Background
The most effective injective treatment approach for sacroiliac joint (SIJ) pain remains unclear. Aim of this study was to quantify the safety and effectiveness of the available injective ...strategies to address SIJ pain.
Methods
A systematic review and meta-analysis of the literature was conducted on PubMed, Scopus, and Embase databases from inception until January 2023. Inclusion criteria were studies written in English, comparative and non-comparative studies regardless of the minimum follow-up, and case series on SIJ injections. Safety and efficacy of the different injection therapies for the SIJ were quantified. A meta-analysis was conducted on the available data of the documented injective therapies. The “Checklist for Measuring Quality” by Downs and Black was used to assess the risk of bias and the quality of papers.
Results
The literature search retrieved 43 papers (2431 patients): 16 retrospective case series, 2 retrospective comparative studies, 17 prospective case series, 3 prospective comparative studies, and 5 randomized controlled trials. Of the selected studies, 63% examined the effect of steroid injections, 16% of PRP injections, while 21% reported other heterogeneous treatments. The failure rate was 26% in steroid injections and 14% in PRP injections. The meta-analysis showed a statistically significant reduction in pain with the VAS score for both steroids and PRP: steroids improvement at mid-term 3.4 points (
p
< 0.05), at long-term 3.0 (
p
< 0.05), PRP improvement at mid-term 2.2 (
p
= 0.007), at long-term 2.3 points of the VAS pain scale (
p
= 0.02).
Conclusions
Steroids are the most documented injective approach, with studies showing an overall safety and effectiveness. Still, the high number of failures underlined by some studies suggest the need for alternative procedures. Early PRP data showed promise, but the limitations of the current literature do not allow to clearly define the most suitable injective approach, and further studies are needed to identify the best injective treatment for SIJ patients.
Zusammenfassung
Operationsziel
Schmerzreduktion und Verbesserung der Lebensqualität durch ISG-Fusion.
Indikationen
Chronische Iliosakralgelenk-assoziierte Schmerzen. Positive ISG-Testinfiltration mit ...Lokalanästhetikum. Positive ISG-Provokationstests. Erfolglose konservative Therapie über 6 Monate.
Kontraindikationen
Nicht ISG-assoziierte Beschwerden. Tumor/Infektion/instabile Fraktur im Implantationsareal. Fehlbildungen, Tumor oder Osteolyse des Sakrum- oder Iliumknochens. Aktive Infektion an der Behandlungsstelle. Allergie gegen Metallkomponenten. Sekundärer Krankheitsgewinn, Rentenbegehren. Unzureichend behandelte Osteoporose.
Operationstechnik
Über einen lateralen minimal-invasiven Zugang bildwandlergesteuertes Einbringen von Kirschner-Drähten transartikulär durch das ISG in das Sakrum. Aufmeißeln des Implantatlagers über die Kirschner-Drähte und Einbringen von insgesamt 3 triangulären Titanimplantaten zur ISG-Arthrodese.
Weiterbehandlung
Thromboseprophylaxe. Drei Wochen Teilbelastung und anschließend schrittweise Aufbelastung. Röntgenkontrollen in definierten Intervallen. Physiotherapie.
Ergebnisse
Es wurden 26 konsekutive Patienten nach 48 Monaten untersucht. Die evaluierten Endpunkte waren tieflumbale Schmerzen entsprechend der visuellen Analogskala (VAS 0–10), Funktionseinschränkungen entsprechend Oswestry Disability Index (ODI) und Lebensqualität entsprechend EuroQOL-5D (EQ-5D). Nach 4 Jahren zeigte sich der Rückenschmerz im Vergleich zu präoperativ deutlich verbessert (VAS präoperativ 8,4, VAS 4 Jahre postoperativ 4,6). Die Funktionseinschränkungen zeigten sich rückläufig (ODI präoperativ 58,1, ODI 4 Jahre postoperativ 32,1), und ein Anstieg der Gesundheitsbewertung im EQ-5D war zu verzeichnen (präoperativ 0,5, nach 4 Jahren 0,7). Die Rate an Patienten, welche Opiate zur Schmerztherapie einnahmen, konnte deutlich gesenkt werden (präoperativ 82 %, postoperativ 39 %). Es zeigte sich keine Implantatlockerung im untersuchten Zeitraum.
Sacroiliac joint (SIJ) painful dysfunction is a common source of low back pain (LBP). Several surgical treatment options for SIJ fusion were described. A promising treatment option with demonstrated ...clinical improvement is the minimally-invasive SIJ fusion.
