Sacroiliac Joint Pain Research Articles

Posterior Oblique Approach for Sacroiliac Joint Fusion.

Introduction Sacroiliac joint (SIJ) pain is a common source of low back pain. Though this condition can be treated with conservative measures, there is a subset of patients who fail to respond to conservative treatment. For them, surgical treatment using minimally invasive techniques could be considered. There are currently a number of SIJ fixation methods described. However, there is no case series reported on posterior oblique approach. Therefore, in this paper, the authors report their experience with the Sacrix system via the posterior oblique approach. Method In this series, 19 patients aged 44-84 years, with a median of 58 years, underwent SIJ fusion using this technique. This is a posterior oblique approach in which two screws are inserted into the ilium through the posterior part of the iliac crest and then advanced into the sacrum through the SIJ. Results The follow-up is between 7 and 30 months, with a median of 12 months. Eighteen patients had excellent pain relief. There was no complication from the procedure, and the blood loss was minimal. All eight patients who had follow-up radiographs showed solid fusion. Conclusion Posterior oblique approach for SIJ fusion is a minimally invasive procedure that proved to be effective and safe in this series. It also resulted in solid radiographic fusion, decreased pain, and improved function.

COMPARISON OF REGIONAL MANUAL THERAPY AND STANDARD PHYSICAL THERAPY INTERVENTION IN FEMALES WITH SACROILIAC JOINT PAIN

Background and Aim: Sacroiliac joint pain is localized in the region of sacroiliac joint which can be increased by stress and provocation tests of the joint. Aim of this study was to compare two interventions for reduction of sacroiliac joint pain. Methodology: Study design was randomized clinical trial. Study was conducted in bajwah hospital and children polyclinic Lahore. Duration of study was six months. The total sample size was 64 patients. Females of 20-50 years old with diagnosed sacroiliac joint pain were included in this study. Compression and distraction objective tests were performed for further confirmation of sacroiliac joint pain. Purposive sampling technique was used. Numeric pain rating scale (NPRS) and Oswestry low back disability questionnaire (ODI) were used to collect the data. Exclusion criteria was females with fractures and other abnormalities of spine. Results: Results showed that both groups were equal when assessed on baseline by normality test colmogorov-smirnova. Independent t test was applied to compare the mean value of NPRS. Pretreatment mean of NPRS scale for both the regional treatment and standard treatment groups was 7.After 4 weeks NPRS of regional treatment group was 4 and of standard treatment group was 7. The mean value of pretreatment ODI for regional treatment group was 33 and for standard treatment group was 34.After 4 weeks ODI of regional treatment group was 24 and mean of standard treatment group was 27. Conclusion: It is concluded that after giving equal sessions to both groups when results were assessed regional treatment is more effective than standard treatment.

Retrospective evaluation of quality of life in patients undergoing sacroiliac joint denervation with simplicity.

The sacroiliac joint (SIJ) is the third most common cause of low back pain. The treatment of SIJ-induced pain is often conservative. When conservative treatments fail, interventional treatment methods, such as intra-articular injection or radiofrequency (RF) denervation are applied. Recently, in addition to the success of this interventional treatment applied, increased patient satisfaction and quality of life after treatment have also gained importance. The aim of this retrospective study was to evaluate pain management and improvement in the quality of life in patients with SIJ pain who underwent RF denervation with the simplicity probe. The files of patients with SIJ degeneration on Ferguson X-ray, who underwent diagnostic intra-articular block for SIJ and had more than 50% reduction in pain were screened, and 38 cases in which simplicity RF neurotomy was applied were identified. The age, sex, and numerical rating scale (NRS) and short form (SF)-36 scores of the remaining 30 patients were recorded before and at 6 months after the procedure. There was a statistically significant decrease in NRS between the pre-procedure and post-procedure (6-month) values. The decrease in NRS did not significantly differ according to sex. A statistically significant improvement in all the domains of SF-36 in the post-procedure period compared to the pre-procedure period. There was no significant sex-related difference in the improvement of the SF-36 domains, except for the emotional role functioning domain, for which the scores were significantly higher in women than in men. In patients with SIJ pain who positively respond to steroid injection, the application of Simplicity III achieves long-term pain management and increases patient comfort and satisfaction pain without any complications.

