Chronic Sacroiliac Joint 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.

Study protocol for a prospective, randomized, multicenter trial to investigate the influence of peripheral nerve stimulation on patients with chronic sacroiliac joint syndrome (SILENCING)

BackgroundThe prevalence of sacroiliac joint pain (SIJP) is estimated to be 10–30% in patients with chronic low back pain. Numerous conservative and surgical treatment modalities for SIJP have been described with limited evidence regarding long-term pain relief.Spinal cord stimulation (SCS) is a well-established technique to treat patients with chronic low back pain. However, the effect on patients with SIJP is not consistent. Therefore, peripheral nerve stimulation (PNS) for chronic SIJP was implemented in experimental trials. Clinical data on PNS for SIJP is still lacking. The authors present a case series and a protocol for a prospective, multicenter study to determine the effect of PNS in patients with chronic intractable SIJP.MethodA multicenter, prospective randomized controlled trial was designed. Patients with chronic intractable SIJP will be recruited and randomized in a 4:3 ratio to either the peripheral nerve stimulation group or to the best medical treatment group. A total of 90 patients are planned to be enrolled (52 in the PNS group and 38 in the BMT group). Patients in the intervention group receive a percutaneous implantation of a unilateral or bilateral lead which is externalized for a trial phase for 3–14 days. After trial phase only patients with at least 50% reduction of pain receive an impulse generator for permanent stimulation. Regular visits for participants are planned on day 0, after 3 months (± 30 days), 6 months (± 30 days), and 12 months (± 60 days). The primary outcome measurements is the difference in Numeric Pain Rating Scale (NRS) between baseline and after 6 months. Secondary outcomes is improvement of pain associated disability (ODI) and improvement of health-related quality of life after 6 and 12 months.DiscussionWe have described the protocol for a prospective, multicenter, randomized trial evaluating the influence of PNS on patients with chronic sacroiliac joint syndrome. We believe that PNS on patients with chronic sacroiliac joint syndrome will show promising results regarding pain relief and quality of life in comparison to BMT after 12 months. The design of this trial promises high evidence in comparison to the data to date.Trial registrationClinicalTrials.gov, NCT05357300. Registered on April 26, 2022.

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.

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...

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.

Novel Physical Examination Tests for the Diagnosis of Chronic Sacroiliac Joint Dysfunction and Differentiate It From Lumbar Disc Herniation

BACKGROUND: Traditional sacroiliac joint (SIJ) provocation tests have been used to diagnose SIJ pain. However, this can simply be changed to chronic SIJ dysfunction (cSIJD) manifests as mechanical changes in the pelvis and lower extremities in addition to pain. A novel composite of physical examinations based on the iliac pronation, pubic tubercle tenderness, and plantar fascia tenderness tests (IPP triple tests) was designed for the diagnosis of cSIJD. OBJECTIVES: To evaluate IPP triple tests in the diagnosis of cSIJD and differential diagnosis from lumbar disc herniation (LDH) in comparison with traditional provocation tests. STUDY DESIGN: Prospective single-blind controlled study. SETTING: This study was conducted at the Department of Spine and Spinal Cord Surgery of China Rehabilitation Research Center in Beijing, China. METHODS: One hundred and sixty-six patients were assigned into the cSIJD group, LDH group, or healthy control group. The cSIJD diagnosis was confirmed by SIJ injection. The diagnosis of LDH was confirmed according to the 2014 North American Spine Association diagnosis and treatment guidelines for LDH. All patients were examined with IPP triple tests and traditional provocation tests. The sensitivity, specificity, positive and negative likelihood ratios, and areas under the curve (AUCs) were used to evaluate the diagnostic accuracy of the composites or single of the IPP triple tests, and traditional provocation tests. The Delong’s test was used for the comparison among AUCs. The kappa analysis was used for the IPP triple tests and traditional provocation tests compared with the reference standard (REF). The independent t test and chi-square test were used to analyze the influence factors (i.e., age, gender), and group on diagnostic accuracy. RESULTS: There was no statistical difference in gender (chi-squared = 0.282, P = 0.596) and age (F = 0.096, P = 0.757) between the 3 groups. The AUC of the iliac pronation test was 0.903 when it was used alone; the AUC of the novel composites of the IPP triple tests was 0.868 (95% confidence interval [CI] = 0.802-0.919); and the diagnostic accuracy of the traditional provocation test was relatively low (AUC = 0.597, 95% CI = 0.512-0.678). The diagnostic accuracy of the IPP triple tests was higher than that of the traditional provocation test, P &lt; 0.05. Kappa consistency comparison showed that the kappa value between the IPP triple tests and the REF was 0.229, the kappa between the traditional provocation test and the REF was 0.052. The age of the patients with inaccurate diagnosis was higher than that of the patients with accurate diagnosis in both methods (traditional tests, P = 0.599; IPP:P = 0.553). Different types of diseases (groups) affect the accuracy of diagnosis, the proportion of inaccuracy of traditional provocation tests was higher than that of the IPP triple tests (77.8% vs 23.6%) in cSIJD, while the 2 methods have high differential diagnostic accuracy in LDH (96.77%) and control groups (97.56%). LIMITATIONS: Small size of LDH patients and differences in physical tests among examiners. CONCLUSIONS: The novel composites of IPP triple tests have higher accuracy than the traditional provocation tests in diagnosing cSIJD and both have good accuracy in differentiating cSIJD from LDH. IPP triple tests may be an alternative physical examination for clinical screening of cSIJD. KEY WORDS: Sacroiliac joint dysfunction, low back pain, lumbar disc herniation, provocation test, physical examination, kinematics

