SIJ Pain Research Articles

Randomized, controlled blind study comparing sacroiliac intra-articular steroid injection to radiofrequency denervation for sacroiliac joint pain

Background and objectiveSacroiliac joint pain is a common cause for chronic axial low back pain, with up to 20% prevalence rate. To date, no effective long-term treatment intervention has been embarked on yet. The aim of our study was to compare steroid block to radiofrequency ablation for SIJ pain conditions.MethodsA randomized, blind, study was conducted in 30 patients with sacroiliac joint pain. Fifteen patients received radiofrequency denervation of L4–5 primary dorsal rami and S1–3 lateral sacral branch, and 15 patients received steroid under fluoroscopy. Those in the steroid group who did not respond to steroid injections were offered to cross over to get radiofrequency ablation.ResultsAt 1-, 3- and 6-months post-intervention, 73%, 60% and 53% of patients, respectively, gained ⩾50% pain relief in the radiofrequency (RF) ablation group. In the steroid group, at one month postintervention follow-up, only 20% gained ⩾50% pain relief, but failed to show any improvement at 3 month and 6 month follow-up.ConclusionsRadiofrequency ablation at L4 and L5 primary dorsal rami and S1–3 lateral sacral branch may provide effective and longer pain relief compared to the classic intra-articular steroid injection, in properly selected patients with suspected sacroiliac joint pain. Larger studies are called for to confirm our results, and lay out the optimal patient selection and treatment parameters for this poorly comprehended disorder.

Sacroiliac Joint Pain after Lumbo-Sacral Fusion: Incidence and Management Modalities

Background Data: Incidence of sacroiliac dysfunction in a population suffering from low back pain (LBP) after lumbosacral (LS) fusion is unknown. The underlying pathophysiology of SIJ pain may be increased by mechanical load, iliac crest bone grafting, or a misdiagnosis of SIJ syndrome. Purpose: To evaluate the incidence of SIJ pain and the accuracy of diagnostictools with utility of different therapeutic modalities after lumbosacral fusion. Study design: Prospective Cohort study.Patients and Methods: We prospectively studied all the patients operated with postero-lateral fusion for the incidence and management of pain originating from SIJ joint in Neurosurgery Department, Sohag University between December 2011 and December 2015. The total number of patients was 205 patients. Indications, levels, techniques of fusion, andPostoperative course (improvement of symptoms, and complications such as infection, peudoarthrosis, metal failure, adjacent segment diseases) all were assessed. Inclusion and exclusion parameters were selected. In addition twomanagement modalities were addressed. Results: Out of 205 patients, 21 patients (10%) missed in follow up, 117 patients (57%) revealed complete clinical improvement in their manifestations, while 67 patients (32.6%) revealed postoperative pain. 67 patients (32.6%) revealed postoperative pain, (low back pain only in 12 patients 20%, lowerlimb pain only in 9 patients 13.5%, and both in 46 patients 66.5%).44 patients who form the basis for this report. Nine patients (20.5%) improved by medical treatment. Thirty-five patients (79.5%) improved by local injection of glucocorticoids, and local anesthetic. Conclusion: SLJ pain should be considered at any patient developed low back pain below the waist and gluteal pain with or without nonspecific leg or groin pain in patients after lumbosacral fusion.(2016ESJ105)

Are pelvic movement anomalies associated with low back pain of sacroiliac joint origin?

Methods: Participants (n= 122) between the ages of 18 to 50 years, suffering from chronic non-specific LBP (≥3 months) volunteered in the study. An experienced musculoskeletal physiotherapist evaluated and classified participants into either a SIJ-positive (n= 45) or a SIJ-negative (n= 77) group, using the reference standard of SIJ pain provocation tests [≥3 positive tests = SIJ-positive], as recommended by current guidelines for pelvic girdle pain. Another musculoskeletal physiotherapist, blinded to the outcome of the reference standard, evaluated participants for reproduction of familiar pain during each increment (10◦, 20◦, 30◦, 40◦, and 50◦) of the HABER test. The association between clinical group and familiar pain reproduction in the HABER test was determined using binary logistic mixed model regression analysis. Sensitivity, specificity, predictive values and likelihood ratios along with their 95% confidence interval were calculated to determine the diagnostic accuracy of HABER test against the reference standard of SIJ pain provocation tests. A receiver operator curve (ROC) analysis was conducted to determine the incremental positions of the HABER test that had the highest sensitivity and specificity for identifying SIJ-positive individuals. Results: Binary logistic regression analysis demonstrated the HABER test significantly reproduced familiar pain in SIJ-positive individuals when compared with SIJ-negative individuals [p< 0.001, R2 = 0.38, Exp(β) = 5.95 to 10.32]. The HABER test overall demonstrated moderate levels of diagnostic accuracy (sensitivity = 67% to 78% and specificity = 71% to 72%), and the incremental test positions of ≥30◦ had the highest sensitivity (83% to 100%) and specificity (52% to 64%) for identifying SIJ-positive LBP individuals. Conclusion(s): The HABER test is capable of reproducing familiar pain in SIJ-positive LBP individuals, and demonstrates acceptable levels of diagnostic accuracy for identifying and discriminating LBP of SIJ origin. Implications: The current study provides a new clinical test for accurate diagnosis of LBP of SIJ origin. We recommend the HABER test be added to the available battery of SIJ clinical tests for improving the sensitivity and specificity of SIJ-positive LBP diagnosis. The high levels of sensitivity of the ≥30◦ HABER’s increment test positions can be used to rule out a SIJ-positive LBP diagnosis. Patients demonstrating familiar pain reproduction at <30◦ of HABER test positions can be considered more likely to have LBP of non-SIJ origin.

Sagittal Sacropelvic Morphology and Balance in Patients with Sacroiliac Joint Pain Following Lumbar Fusion Surgery

ObjectiveTo investigate the sagittal sacropelvic morphology and balance of the patients with SIJ pain following lumbar fusion.MethodsAmong 452 patients who underwent posterior lumbar interbody fusion between June 2009 and January 2013, patients with postoperative SIJ pain, being responded to SIJ block were enrolled. For a control group, patients matched for sex, age group, the number of fused level and fusion to sacrum were randomly selected. Patients were assessed radiologic parameters including lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). To evaluate the sagittal sacropelvic morphology and balance, the ratio of PT/PI, SS/PI and PT/SS were analyzed.ResultsA total of 28 patients with SIJ pain and 56 patients without SIJ pain were assessed. Postoperatively, SIJ pain group showed significantly greater PT (p=0.02) than non-SIJ pain group. Postoperatively, PT/PI and SS/PI in SIJ pain group was significantly greater and smaller than those in non-SIJ pain group respectively (p=0.03, 0.02, respectively) except for PT/SS (p=0.05). SIJ pain group did not show significant postoperative changes of PT/PI and SS/PI (p=0.09 and 0.08, respectively) while non-SIJ pain group showed significantly decrease of PT/PI (p=0.00) and increase of SS/PI (p=0.00).ConclusionThis study presents different sagittal sacropelvic morphology and balance between the patients with/without SIJ pain following lumbar fusion surgery. The patients with SIJ pain showed retroversed pelvis and vertical sacrum while the patients without SIJ pain have similar morphologic features with asymptomatic populations in the literature.