Assessing the outcomes of Prp and corticosteroid injections for sacroiliac joint pain

Sacroiliac joint pain is a symptom that can affect the life activities of patients in daily life. Invasive methods also occupy an important place in the treatment of this symptom. Our study evaluated the follow-up results of patients injected with Platelet-rich plasma and steroids due to sacroiliac joint pain. Patient files between the years 2018-2022 were evaluated retrospectively. Patients who underwent ultrasound-guided sacroiliac joint injection of platelet-rich plasma and steroids were divided into 2 groups. VAS and The Modified Oswestry Disability Questionnaire scores were evaluated at 1, 3, and 6 months. Eighty-seven patients were included in the study. It was understood that patients in both groups benefited after injection (p<0.001). In the 1st month follow-up, it was concluded that the VAS and the Modified Oswestry Disability Questionnaire scores of the patient group who received steroids were significantly better (p<0.001). In the 3rd month, the VAS (p=0.695) and the Modified Oswestry Disability Questionnaire (p=0.215) scores of both groups were similar in both groups. In the 6th month, the platelet-rich plasma group's results were significantly better (p<0.001). Platelet-rich plasma and steroid injections are safe treatment methods for sacroiliac joint pain. Steroid injections in the short term and platelet-rich plasma injections in the long term are more effective.

Clinical Features Requiring Sacroiliac Joint Arthrodesis in Patients with Sacroiliac Joint Pain

This study aimed to reveal the clinical features requiring sacroiliac joint (SIJ) arthrodesis, which was performed for patients who complain of severe SIJ pain.The differences in clinical features between a surgical treatment group (n=20) and a conservative treatment group (n=66) were investigated. All patients were definitively diagnosed with SIJ pain by the use of SIJ injections.Six significant features were identified in the surgical treatment group, namely, sitting tolerance (<15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and any accident that induced SIJ pain (P<0.01). Univariate logistic regression analysis revealed that sitting tolerance <15 minutes (odds ratio : 31.73), pain in the supine position (13.07), and pain while lying on the painful side (18.30) showed a high odds ratio.Sitting tolerance (<15 minutes), walking with a cane, pain in the supine position, pain while lying on the painful side, numbness in the lower limbs, and a history of any accident that induced SIJ pain may be considered as indicators for surgery after >?6 months of continued substantial conservative treatment. J. Med. Invest. 70 : 123-128, February, 2023.

Comparison of the Efficacy of Intra-articular Platelet-rich Plasma with Intra-articular Steroid in the Management of Pain due to Sacroiliac Joint Dysfunction

Background: Platelet-rich plasma (PRP) has proved to be beneficial due to its remodeling property in various conditions in the past. When given intra-articularly, it may also provide adequate analgesia in low back pain. Aims: This study was aimed to compare the efficacy between intra-articular sacroiliac joint (SIJ) injection of PRP and steroid in the management of SIJ dysfunction pain. Materials and Methods: This prospective, randomized parallel group study was conducted for 24 months period at a tertiary care hospital. A total of 50 patients above 18 years were included in the study and allocated into two groups (n = 25) by computer randomization. Patients in the respective group received sacroiliac intra-articular injection of either autologous PRP or triamcinolone (steroid). For the primary outcome, the Numerical Rating Scale Score was recorded preprocedure and postprocedure at the 24 h, 1st, 3rd, and 6th month. The need for any rescue analgesia or repeat injection during the study period was considered the secondary outcome. Results: At the 1st, 3rd, and 6th month postprocedure, 100%, 88%, and 76% of patients, respectively, obtained significant pain relief after injection of PRP. In contrast, at 3rd and 6th month postprocedure, only 20% and 28%, respectively, had short-term pain relief in the steroid group. Conclusions: Single intra-articular injection of PRP provides significant pain relief and functional improvement in patients with SIJ pain.

Manipulations of Oblique Pulling Affect Sacroiliac Joint Displacements and Ligament Strains: A Finite Element Analysis.

