Chronic Sacroiliac Joint Research Articles

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.

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.

Repeat Cooled Radiofrequency Ablation Is Beneficial for Chronic Posterior Sacroiliac Joint Pain.

This study aimed to investigate the effectiveness of repeat cooled radiofrequency ablation (CRFA) in chronic posterior sacroiliac joint (SIJ) pain. The electronic records of 41 adult patients who had successful CRFA were reviewed for duration of pain relief and utilization of medical care for six months before and after each CRFA procedure. Academic, tertiary medical center. Forty-one adult patients who had CRFA for chronic posterior SIJ pain. A repeat ipsilateral CRFA ablation procedure provided 9.0 months of pain relief compared with 5.5 months after the first CRFA procedure (P = 0.0378). The total number of medical treatments decreased after the first CRFA procedure (from 343 to 201). The medical cost decreased by 51.0% after the first CRFA and by 70.4% after the repeated CRFA procedure. Using repeated nonsurgical, minimally invasive approach, CRFA relieves chronic posterior SIJ pain and reduces patients' utilization of medical services.

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.

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 outcome of 84 horses with sacroiliac joint region pain with (n = 69) or without (n = 15) other orthopaedic problems

SummaryThe objective of this study was to establish the long‐term outcome of horses with sacroiliac joint region pain alone, and those with sacroiliac joint region pain in association with other problems, that were managed conservatively. Horses diagnosed with sacroiliac joint region pain using diagnostic analgesia, with or without other concurrent orthopaedic problems, between January 2010 and December 2015 were identified. Only those horses managed conservatively were included in the study. Clinical data were obtained from the horses’ files. Information on outcome and on the immediate rehabilitation following diagnosis was obtained from the owner or rider via a standardised telephone questionnaire. Descriptive statistics were performed and a Chi‐squared test was used to assess association between the outcome and variables on signalment, clinical parameters and variables related to rehabilitation. One hundred and seventy‐eight horses were identified as cases; the questionnaire was completed for 84 horses (47.2% response rate). Fourteen horses (16.7%) returned to full work (mean follow‐up: 233.4 weeks). Ten horses (11.9%) were still working at this level at the time of the telephone questionnaire, one horse deteriorated after 2 years and three within 9 months. Twenty‐seven horses (32.1%) returned to a lower level of work. Twenty‐nine horses (34.5%) were retired and 14 (16.7%) were subjected to euthanasia shortly after the diagnosis. The outcome was significantly associated with the estimated magnitude of contribution of SI joint region pain to the horse's problem (P = 0.03). No horses with sacroiliac joint region pain alone returned to their previous level of work. Chronic sacroiliac joint region pain, either alone or in combination with other orthopaedic conditions, carries a poor prognosis for returning to full athletic function and a guarded prognosis for returning to some form of athletic activity at a lower level.

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.

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.

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.

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.

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.

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.

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.

Sacroiliac Joint Fusion: One Year Clinical and Radiographic Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery.

Background:Recalcitrant sacroiliac joint pain responds well to minimally-invasive surgical (MIS) techniques, although long-term radiographic and fusion data are limited.Objective:To evaluate the one-year clinical results from a cohort of patients with chronic sacroiliac (SI) joint pain unresponsive to conservative therapies who have undergone minimally invasive SI joint fusion.Methods:SI joint fusion was performed between May 2011 and January 2014. Outcomes included radiographic assessment of fusion status, leg and back pain severity via visual analog scale (VAS), disability via Oswestry Disability Index (ODI) and complication rate. Outcomes were measured at baseline and at follow-up appointments 6 months and 12 months post-procedure.Results:Twenty minimally invasive SI joint fusion procedures were performed on 18 patients (mean age: 47.2 (14.2), mean BMI: 29.4 (5.3), 56% female). At 12 months, the overall fusion rate was 88%. Back and leg pain improved from 81.7 to 44.1 points (p<0.001) and from 63.6 to 27.7 points (p=0.001), respectively. Disability scores improved from 61.0 to 40.5 (p=0.009). Despite a cohort containing patients with multiple comorbidities and work-related injuries, eight patients (50%) achieved the minimal clinically important difference (MCID) in back pain at 12 months, with 9 (69%) patients realizing this improvement in leg pain and 8 (57%) realizing the MCID in ODI scores at 12 months. No major complications were reported.Conclusion:Minimally invasive SI joint surgery is a safe and effective procedure, with a high fusion rate, a satisfactory safety profile and significant improvements in pain severity and disability reported through 12 months post-procedure.

Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants\xa0vs conservative management

PurposeTo compare the safety and effectiveness of minimally invasive sacroiliac joint fusion (SIJF) using triangular titanium implants vs conservative management (CM) in patients with chronic sacroiliac joint (SIJ) pain.Methods103 adults with chronic SIJ pain at nine sites in four European countries were randomly assigned to and underwent either minimally invasive SIJF using triangular titanium implants (N = 52) or CM (N = 51). CM was performed according to the European guidelines for the diagnosis and management of pelvic girdle pain and consisted of optimization of medical therapy, individualized physical therapy (PT) and adequate information and reassurance as part of a multifactorial treatment. The primary outcome was the difference in change in self-rated low back pain (LBP) at 6 months. Additional endpoints included quality of life using EQ-5D-3L, disability using Oswestry Disability Index (ODI), SIJ function using active straight leg raise (ASLR) test and adverse events. NCT01741025.ResultsAt 6 months, mean LBP improved by 43.3 points in the SIJF group and 5.7 points in the CM group (difference of 38.1 points, p < 0.0001). Mean ODI improved by 26 points in the SIJF group and 6 points in the CM group (p < 0.0001). ASLR, EQ-5D-3L, walking distance and satisfaction were statistically superior in the SIJF group. The frequency of adverse events did not differ between groups. One case of postoperative nerve impingement occurred in the surgical group.ConclusionsIn patients with chronic SIJ pain, minimally invasive SIJF using triangular titanium implants was safe and more effective than CM in relieving pain, reducing disability, improving patient function and quality of life.

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.

Psychometric properties including reliability, validity and responsiveness of the Majeed pelvic score in patients with chronic sacroiliac joint pain.

The Majeed scoring system is a disease-specific outcome measure that was originally designed to assess pelvic injuries. The aim of this study was to determine the psychometric properties of the Majeed scoring system for chronic sacroiliac joint pain. Internal consistency, content validity, criterion validity, construct validity and responsiveness to change was assessed prospectively for the Majeed scoring system in a cohort of 60 patients diagnosed with sacroiliac joint pain. This diagnosis was confirmed with CT-guided sacroiliac joint anaesthetic block. The overall Majeed score showed acceptable internal consistency (Cronbach alpha=0.63). Similarly, it showed acceptable floor (0%) and ceiling (0%) effects. On the other hand, the domains of pain, work, sitting and sexual intercourse had high (>30%) floor effects. Significant correlation with the physical component of the Short Form-36 (p=0.005) and Oswestry disability index (p≤0.001) was found indicating acceptable criterion validity. The overall Majeed score showed acceptable construct validity with all five developed hypotheses showing significance (p≤0.05). The overall Majeed score showed acceptable responsiveness to change with a large (≥0.80) effect size and standardized response mean. Overall the Majeed scoring system demonstrated acceptable psychometric properties for outcome assessment in chronic sacroiliac joint pain. Thus, its use in this condition is adequate. However, some domains demonstrated suboptimal performance indicating that improvement might be achieved with the development of an outcome measure specific for sacroiliac joint dysfunction and degeneration.

Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction.

Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n = 102) or non-surgical management (NSM, n = 46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. In this Level 1 multicenter prospective randomized controlled trial, minimally invasive SIJF with triangular titanium implants provided larger improvements in pain, disability and quality of life compared to NSM. Improvements after SIJF persisted to 24 months. This study was approved by a local or central IRB before any subjects were enrolled. All patients provided study-specific informed consent prior to participation.