Radiofrequency Ablation of L4 and L5 Dorsal Rami for Unilateral Sacroiliitis: A Case Report

In this case report, we present the successful treatment of a 67-year-old man with chronic sacroiliac joint pain and left unilateral sacroiliitis observed on computed tomography using L4 and L5 dorsal rami radiofrequency ablation.

Minimally Invasive SI Joint Fusion Procedures for Chronic SI Joint Pain: Systematic Review and Meta-Analysis of Safety and Efficacy.

Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available. Data abstraction and random effects meta-analysis of safety and efficacy outcomes from published patient cohorts. Patient-reported outcomes (PROs) and safety measures were stratified by surgical technique: transiliac, including lateral transiliac (LTI) and posterolateral transiliac (PLTI), and posterior interpositional (PI) procedures. Fifty-seven cohorts of 2851 patients were identified, including 43 cohorts (2126 patients) for LTI, 6 cohorts (228 patients) for PLTI, and 8 cohorts (497 patients) for PI procedures. Randomized trials were only available for LTI. PROs were available for pain (numeric rating scale) in 57 cohorts (2851 patients) and disability (Oswestry Disability Index [ODI]) in 37 cohorts (1978 patients).All studies with PROs showed improvement from baseline after surgery. Meta-analytic improvements in pain scores were highest for LTI (4.8 points [0-10 scale]), slightly lower for PLTI (4.2 points), and lowest for PI procedures (3.8 points, P = 0.1533). Mean improvements in ODI scores were highest for LTI (25.9 points), lowest for PLTI procedures (6.8 points), and intermediate for PI (16.3 points, P = 0.0095).For safety outcomes, acute symptomatic implant malposition was 0.43% for LTI, 0% for PLTI, and 0.2% for PI procedures. Wound infection was reported in 0.15% of LTI, 0% of PLTI, and 0% of PI procedures. Bleeding requiring surgical intervention was reported in 0.04% of LTI procedures and not reported for PLTI or PI. Breakage and migration were not reported for any device. Radiographic imaging evaluation reporting implant placement accuracy and fusion was only available for LTI. Literature support for SI joint fusion is growing. The LTI procedure contains the largest body of available evidence and shows the largest improvements in pain and ODI. Only LTI procedures have independent radiographic evidence of fusion and implant placement. The adverse event rate for all procedures was low.

Posterior oblique technique for sacroiliac joint fusion leads to greater pain relief and similar improvement in function compared to the lateral technique: A retrospective, comparative study

BackgroundManagement of chronic sacroiliac joint (SIJ) pain among patients who do not respond to nonsurgical treatment is increasingly turning toward minimally invasive SIJ fusion. There are different techniques available to perform this procedure, with the lateral technique being more commonly studied than the posterior oblique technique. This study examined the effects of these techniques on pain relief and functional improvement, both preoperatively and at a 12-month follow-up. MethodsThis retrospective cohort study analyzed data from 45 patients who underwent SIJ fusion. Included patients were ≥50 years old, nonresponsive to conservative treatment. Subjects were divided into 2 cohorts based on the SIJ fusion technique. Primary outcomes were pain relief, measured by Visual Analog Scale (VAS), and functional improvement, determined by the Oswestry Disability Index (ODI); both were recorded and assessed at baseline, postoperative, and the change from pre- to postoperative. Additionally, data regarding patient demographics, previous lumbar fusion, operative time, and duration of hospital stay were collected and analyzed. ResultsBaseline demographic and clinical variables exhibited no significant differences in distribution between groups. The posterior oblique cohort demonstrated a substantial reduction in operative time (over 50%) and duration of hospital stay compared to lateral cohort. Pain relief (postoperative VAS: lateral 3.5±1.7 vs. posterior oblique 2.4±1.5 [p=.02]) and functional improvement (postoperative ODI: lateral 29.6±7.3 vs. posterior oblique 21±5.7 [p≤.001]) were significantly better in the posterior oblique group. Pre- to postoperative improvement analysis indicated greater reduction in pain (VAS: lateral −4.4±1.9 vs. posterior oblique −6.1±1.5 [p=.002]) in the posterior oblique group. ConclusionsCompared to the lateral technique group, patients undergoing minimally invasive SIJ fusion through the posterior oblique technique experienced greater pain relief and demonstrated a trend toward better functional improvement, with shorter operative times and duration of hospital stay. The posterior oblique technique may be more efficient and beneficial to manage patients suffering from chronic SIJ pain through joint fusion.