Clinical studies have found that manipulation of oblique pulling has a good clinical effect on sacroiliac joint pain. However, there is no uniform standard for manipulation of oblique pulling at present. The purpose of this study was to investigate the effects of four manipulations of oblique pulling on sacroiliac joint and surrounding ligaments. A three-dimensional finite element model of the pelvis was established. Four manipulations of oblique pulling were simulated. The stresses and displacements of sacroiliac joint and the strains of surrounding ligaments were analyzed under four manipulations of oblique pulling. Manipulation of oblique pulling F2 and F3 caused the highest and lowest stress on the pelvis, at 85.0 and 52.6 MPa, respectively. Manipulation of oblique pulling F3 and F1 produced the highest and lowest stress on the left sacroiliac joint, at 6.6 and 5.6 MPa, respectively. The four manipulations of oblique pulling mainly produced anterior-posterior displacement. The maximum value was 1.21 mm, produced by manipulation of oblique pulling F2, while the minimal value was 0.96 mm, produced by manipulation of oblique pulling F3. The four manipulations of oblique pulling could all cause different degrees of ligament strain, and manipulation of oblique pulling F2 produced the greatest ligament strain. The four manipulations of oblique pulling all produced small displacements of sacroiliac joint. However, they produced different degrees of ligament strain. Manipulation of oblique pulling F2 produced the largest displacement of sacroiliac joint and the greatest ligament strain, which could provide a certain reference for physiotherapists.

Radiofrequency Neurotomy for Sacroiliac Joint Pain: Twelve Month Outcomes and Comparison Between Two Techniques

Background: Radiofrequency neurotomy (RFN) is an effective treatment option for patients with severe sacroiliac joint (SIJ) pain. Aims: We evaluated the 12-month clinical outcomes between patients (n=93) having RFN of the lateral branches of S1-S3 compared to patients (n=89) undergoing the same procedure augmented with RFN of the L4 medial branch and L5 dorsal ramus. Methods: This was a retrospective chart review. Following diagnostic intra-articular anesthetic injections and multi-site multi-depth lateral branch nerve blocks to establish SIJ pain, patients underwent bipolar ablation of the S1-S3 lateral branches using the Nimbus multitined electrode. The second group of patients underwent supplementary monopolar RFN of the L4 medial branch and the L5 dorsal ramus. Pain severity and global Pain Disability Quality of Life Questionnaire-Spine (PDQQ-S) scores were obtained prior to RFN and at 12 months. Results: There were 61% and 59% average 12-month improvements in SIJ-related pain severity and global PDQQ-S scores, respectively, in the overall study group (P&lt;0.001 for both comparisons). Efficacy was moderately better for patients with augmented ablation that captured the L4 medial branch/L5 dorsal ramus. For example, 12-month average pain reduction was 54% and 66%, and PDQQ-S improvement was 56% and 62% for patients treated with S1-S3 lateral branch RFN and the augmented RFN procedure, respectively. The percentage of patients exhibiting ≥ 50% improvement in pain severity at 12-months was 73% (68 of 93) and 88% (78 of 89) (P=0.016) for the same study groups. Conclusion: RFN of the S1-S3 sacral lateral branches using an anatomically accurate bipolar strip lesion technique produced a sufficient lesion topography to provide highly significant pain reduction and improvement in PDQQ-S at 12-months follow-up. Including the L4 medial branch and L5 dorsal ramus in the RFN treatment protocol may offer more complete denervation of all afferent pain pathways and provide additional clinical benefit.