The aim of this case study was to document the effectiveness and safety of the new SIJ system (Torpedo®) over a period of 6 months after the minimally invasive implantation.
Patients with failed conservative treatment of painful SIJ dysfunction were enrolled successively in two centers. The Diagnosis was made by positive response to SIJ-injection with local anesthetic and at least by two positive SIJ provocation tests. The Torpedo® Implant system was used for the implantation. This workpiece made of titanium alloy is characterized by a helical profile geometry (CST: chronical spinal turn) with a hydrophilic surface. The evaluated endpoints LBP and grade of disability were assessed using a 0-10 numerical rating scale (NRS), and Oswestry Disability Index (ODI) preoperatively and at one, three and six months postoperatively.
15 patients (10 female, 5 male; mean age 59 ± 13 years) were operated on one after the other. The pain intensity decreased in all 15 patients. After 6 months, a decrease in the median values of 70% (quartiles 1-3: 65-79%) was calculated. The median values of the Oswestry Disability Index after 6 months were 62% (quartiles 1-3: 53-67) lower than before the operation. Before surgery, 13 patients (87%) were taking opioids for pain management. Six months after the operation, opioids were only needed by 3 patients (20%). Implant malpositioning was not detected on plain radiograph. No surgical site infections or perioperative complications occurred.
The clinical improvement in early follow up and the absence of surgery related complications demonstrate a high grade of device-related safety and effectiveness of the treatment with a novel minimally-invasive SIJ fusion system.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Studies have found that up to one-third of patients with LBP have sacroiliac joint (SIJ) dysfunction as a contributing cause. Historically, the management of SIJ dysfunction has been plagued by ...ineffectiveness or significant morbidity. In 2008, minimally invasive lateral SIJ fusion was developed. While this procedure is a safe and effective treatment, there is still a significant proportion of patients who will not experience therapeutic success. There is a paucity of data in the literature regarding the management of these patients. Recently, a novel posterior sacroiliac joint fusion device has been developed which minimizes complications compared to lateral approaches and may serve to salvage therapeutic failures in this patient population.
Determine the efficacy and feasibility of a posterior SIJ fusion device as a salvage technique in patients who have not experienced therapeutic success following lateral SIJ fusion.
Multi-center retrospective observational study.
Patients who had previously undergone lateral SIJ fusion and had persistent LBP were evaluated and diagnosed to have persistent primary SIJ pathology. All patients underwent posterior SIJ fusion utilizing a machined allograft transfixing sacroiliac fusion device. Demographic data and patient reported pain scores were collected.
A total of 7 patients who had undergone lateral SIJ fusion were included in the study and underwent posterior SIJ fusion. The mean patient reported pain improvement following posterior fusion was 80% with an average follow-up time of 10 months. Median morphine milliequivalents were 20 pre-procedure and 0 post-procedure.
We were able to show significant reductions in pain scores and opioid consumption, which suggests that minimally invasive posterior SIJ utilizing a novel implant and technique may be a viable treatment option to salvage pain relief in this patient population. Further, the favorable safety profile of this posterior technique uniquely positions it to be an appropriate first-line surgical therapy.
Background. The intra-articular cortico-steroid (IA-CS) injections treatment are still debatable despite its effectiveness. The failure can cause sciatica which IA-CS injected at the sacroiliac joint ...(SIJ). The study was done to determine non-technical factors that cause recurrent LBP after optimal SIJ IA-CS injections. Methods. A prospective-clinical study was done that looked at recurring sciatica variables in the cases that received intra-articular injection of CS. Cases were diagnosed with sciatica according to the IASP criteria. All patients had intra-articular CS injections. The numerical rating scale (NRS) was used for rating the pain in the SIJ on a range of (0-10). The scale was reviewed 3, 6, and 9 months post treatment. Age, gender, BMI, trauma history, long-term standing, NSAID used and knee pain were all documented as intra-articular injection treatment possible failure factors. Results. In total, 50 subjects were enrolled, with more females (60%) than males (40%). The mean of age was 55.8±7.4 years. History of trauma was reported in 60%. Long sitting and standing history presented in 70% and 20%, respectively. The recurrence of sciatica affected 30(60%) patients. The right sciatica was affecting more than half of the cases (60%). The vast majority of cases (80%) used NSAID. The pain began within the last three months in 80% of the patients. History of CS injection was recorded in 38% of the cases. Lower limb pain was reported in 80% of the cases. Cases with and without recurrence had the mean age of 55.9 ± 9.5 years and 50.6 ± 14.9 years, respectively. The SIJ pain recurrence is strongly connected with elderly and long sitting in logistic regression analysis. Conclusions. Elderly, NSAID utilize, and uni-lateral sciatica involvement are protective factors against SIJ discomfort recurrence.