Cooled radiofrequency ablation versus standard medical management for chronic sacroiliac joint pain: a multicenter, randomized comparative effectiveness study

IntroductionLow back pain is the leading cause of disability worldwide, with sacroiliac joint pain comprising up to 30% of cases of axial lower back pain. Conservative therapies provide only modest...

Efficacy of Sequential Bipolar Radio-Frequency Ablation in Treatment of Chronic Sacroiliac Joint Pain

Efficacy of Sequential Bipolar Radio-Frequency Ablation in Treatment of Chronic Sacroiliac Joint Pain

P154. Low back pain with surgical and nonsurgical treatment of closed pelvic ring fractures with sacral injuries: a single institutional retrospective review

<h3>BACKGROUND CONTEXT</h3> Sacroiliac joint (SIJ) fusion surgery for chronic back pain has grown in popularity since 2011. A variety of implants have been developed since then to allow surgeons to perform this technique with ease while decreasing complications associated with a new technology. Despite the wide acceptance of this technology, factors that would lead to a satisfactory surgical outcome still remain unclear. Due to the robust mechanical properties of the incongruent sacroiliac joint, one could argue that the joint is truly not unstable. Adding additional stability by fusing the joint that is already stable does not explain why the procedure would be beneficial. Based on the hypothesis that SIJ pain is not necessarily due to mechanical instability, this study will review patients with pelvic trauma who either underwent nonoperative management versus operative management to assess who eventually developed chronic SIJ pain and required further ongoing intervention. For patients who underwent sacroiliac joint fusion, theoretically they should not develop chronic SIJ pain afterward. For patients who were treated nonoperatively, leading to potential mechanical instability, they would be more likely to develop chronic sacroiliac joint pain. This study will either validate or refute the belief that sacroiliac joint dysfunction is truly mechanically related. <h3>PURPOSE</h3> The purpose of this study is to determine if surgery negates the need for additional intervention for SI joint pain and determine if any displacement addressed during surgery contributes to better outcomes for the patient. <h3>STUDY DESIGN/SETTING</h3> This is a retrospective review of patients from a single Level I trauma center. <h3>PATIENT SAMPLE</h3> A total of 68 patients (56% male) from the University of Missouri-Columbia were included between 2015 and 2019. Patients between 18 and 65 years of age who sustained closed pelvic ring fractures with SI joint involvement were included in the study. Exclusion criteria include no contact information listed in chart, history of back pain prior to the injury, lack of appropriate followup radiographs and previous history of lumbar surgery or lumbar surgery as a result of the inciting injury. <h3>OUTCOME MEASURES</h3> The amount of anterior-posterior and vertical displacement were measured both pre- and postsurgery. Patients were separated into surgical and nonsurgical groups, with additional interventions of chiropractic manipulation, narcotics, physical therapy, non-steroidal anti-inflammatory medications and home exercises. <h3>METHODS</h3> Data analysis was performed with student's T test, Wilcoxon rank sum test and Fischer exact test with statistical significance achieved when p <0.05. A stepwise regression model was used to determine if comorbidities are associated with increased interventions in both the surgical and nonsurgical group. <h3>RESULTS</h3> No significant difference was found between the surgical and nonsurgical groups in terms of both demographics and comorbidities. There was also no significant difference between the number of interventions needed for patients treated with or without surgery. Increased comorbidities are not associated with an increased number of interventions needed in either the surgical or nonsurgical group. Additionally, surgery did not significantly decrease the amount of anterior-posterior and vertical displacement as measured on X-rays. <h3>CONCLUSIONS</h3> Conservative management is likely just as effective for certain pelvic ring injuries involving the SIJ. Based on current findings, providing additional mechanical stability for the SIJ does not necessarily provide a greater clinical outcome in these fractures. Therefore, the explanation for the clinical improvement of SIJ fusion in nontrauma patients remains elusive. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials.