Day II: Friday, March 24, 2023; 5.30 PM Plumeria 3: Disability, Validation studies, Cancer: AB No: 110 Functional Disability due to Sacroiliac joint pain and Kinesiophobia in Multigravida Women – A Cross-sectional study

Day II: Friday, March 24, 2023; 5.30 PM Plumeria 3: Disability, Validation studies, Cancer: AB No: 110 Functional Disability due to Sacroiliac joint pain and Kinesiophobia in Multigravida Women – A Cross-sectional study

Family History of Sacroiliac Joint Pain as a Risk Factor for Development of Sacroiliac Joint Pain: A Case-Control Study

Background: Chronic lower-back pain is among the most common health problems and accounts for a significant amount of disability worldwide. Sacroiliac joint (SIJ) pain is one of the leading causes of lower-back pain; however, diagnosis of SIJ pain can sometimes be challenging. Family history is a known predictive factor for arthritis in both seropositive and seronegative arthropathies, including osteoarthritis; however, the role of family history in SIJ pain has not been studied. Study: This case-control study examined whether family history of SIJ pain is a risk factor for developing SIJ pain. Discussion: Results indicate that a high proportion of patients with SIJ pain reported positive family history of SIJ pain (58.6% vs 10.5%, P &lt; .001). Cases were 6.5 times more likely than controls to report any relative with history of SIJ pain. Conclusion: Patients with a prior family history of SIJ pain can be identified early, monitored closely, diagnosed early, and started on aggressive physical therapy and close follow-up. Key words: Sacroiliac joint pain, sacroiliac joint dysfunction

천장관절융합술 후 기능 회복에 대한 추나요법을 포함한 한의복합치료 증례보고 1례

Objectives This case study aimed to investigate the effect of complex Korean medicine treatment including Chuna manual therapy on sacroiliac joint (SIJ) pain status post SIJ fusion with sacroiliac screw fixation. Methods Complex Korean medicine treatments including Chuna manual therapy were provided to patients with SIJ widening due to a traffic accident trauma. Measurement of range of motion and manual muscle test to evaluate functional activities of daily living was conducted before and after treatment. Moreover, outcome estimates were performed using the numeric rating scale, pain disability index, and EuroQol 5-dimension five-level questionnaire. Results After complex treatment, functional activities of daily living improved. Sacroiliac joint pain decreased and the quality-of-life score improved. Conclusions This study suggests that treatment with complex Korean medicine treatment including Chuna manual therapy may improve traumatic SIJ widening status post SIJ fusion. A postoperative rehabilitation protocol based on accumulated research results considering a multidisciplinary approach should be prepared to ensure holistic treatment.

Sacroiliitis: A Review on Anatomy, Diagnosis, and Treatment.

Sacroiliitis is an inflammation of one or both of the sacroiliac (SI) joints, most often resulting pain in the lower back that can extend down the legs. Pain arising from the SI joint can be difficult to diagnose and treat due to the intricate surrounding ligamentous structure, nerve innervation, and its role in transferring weight from the upper body to the lower limbs. SI joint dysfunction accounts for up to 25% of cases of lower back pain and has a debilitating effect on patient functionality. This review aims to provide comprehensive coverage of all aspects of SI joint pain, with a specific focus on differential diagnosis and treatment. Current literature on SI joint pain and inflammation, other etiologies of lower back pain, and new treatment options were compiled using the databases PubMed and Cochrane and used to write this comprehensive review. There were no restrictions when conducting the literature search with regard to publication date, study language, or study type. The diagnosis protocol of SI joint pain arising from sacroiliitis usually begins with the presentation of lower back pain and confirmatory diagnostic testing through fluoroscopy joint block. Reduction in pain following the anesthetic is considered the golden standard for diagnosis. The treatment begins with the conservative approach of physical therapy and analgesics for symptom relief. However, refractory cases often require interventional methods such as corticosteroid injections, prolotherapy, radiofrequency ablation, and even SI joint fusion surgery. SI joint pain is a complex problem that can present with varying patterns of pain due to uncertainty regarding its innervation and its prominent surrounding structure. It is therefore especially important to obtain a thorough history and physical on top of diagnostic tests such as a diagnostic block to properly identify the source of pain. Conservative treatment options with physical therapy and analgesics should be attempted first before interventional strategies such as ablation, injections, and prolotherapy can be considered. SI joint fusion surgery is a solution to cases in which previous methods do not provide significant relief.