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

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.

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.

Intra-articular pulsed radiofrequency with methyl prednisolone injection in chronic sacroiliac joint arthritis: A randomized clinical trial

ABSTRACT Background Sacroiliac 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. The goal of our research was to assess the effectiveness of radiofrequency ablation combined with steroid injection versus steroid injection alone in the treatment of chronic sacroiliac joint arthritis (SIJ) pain. Methods Sixty patients with chronic SIJ pain were divided into two groups randomly: Group RF (n = 30) received intraarticular RF + methylprednisolone, while Group C (n = 30) received intraarticular methylprednisolone alone. The Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Patient Global Impression of Change Scale (PGIC) were followed up at each observation time (before the intervention, 1 month, 3 months, 6 months, 9 months, and 12 months). Results The NRS and ODI reduced following treatment compared to pretreatment values; however, the PGIC increased in both groups. The NRS in the RF group reduced significantly than in the control group after treatment at nearly all time intervals after the third month with p = 0.015*, 0.004*, 0.049*, and 0.025*, respectively. After the first month, the difference in PGIC score between the two groups becomes statistically significant at nearly all time intervals with p < 0.05. At nearly all time intervals, the RF group had higher PGIC scores. Conclusion PRF ablation with methylprednisolone injection is a safe and efficient treatment for sacroiliac pain. It has the potential to considerably reduce sacroiliac pain, lower ODI, raise PGIG, and improve physical and mental quality of life.

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.

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.

Prospective Trial of Sacroiliac Joint Fusion Using 3D-Printed Triangular Titanium Implants: 24-Month Follow-Up.

BackgroundStrong evidence supports minimally invasive sacroiliac joint (SIJ) fusion using triangular titanium implants (TTI) for chronic SIJ dysfunction.ObjectiveTo report safety and effectiveness of SIJF using a 3D-printed TTI at 24 months.MethodsSIJF with TTI was performed in 51 subjects. Structured follow-up occurred at 3, 6, 12 and 24 months. Both quality of life questionnaires and functional tests were performed at all study visits.Results84% of subjects were available for 24-month follow-up. Observed were rapid and persistent improvements in dysfunction due to pain (Oswestry Disability Index [ODI], mean 52.8 at baseline and 28.3 at 24 months, p<0.0001) and SIJ pain ratings (mean 78.5 at baseline [0–100 scale] to 21.5 at 24 months). Opioid use for SIJ pain decreased markedly from baseline. Physical function tests impaired by SIJ pain showed persistent improvements compared to baseline. There was no evidence of device breakage, migration or subsidence and few late adverse events occurred attributable to the device.ConclusionIn this prospective study, SIJF using 3D-printed TTI resulted in immediate, marked and persistent improvements in pain and quality of life, with improved physical function, reduced opioid use and a low rate of late device-related adverse events.Level of EvidenceLevel II.

Serial Lipocalin 2 and Oncostatin M levels reflect inflammation status and treatment response in axial spondyloarthritis