Radiofrequency ablation (RFA) has emerged as a popular intervention for chronic pain management, including pain originating in the sacroiliac joint. It offers a less invasive option than surgery but with better results than the previous standard treatment with steroid and anesthetic injections. Procedure volumes have enjoyed significant growth in the market in recent years. The evidence supporting this intervention, in the form of randomized controlled trials, however, is both thin and mixed. The purpose of this systematic review is to evaluate the body of randomized controlled trials (RCTs) to determine the quality of support for and against the use of radiofrequency ablation to treat sacroiliac joint (SIJ) pain. Several important new papers have emerged since previous systematic reviews with similar objectives were published. The review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and three databases were used: PubMed, Google Scholar, and Scopus. Only RCTs were sought, and no other filters, such as a historical timeline cut-off, were used. Among 95 publications that returned in response to the query, 16 were ultimately accepted as meeting the inclusion/exclusion criteria. The Cochrane risk-of-bias tool was utilized as a quality assessment measure, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework was used to assess the certainty of the evidence. Among the included publications, 15 out of 16 publications featured positive results and conclusions that supported the use of RFA in treating chronic sacroiliac joint pain. The single negative study was also the largest trial (n=681), but it was identified as “High Risk” using the Cochrane risk-of-bias tool. It included several design flaws including neither operator nor patient blinding, missing information, use of inconsistent treatment modalities across groups, and disproportionate drop-out rates. Despite its flaws, we have included this study in the present review because of its sheer size. Taken in aggregate, the total body of research included in this review supports this intervention. Questions continue to exist around whether there are clinically significant benefits associated with different RFA modalities (for example, unipolar vs. bipolar), with convincing evidence supporting each of them. Finally, it can be concluded that while the benefits are reasonably and justifiably supported in this patient population for up to one year, there is a dearth of evidence beyond a 12-month post-intervention follow-up.

Biomechanical Stability of the Sacroiliac Joint with Differing Implant Configurations in a Synthetic Model.

The sacroiliac joint (SIJ) is responsible for 15%-30% of chronic low back pain and fusion is increasingly used to alleviate chronic SIJ pain in adults. However, questions remain as to the most effective implant patterns to stabilize the joint. The objective of this biomechanical study was to evaluate how different implant spacing, configuration and quantity effect range of motion (ROM) of a synthetic foam SIJ model. Triangular SIJ fusion implants were tested in six patterns using three implants, and two patterns with two implants (n = 5/pattern). Linear, triangular, and angled (10° or 20°) implant patterns were used with spacing of 13 or 22 mm between implants. Implants were placed through a denser polyurethane foam block (0.32 g/cm3) representing the ilium and into a less dense block representing the sacrum (0.16 g/cm3) to a depth 30 mm with a 2-mm gap between blocks. Cyclic torsion and shear testing were conducted for 10,000 cycles and ROM was recorded. Pullout testing was conducted on non-cycled (n = 10) implants and individually on all implants after construct cycling. ROM was significantly lower for all 22-mm implant patterns compared to the 13 mm linear pattern after cyclic loading in both torsion and shear. The use of three implants provided 60% and 86% greater stability, respectively, than two implants with spacing of 22 and 13 mm. Pullout resistance followed similar trends with the lowest forces occurring in closely spaced patterns that used two implants. This study demonstrated that the use of three implants and maximizing the spacing between implants might provide greater stability to the SIJ. If implants must be placed closely, then nonlinear patterns may improve construct stability.

International Society for the Advancement of Spine Surgery Policy 2020 Update-Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity.

The index 2014 International Society for the Advancement of Spine Surgery Policy Statement-Minimally Invasive Surgical Sacroiliac Joint Fusion-was generated out of necessity to provide an International Classification of Diseases, Ninth Revision (ICD-9)-based background and emphasize tools to ensure correct diagnosis. A timely ICD-10-based 2016 update provided a granular threshold selection with improved level of evidence and a more robust and relevant database (Appendix Table A1). As procedures and treatment options have evolved, this 2020 update reviews and analyzes the expanding evidence base and provides guidance relating to differences between the lateral and dorsal surgical procedures for minimally invasive surgical sacroiliac joint fusion.