Double-center observational study of minimally invasive sacroiliac joint fusion for sacroiliac joint dysfunction: one-year results

BackgroundFor a substantial part of patients with chronic low back pain, the origin is located in the sacroiliac joint (SIJ). Minimally invasive sacroiliac joint fusion (MISJF) is increasingly being implemented as a treatment option in SIJ dysfunction. Despite remaining controversy, evidence continues to increase. This study evaluates the clinical results and safety of MISJF in a double-center consecutive case series in patients with SIJ dysfunction over a one-year observation period.MethodsSIJ complaints were diagnosed after history taking, physical examination and least a 50% reduction of SIJ pain 30–60 min following image-guided injection. Primary outcome measures were patient reported outcome measurements (PROMs), consisting of Visual Analogue Scale (VAS) pain score and EuroQol 5-dimensions 3-levels (EQ-5D-3L). Patients’ perspectives on the effects of surgery were collected through questionnaires. Secondary outcome measures were implant positioning and (serious) adverse events ((S)AE’s).ResultsA total of 29 patients were included. In 44.8% of patients, SIJ dysfunction was of postpartum origin. The mean VAS-pain score improved from 7.83 (± 1.71) to 4.97 (± 2.63) postoperatively (p < 0.001). EQ-5D-3L score improved from 0.266 (± 0.129) to 0.499 (± 0.260) postoperatively (p < 0.001). Opioid consumption decreased from 44.8 to 24.1% postoperatively (p = 0.026). In 13.7% of patients, an (S)AE occurred.ConclusionMISJF appears to be an effective and safe procedure in this cohort. Statistically significant and clinically relevant improvements in pain and quality of life were observed one-year postoperatively. Future studies should focus on the long-term outcomes to further evaluate the safety and effectiveness of MISJF.

Comparative Clinical Efficacy and Safety of Sacral-2-Alar Iliac Screw Versus Iliac Screw in the Lumbosacral Reconstruction of Spondylodiscitis

This study aimed to evaluate the clinical efficacy and safety of S2-alar-iliac (S2AI) and iliac screw (IS) techniques in treating lumbosacral spondylodiscitis. Between January 2020 and January 2022, 28 patients suffering from lumbosacral spondylodiscitis underwent lumbosacral fixation and were divided into the IS group (14 patients) and the S2AI group (14 patients). Surgical details, demographic characteristics, preoperative and postoperative Oswestry Disability Index, visual analog scale, and complications were analyzed. Twenty-eight patients were included in this study, including 14 patients treated with IS and 14 patients treated with S2AI. The 2 groups were similar in sex, age, follow-up period, total drainage volume, hospitalization stay, and fusion time. (P>0.05) The estimated blood loss and surgical time of S2AI during surgery were significantly lower than those of IS. (P<0.05) The visual analog scale and Oswestry Disability Index scores significantly improved in both groups from preoperative to the last follow-up. Sacroiliac joint pain was found in both groups in the follow-up period, but the incidence was not significantly different (P=0.663). Compared with the IS approach, the incidence of symptomatic screw prominence was lower in the S2AI group, but the difference was not significant. (P=0.088). S2AI, as well as IS techniques, can achieve promising results for reconstructing lumbosacral stability in spondylodiscitis. In addition, the S2AI technique can also reduce surgical trauma and operation time.

Radiofrequency Ablation in Chronic Pain Syndromes

Chronic pain is a frequent, intricate, and adverse condition that has a considerable influence on individuals and society at large. In India, its prevalence is around 20%. Although a spectrum of conservative treatment modalities is available, a significant proportion of patients with chronic pain syndromes remain refractory and require surgical intervention. In these groups of patients, radiofrequency ablation (RFA) techniques are safe minimally invasive treatments and provide significant and durable pain relief. Thus, we aimed to formulate the Indian Society for the Study of Pain (ISSP) guidelines for the management of chronic pain syndromes with various RFA techniques. An in-depth literature review by experts in Pain Medicine practising in India, was used to produce 16 statements across 4 common chronic pain syndromes, including knee pain, headache and facial pain, lumbar facet joint pain, and sacroiliac joint pain. The quality of evidence was assessed with the Third US Preventive Service Task Force guidance document and the strength of the recommendation was determined by the Delphi consensus process. The level of evidence for most of the statements was I. Moreover, for most statements, the level of agreement between the experts was good (≥80% of the experts). The ISSP guidelines for the management of chronic pain syndromes are developed by experts in pain medicine. For most of the statements, the highest level of evidence was available and inter-expert agreement was good. However, further high-quality research is required to formulate more inclusive guidelines in this evolving pain medicine speciality.