BackgroundInformative serum biomarkers for monitoring inflammatory activity and treatment responses in axial spondyloarthritis (axSpA) are lacking. We assessed whether Lipocalin 2 (LCN2) and Oncostatin M (OSM), both having roles in inflammation and bone remodeling, may accurately reflect chronic joint inflammation and treatment response in axSpA. Previous reports in animal models showed involvement of LCN2 and OSM in joint/gut inflammation. We asked whether they also play a role in human axSpA.MethodsWe analyzed a longitudinal observational axSpA cohort (286 patients) with yearly clinical assessments and concurrent measurements of serum LCN2 and OSM (1204 serum samples) for a mean of 4 years. Biomarker levels were correlated with MRI scoring and treatment response.ResultsPersistent and transient elevation of LCN2 and OSM were observed in axSpA patients. Persistent elevation of LCN2 or OSM, but not CRP, correlated with sacroiliac joint (SIJ) MRI SPARCC scores (Pearson’s correlation p = 0.0005 and 0.005 for LCN2 and OSM respectively), suggesting that LCN2/OSM outperforms CRP as reflective of SIJ inflammation. We observed both concordant and discordant patterns of LCN2 and OSM in relationship to back pain, the cardinal clinical symptom in axSpA. Twenty-six percent (73/286) of the patients remained both clinically and serologically active (CASA). Sixty percent (173/286) of the patients became clinically quiescent, with back pain resolved, but 53% (92/173) of them were serologically active (CQSA), indicating that pain control may not indicate control of joint inflammation, as reflected by positive MRI imaging of SIJ. With respect to treatment responses, transient elevation of LCN2 or OSM over time was predictive of better response to all treatments.ConclusionIn axSpA, persistent LCN2 and/or OSM elevation reflects chronic SIJ inflammation and suboptimal treatment response. In our cohort, half of the currently deemed clinically quiescent patients with back pain resolved continued to demonstrate chronic joint inflammation. LCN2 and OSM profiling outperforms CRP as a predictive measure and provides an objective assessment of chronic local inflammation in axSpA patients.

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.

Bone turnover biomarkers, disease activity, and MRI changes of sacroiliac joints in patients with spondyloarthritis.

The lack of valid biomarkers in patients with spondyloarthritis (SpA) requires searching for additional options to increase sacroiliac joint (SIJ) evaluation effectiveness. We assessed the serum levels of bone turnover markers and their relationships with active and chronic changes in SIJs using magnetic resonance imaging (MRI), indices, and laboratory parameters of disease activity in SpA patients. 102 patients with SpA and 15 healthy subjects were included. Testing of serum levels of transforming growth factor-beta (TGF-β1), Wnt3, sclerostin, and Dickkopf-1 (Dkk-1) was conducted. Active inflammatory lesions in SIJs were evaluated using Spondyloarthritis Research Consortium of Canada (SPARCC) MRI SIJ score, and chronic changes using the Danish scoring method. Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Ankylosing Spondylitis Disease Activity Scores with CRP, and ESR were used to assess disease activity. Serum levels of Dkk-1, TGF-β1, and sclerostin were significantly lower in SpA patients compared to healthy controls. The serum levels of Dkk-1 positively correlated with CRP. Dkk-1 had a significant negative correlation with Danish score. The sclerostin serum level had a weak negative correlation with the active inflammatory MRI SIJ lesions. There were positive correlations between TGF-β1 and sclerostin with Dkk-1, and negative correlation between Wnt3 and sclerostin. Dkk-1 positively correlated with CRP and negatively with chronic SIJ changes by Danish score. Sclerostin negatively correlated with the active SIJ lesions by SPARCC. This suggests that Dkk-1 and sclerostin are the most promising candidates to reveal inflammation and bone turnover in patients with SpA.

Effect of Sacroiliac Joint Mobilization on Chronic Non-Spacific Low Lumbar Pain and Function in Women

Background. Research aim was to investigate the effect of sacroiliac joint mobilization on chronic non-specific lumbar pain and function in women.Methods. 1. VAS scale evaluation; 2. Measurement of lumbar range of motion; 3. Lumbar muscle stamina tests. Twenty women who felt chronic non-specific lumbar pain and havd sacroiliac joint disfunction were investigated in this research.Results. The results of the study showed that the pain decreased from 3.87 ± 0.41 to 1.86 ± 0.33 points in the study group, and from 3.4 ± 0.52 to 1.6 ± 0.28 points in the control group (p &lt; 0.05). The mean value of the abdominal muscle endurance test in the study group increased by 21.2 ± 3.65 s, in the control group – by 19.6 ± 3.69 s (p &lt; 0.05). The isometric means of the abdominal muscle endurance test increased by 21.7 ± 2.58 s in the study group – and by 18.1 ± 4.07 s in the control group (p &lt; 0.05). After physiotherapy, a statistically significant improvement in torso movement amplitudes was observed in both groups, but no statistically significant change was observed between the groups.Conclusions. Spinal stabilization exercises combined with sacroiliac joint mobilization were more effective treatment than the use of stabilization exercises alone, as they statistically significantly reduced the intensity of perceived pain and increased torso muscle endurance.Keywords: sacroiliac joint mobilization, chronic non-specific lumbar pain, functional lumbar indicators.