Chronic sacroiliac joint pain treated with pulsed radiofrequency ablation

Chronic sacroiliac joint (SI) pain can cause disability in an aging society. Effective treatment of low back pain (LBP) originating from sacroiliac joints is difficult to achieve. We report the successful treatment of pulsed radiofrequency (PRF) ablation in a patient with chronic SI joint pain. There were no post-interventional complications. Clinical improvement reported after 12 months.

The Effect of Peripheral Neuromodulation on Pain From the Sacroiliac Joint: A Retrospective Cohort Study

To report a retrospective review of the longer-term results of peripheral neuromodulation in 12 patients with significant chronic sacroiliac joint pain who had previously failed multiple conservative and interventional pain therapies. To allow for the assessment of meaningful longer-term outcome, implants for all 12 patients had been in place for a minimum of 18 months to a maximum of 36 months prior to the formal review. Compared to the preimplantation baseline, the longer-term follow-up revealed a significant and sustained reduction in visual analog scale pain scores from 8.7T 1.1 to 1.1T 1.0 (p < 0.001), with a 75% reduction in analgesia requirement, and improvement in pain impact on daily function from 94.1% T 5.9% to 5.8% T 6.0% (p < 0.001). This initial case series has highlighted that SIJ neuromodulation results in the reduction in pain intensity and improved functionality in patients who have already failed conventional medical management and interventional techniques, including RF denervation. These preliminary results merit a prospective randomized trial of peripheral neuromodulation.

Clinical observation of CT-guided intra-articular conventional radiofrequency and pulsed radiofrequency in the treatment of chronic sacroiliac joint pain.

BackgroundSacroiliac joint pain (SIJP) is an important cause of low back pain and seriously affects the patients’ quality of life. Therefore, it is urgent to find effective treatment methods.ObjectiveTo observe the efficacy of intra-articular (IA) conventional radiofrequency (CRF) and pulsed radiofrequency (PRF) treatment of Sacroiliac joint syndrome (SIJS) under computed tomography (CT) guidance.Study designRetrospective comparative study.SettingShengjing Hospital of China Medical University.Patients and methodsSixty-four patients with SIJS were enrolled in the Pain management. Patients were randomized into two groups: CRF (CRF group, n=32) and PRF (PRF group, n=32). At each observation time, the general condition, visual analog scale (VAS), the total efficiency rate, Oswestry disability index (ODI), and 36-item short-form health survey were followed up.ResultsCompared to the pretreatment value, the VAS and the ODI decreased in both groups after treatment (P<0.05). In the CRF group, the VAS and the ODI decreased significantly at 1 week after treatment (P<0.05); at 6 and 12 months after treatment, the VAS and the ODI were lower than that in the PRF group (P<0.05). The total efficiency rate in the CRF group and PRF group was 56.3% and 31.3%, respectively (P<0.05). After the relief of pain, both groups received different degrees of improvement in the quality of life. Compared to the pretreatment value, physical component summary (PCS) and the mental component summary (MCS) in both groups were increased after treatment (P<0.05); in the CRF group, PCS and MCS increased significantly at 1 week after treatment (P<0.05); and at 6 and 12 months after treatment, PCS and MCS were higher than those in the PRF group (P<0.05).ConclusionCT-guided IA PRF and CRF in the treatment of sacroiliac pain are safe and effective. CRF is superior to PRF in the early and late stage. It is recommended for the treatment of SIJP.

Sacroiliac joint arthrodesis for chronic sacroiliac joint pain: an anterior approach and clinical outcomes with a minimum 5-year follow-up.