A Retrospective Study on Patient-Specific Predictors for Non-Response to Sacroiliac Joint Injections

Intra-articular or peri-articular corticosteroid injections are often used for treatment of sacroiliac joint (SIJ) pain. However, response to these injections is variable and many patients require multiple injections for sustained benefit. In this study, we aim to identify patient-specific predictors of response or non-response to SIJ injections. Identification of these predictors would allow providers to better determine what treatment would be appropriate for a patient with SIJ pain. A retrospective review of 100 consecutive patient charts spanning a 2-year period at an academic multi-specialty pain center was conducted and a multivariate regression analysis was used to identify patient-specific predictors of response to SIJ injections. Our analysis identified that a history of depression and anxiety (OR: 0.233, 95%CI: 0.057-0.954) and increased age (OR: 0.946, 95%CI: 0.910-0.984) significantly reduced the odds of responding to injections. We also found that the associated NPRS score change for SIJ injection responders was less than the minimally clinically significant value of a 2-point differential, suggesting that reported changes in pain scores may not accurately represent a patient's perception of success after SIJ injection. These findings warrant further investigation through a prospective study and can potentially influence clinical decision making and prognosis for patients receiving SIJ injections.

Periarticular Steroid Injection in Sacroiliac Joint Pain Patients with Ultrasound Guidance: A Case Report

Introduction: Pain in the sacroiliac joint area is pain below the level of the sacroiliac joint. L5 without symptoms of numbness or paresthesias and lower back pain that is aggravated after prolonged sitting, bending forward, and transitioning from sitting to standing. This study aims to describe cases of sacroiliac joint pain treated with periarticular steroid injection.&#x0D; Case presentation: A man, 47 years old, came with a complaint of pain in the right buttock area. The pain has been felt since 1 month ago. The pain is felt continuously and gets worse when standing for a long time while working. The pain radiates to the right thigh and calf. The patient was diagnosed with sacroiliac joint pain. The patient is then prepared for an ultrasound-guided steroid injection. The drugs injected were triamcinolone 40 mg 1 mL and Bupivacaine 0.5% 3 mL with the help of a linear ultrasound probe&#x0D; Conclusion: The procedure of sacroiliac joint injection provides a significant pain reduction response in sacroiliac joint pain.

Non-technical factors for recurrence of sacroiliac joint pain after intra-articular steroid injection: a cohort study

Background &amp; Objective: The effectiveness of intra-articular corticosteroid injection therapy is still debatable, despite numerous studies which demonstrated the benefits of steroid injections. Injection failure can be caused by a variety of technical factors, some of which have been identified in studies, including the accuracy with the injection location is performed and the pattern of corticosteroid distribution. We investigated the non-technical factors that influence the effectiveness of intra-articular corticosteroid injection at the sacroiliac joint (SIJ) in the past.&#x0D; Methodology: It was a prospective cohort study to determine non-technical factors associated with recurrence in patients with SIJ pain who had received multidisciplinary treatment for their ailment. A total of 55 patients met the inclusion and exclusion criteria for the study who were followed up. Patients who had SIJ injections before 9 months and, who had no improvement on the pain scale, or there was a worsening of the pain, or the patient returned with SIJ pain complaints on the same side, were included in the trial. The results were analyzed using logistic regression to determine the likelihood of recurrence.&#x0D; Results: A total of 55 participants was enrolled in the study, with a higher proportion of females (n = 33; 60 %) than males (n = 22; 40 %). Thirty-one patients were returning patients (56.36 %) out of 55 patients. According to the results of the bivariate analysis, age was associated with recurrent SIJ pain. According to the results of the T-test, the mean age of the recurrent patients was 49.32 ± 16.68 y, whereas the mean age of the non-recurrent patients was 56.7 ± 12.76 y. The results of the multivariate analysis revealed that age, NSAID consumption, and unilateral SIJ pain, all had protective values in the context of recurrence of the sacroiliac joint pain.&#x0D; Conclusions: The use of non-steroidal anti-inflammatory drugs (NSAIDs) and the involvement of a single SI joint are protective factors against the recurrence of SI joint pain.&#x0D; Abbreviations: COST: European Cooperation in Science and Technology; NSAIDs: Non-steroidal anti-inflammatory drugs; SIJ: Sacroiliac joint;&#x0D; Key words: Anti-inflammatory agent; Non-technical risk factors; Intra-articular; Age; Recurrent sacroiliac joint pain&#x0D; Citation: Siahaan YMT, Pangestu AR. Sungono V. Non-technical factors for recurrence of sacroiliac joint pain after intra-articular steroid injection: a cohort study. Anaesth. pain intensive care 2022;26(5):773-777. &#x0D; DOI: 10.35975/apic.v26i6.2049