Spinopelvic parameters are vital components that must be considered when treating patients with spinal disease. Several finite element (FE) studies have explored spinopelvic parameters such as sacral ...slope (SS) and the impact on the lumbar spine, although no study has examined the effect on the hip and sacroiliac joint (SIJ) on varying SS angles. Therefore, it is necessary to have a biomechanical understanding of the impact on the spinopelvic complex.
An FE lumbar, pelvis, and femur model was created from computed tomography scans of a 55-year-old female patient with no abnormalities. Three models were created: a normal model (SS = 26°), a model with high SS (SS = 30°), and a model with low SS (SS = 20°). These models underwent loading for flexion, extension, lateral bending, and axial rotation. Range of motion (ROM), intradiscal pressures, hip joint, and SIJ contact stresses were analyzed.
The high SS model (SS = 30°) indicated the highest ROM in the L5-S1 (slip angle) level and the highest intradiscal pressures. The highest average hip and SIJ contact stresses were present in this model, although the low SS model (SS = 20°) in extension had the largest stresses for the hip and SIJ.
The results provide evidence that patients with higher SS may be more prone to increased ROM at the slip angle (L5-S1). In addition, patients with higher SS were shown to have higher contact stresses on the hip joint and SIJ, potentially leading to SIJ dysfunction. Clinically, correcting lumbar lordosis including SS is important; however, a high SS may have a negative impact on the intervertebral disc, SIJ, and hip joint.
Purpose
To review the anatomy and function of the sacroiliac joint (SIJ), as well as the pathophysiology, clinical presentation, diagnostic criteria, and treatment options for SIJ dysfunction.
...Methods
The SIJ serves an extremely crucial function in mobility, stability, and resistance against shear forces. Joint mobility becomes increasingly limited with age-related cartilaginous changes that begin in puberty and continue throughout life. Pain can also be localized to the SIJ itself, known as SIJ dysfunction. A literature review was performed on the anatomy, etiology, risk factors, diagnostic modalities, and treatment options for SIJ dysfunction.
Results
SIJ dysfunction is an under-recognized source of low back pain. Dysfunction can result from various clinical conditions, as well as abnormal motion or malalignment of the joint. Diagnosis and evaluation of SIJ dysfunction are difficult, with use of physical maneuvers and image-guided anesthetic injection. Non-operative treatment options are considered first-line due to high surgical complication rates. Such options include conservative management, radiofrequency treatment, nerve blocks, and articular injections. Surgical management involves open and percutaneous approaches.
Conclusion
With the aging nature of the population, SIJ dysfunction has emerged as an extremely prevalent issue. Current research into the pathophysiology and risk factors of SIJ dysfunction is extremely important for planning preventative and therapeutic strategies. Various treatment options exist including conservative management, radiofrequency, nerve blocks, intra-articular or peri-articular injections, and surgical fixation. Improved diagnostic methods in clinical practice are thus critical to properly identify patients suffering from SIJ dysfunction, plan early intervention, and hasten return to function.
Level of Evidence I
Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
The sacroiliac joint (SIJ) can be a new source of pain following lumbar fusion. The aim of this study was to identify the incidence of and predisposing factors for new onset SIJ pain following ...successful lumbar fusion.
We review our series of 317 patients who underwent spinal fusion in the past 5 years to identify patients who developed new onset SIJ pain. All patients had a minimum 12 months follow up. Diagnostic criteria for SIJ pain were: New onset pain localised to lower lumbar region and buttocks, ≥2 positive provocative tests of SIJ and pain relief of >70% achieved from SIJ block.
There were 38 patients who developed new SIJ pain following fusion with an overall incidence of 12.0%. The average time to new onset symptoms was 22 months. Of the 38 patients, 57.9% had fusion to sacrum. The incidence of SIJ pain in patients who had fusion extending into sacrum was 12.6%
. 11.2% in those who had not. The incidence of SIJ pain was 11.1% with 1-level fusion, 12.0% with 2-level fusion, 12.9% with 3-level fusion and 14.0% with equal or more than 4-level fusion.
New onset SIJ pain can arise following spinal fusion. We have not found a higher frequency of SIJ pain in patients with fusion extending to sacrum or longer spinal construct.
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