OBJECTIVE The authors evaluated the outcomes of sacroiliac joint (SIJ) arthrodesis via an original anterior approach to the upper anterior surface of the SIJ in patients with a minimum of 5 years' follow-up. METHODS The authors performed anterior SIJ arthrodesis in 45 patients between 2001 and 2015. Of these patients, 27 (11 men and 16 women; mean age at surgery 49 [24-86] years) were followed up for a minimum of 5 years (average 113 months, range 61-157 months). In the 14 patients in the earlier period of this study, the authors used an anterior approach to expose the SIJ by separating the iliac muscle from the iliac bone and performed internal fixation. In the 13 patients later in the study, the authors changed to a pararectal approach, which involved an incision along the lateral border of the rectus abdominal muscle. Then, extraperitoneally, the upper anterior surface of the SIJ was exposed between the psoas major muscle and the iliac muscle. RESULTS Among the 27 patients, 21 had unilateral anterior arthrodesis alone, 4 required additional posterior arthrodesis, and 2 required pelvic ring arthrodesis because of later pain on the opposite side. In the 21 patients with a unilateral anterior arthrodesis, outcome according to the modified Macnab criteria was excellent in 7, good in 11, and fair in 3. Outcomes were excellent, good, fair, and poor in 1 patient each among the 4 with additional posterior fusion. Outcomes were good and poor for 1 patient each among those with pelvic ring arthrodesis. All 27 patients demonstrated bone union of the SIJ on CT. Lateral femoral cutaneous neuralgia developed in 7 of the 27 patients; 6 patients had undergone the initial anterior method and 1 the later method. CONCLUSIONS Anterior SIJ arthrodesis was effective in most patients with severe SIJ pain resistant to conservative therapy. This approach has the advantage of direct curettage and bone graft into the wide area of the SIJ, which result in good bone union. In particular, the authors' current pararectal approach could decrease the potential risk of lateral cutaneous injury.

The efficacy and safety of using cooled radiofrequency in treating chronic sacroiliac joint pain: A PRISMA-compliant meta-analysis.

Background:Cooled radiofrequency procedure is a novel minimally invasive surgical technique and has been occasionally utilized in managing chronic sacroiliac joint (SIJ) pain. A meta-analysis was conducted to systematically assess the efficacy and safety of using cooled radiofrequency in treating patients with chronic SIJ pain in terms of pain and disability relief, patients’ satisfaction degree as well as complications.Methods:Studies of using cooled radiofrequency procedure in managing SIJ pain were retrieved from Medline and Web of Science according to inclusion and exclusion criteria. Quality evaluation was conducted using Cochrane collaboration tool for randomized controlled trials and MINORS quality assessment for noncomparative trials. Statistics were managed using Review Manager 5.3.Results:Totally 7 studies with 240 eligible patients were enrolled. The overall pooled results demonstrated that pain intensity decreased significantly after cooled radiofrequency procedure compared with that measured before treatment. The mean difference (MD) was 3.81 [95% confidence intervals (95% CIs): 3.29–4.33, P < .001] and 3.78 (95% CIs: 3.31–4.25, P < .001) as measured by the Numerical Rating Scale (NRS) and Visual Analog Scale (VAS), respectively. Disability also relieved significantly after treatment compared with that measured before treatment. The MD was 18.2 (95% CIs: 12.22–24.17, P < .001) as measured by the Oswestry Disability Index (ODI). Seventy-two percent of the patients presented positive results as measured by the Global Perceived Effect (GPE). The OR was 0.01 (95% CIs: 0.00–0.05, P < .001). Only mild complications were observed in the 7 studies, including transient hip pain, soreness, and numbness.Conclusion:Cooled radiofrequency procedure can significantly relieve pain and disability with no severe complications, and majority of patients are satisfied with this technique. Thus, it is safe and effective to use this procedure in managing patients with chronic SIJ pain. More high-quality and large-scale randomized controlled trials (RCTs) are required to validate our findings.Limitations:The sample size of the included studies was small and various heterogeneity existed.

Distraction arthrodesis of the sacroiliac joint: 2-year results of a descriptive prospective multi-center cohort study in 171 patients