Minimally Invasive Inferior Intra-Articular Sacroiliac Joint Fusion: Successful Application of Osseous Stabilization Using Allograft Bone.

Minimally invasive sacroiliac joint (SIJ) fusion is the preferred surgical method for managing patients with recalcitrant, chronically severe SIJ pain and dysfunction refractory to conservative medical measures. The primary surgical objective of all minimally invasive SIJ fusion procedures is to provide immediate stabilization within the joint space to support osseous consolidation and the development of a mechanically solid arthrodesis. The intra-articular surgical approach to the SIJ with allograft bone placement utilizes a trajectory and easily identifiable landmarks that allow the surgeon to control the risk of violating important neuro-vascular structures. The intra-articular approach can employ a superior or inferior operative trajectory, with the former restricted to allograft placement in the ligamentous portion of the SIJ. The inferior approach utilizes decortication to surgically create a channel originating in the purely articular portion of the joint space allowing for truly intra-articular implant placement within the osseous confines of the ilium and sacrum. Positioning the implant along the natural joint line and securing it within the underlying sub-chondral bone, mortise and tenon fashion provides stabilization and large surface area contact at the bone implant interface. The inferior, intra-articular approach also places the implant perpendicular to the S1 endplate, near the sacral axis of rotation, which addresses the most significant biomechanical forces across the joint. Short-term, post-surgical observational data from a 57 patient multi-center registry using the inferior, intra-articular approach show uniform and statistically significant improvement in all clinical outcomes (p < 0.001 for all comparisons), including an average 3-point improvement in back pain severity from 6.8 preoperatively to 3.8 at 6 months. Further clinical evaluation with longer-term follow-up of the inferior, intra-articular SIJ fusion procedure is encouraged.

CircRNA GRB10 is a Novel Biomarker for the Accurate Diagnosis of Lumbar Degenerative Disc Disease.

Lumbar degenerative disc disease (LDDD) is frequently misdiagnosed as other spine conditions, and the accurate diagnosis is challenging. This study was conducted to explore the role of circRNA GRB10 in the accurate diagnosis of LDDD. This study included 60 cases of LDDD, 60 cases of patients with sacroiliac joint pain (SJP), 60 cases of lumbar disc herniation (LDH), 60 cases of piriformis syndrome (PS), 60 cases of entrapment neuropathy (EN) and 60 cases of healthy controls (HCs). Plasma was obtained from each patient before and after treatment. Expression of GRB10 was studied with RT-qPCR. The role of plasma GRB10 in the accurate diagnosis of LDDD was analyzed by ROC curve analysis. Compared to HCs, decreased accumulation of GRB10 RNA was only observed in LDDD group, but not in SJP, LDH, PS and EN groups. With plasma expression level of GRB10 measured before treatment as a biomarker, LDDD patients were separated from SJP, LDH, PS, EN and HC groups. After treatment, increased expression levels of GRB10 were only observed in LDDD group, but not in other groups. Therefore, GRB10 was downregulated in LDDD and may serve as a biomarker for the accurate diagnosis of LDDD.