PurposeThe aim of the given study was to evaluate the long-term outcomes of patients undergoing sacroiliac joint (SIJ) distraction arthrodesis to treat SIJ-related pain.MethodsDescriptive prospective multi-center cohort study involving 20 hospitals in Germany. Between January 2011 and June 2012, 171 patients with chronic SIJ pain underwent indirect arthrodesis of the SIJ using a distraction implant. The patients were questioned prior to surgery, 6-weeks, and 3-, 6-, 12- and 24-months postoperatively. Overall patient satisfaction was surveyed along with pain medication intake, the Million Visual Analogue Scale (MVAS), Oswestry Disability Index (ODI), Short-form McGill Pain Questionnaire (SF-MPQ), 12-Item Short-Form Health Survey (SF-12), Visual Analogue Scale (VAS) and a pain drawing. Bony fusion of the SIJ was evaluated using X-ray and computed tomography (CT).ResultsA majority of patients (73%) reported to feel better or much better 24 months post-surgery, 49% of the patients reduced their pain medication intake. The MVAS dropped from 63 to 36%, the ODI improved from 51 to 33%, the SF-MPQ decreased from 50 to 31%, the SF-12 physical component summary rose from 22 to 41%, the mental component summary increased from 40 to 55%, and pain as measured by the VAS decreased from 74 to 37 points (all comparisons p < 0.001). In the follow-up CT scans 31% of the patients showed SIJ fusion.ConclusionsSIJ distraction arthrodesis has shown satisfactory outcomes in patients with SIJ-related pain for all scores reported in the surveys, accompanied by increased functionality.

Innervation of the Anterior Sacroiliac Joint.

Sacroiliac joint pain can be disabling and recalcitrant to medical therapy. The innervation of this joint is poorly understood, especially its anterior aspect. Therefore, the present cadaveric study was performed to better elucidate this anatomy. Twenty-four cadaveric sides underwent dissection of the anterior sacroiliac joint, with special attention given to any branches from regional nerves to this joint. No femoral, obturator, or lumbosacral trunk branches destined to the anterior sacroiliac joint were identified in the 24 sides. In 20 sides, one or two small branches (less than 0.5 mm in diameter) were found to arise from the L4 ventral ramus (10%), the L5 ventral ramus (80%), or simultaneously from both the L4 and L5 ventral rami (10%). The length of the branches ranged from 5 to 31 mm (mean, 14 mm). All these branches arose from the posterior part of the nerves and traveled to the anterior surface of the sacroiliac joint. No statistical significance was found between sides or sexes. An improved knowledge of the innervation of the anterior sacroiliac joint might decrease suffering in patients with chronic sacroiliac joint pain.

The effect of intra-articular stimulation by pulsed radiofrequency on chronic sacroiliac joint pain refractory to intra-articular corticosteroid injection: A retrospective study.

We investigated the degree of pain reduction following intra-articular (IA) pulsed radiofrequency (PRF) stimulation of the sacroiliac joint (SIJ) in patients with chronic SIJ pain that had not responded to IA corticosteroid injection. Twenty patients were recruited. Clinical outcomes after applying PRF stimulation of the SIJ were evaluated by a numeric rating scale (NRS) and a 7-point Likert scale. The NRS scores significantly changed over time. The NRS scores at 1, 2, and 3 months after PRF were significantly lower than those before PRF. However, 4 of the 20 patients (20%) reported successful pain relief (pain relief of ≥ 50%) and were satisfied with the PRF stimulation at 3 months after treatment. IA PRF stimulation of the SIJ was not successful in most patients (80% of all patients). Based on our results, we cannot recommend this procedure to patients with chronic SIJ pain that was unresponsive to IA SIJ corticosteroid injection. Further studies on the effective mode of PRF stimulation and appropriate patient group, and studies on pain conditions that are most responsive to PRF are needed in the future.

Case series of ultrasound-guided platelet-rich plasma injections for sacroiliac joint dysfunction

Two-thirds of adults worldwide will experience low back pain at some point in their life. In the following case series, we present four patients with sacroiliac (SI) joint instability and severe chronic low back pain, which was refractory to other treatment modalities. We investigated the efficacy of platelet-rich plasma (PRP) injections, a novel orthobiologic therapy, for reducing SI joint pain, improving quality of life, and maintaining a clinical effect. Short-form McGill Pain Questionnaire (SFM), Numeric Rating Scale (NRS), and Oswestry Low Back Pain and Disability Index were used for evaluation of treatment at pretreatment, 12-months and 48-months after treatment. At follow-up 12-months post-treatment, pooled data from all patients reported a marked improvement in joint stability, a statistically significant reduction in pain, and improvement in quality of life. The clinical benefits of PRP were still significant at 4-years post-treatment. Platelet-rich plasma therapy exhibits clinical usefulness in both pain reduction and for functional improvement in patients with chronic SI joint pain. The improvement in joint stability and low back pain was maintained at 1- and 4-years post-treatment.