Predictors of Outcome in Conservative and Minimally Invasive Surgical Management of Pain Originating From the Sacroiliac Joint: A Pooled Analysis

Overview

Journal Spine (Phila Pa 1976)

Specialty Orthopedics

Date 2017 Mar 29

PMID 28350586

Citations 26

Authors

Julius Dengler

Bradley Duhon

Peter Whang

Clay Frank

John Glaser

Bengt Sturesson

Steven Garfin

Daniel Cher

Aaron Rendahl

David Polly

Affiliations

Soon will be listed here.

Abstract

Study Design: A pooled patient-level analysis of two multicenter randomized controlled trials and one multicenter single-arm prospective trial.

Objective: The aim of this study was to identify predictors of outcome of conservative and minimally invasive surgical management of pain originating from the sacroiliac joint (SIJ).

Summary Of Background Data: Three recently published prospective trials have shown that minimally invasive SIJ fusion (SIJF) using triangular titanium implants produces better outcomes than conservative management for patients with pain originating from the SIJ. Due to limitations in individual trial sample size, analyses of predictors of treatment outcome were not conducted.

Methods: We pooled individual patient data from the three trials and used random effects models with multivariate regression analysis to identify predictors for treatment outcome separately for conservative and minimally invasive surgical treatment. Outcome was measured using visual analogue scale (VAS), Oswestry Disability Index (ODI), and EuroQOL-5D (EQ-5D).

Results: We included 423 patients assigned to either nonsurgical management (NSM, n = 97) or SIJF (n = 326) between 2013 and 2015. The reduction in SIJ pain was 37.9 points larger [95% confidence interval (95% CI) 32.5-43.4, P < 0.0001] in the SIJF group than in the NSM group. Similarly, the improvement in ODI was 18.3 points larger (95% CI 14.3-22.4), P < 0.0001). In NSM, we found no predictors of outcome. In SIJF, a reduced improvement in outcome was predicted by smoking (P = 0.030), opioid use (P = 0.017), lower patient age (P = 0.008), and lower duration of SIJ pain (P = 0.028).

Conclusions: Our results support the view that SIJF leads to better treatment outcome than conservative management of SIJ pain and that a higher margin of improvement can be predicted in nonsmokers, nonopioid users, and patients of increased age and with longer pain duration.

Level Of Evidence: 1.

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References

Bornemann R, Roessler P, Strauss A, Sander K, Rommelspacher Y, Wirtz D . Two-year clinical results of patients with sacroiliac joint syndrome treated by arthrodesis using a triangular implant system. Technol Health Care. 2016; 25(2):319-325. DOI: 10.3233/THC-161272. View

Rudolf L, Capobianco R . Five-year clinical and radiographic outcomes after minimally invasive sacroiliac joint fusion using triangular implants. Open Orthop J. 2014; 8:375-83. PMC: 4209504. DOI: 10.2174/1874325001408010375. View

Delitto A, Piva S, Moore C, Fritz J, Wisniewski S, Josbeno D . Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015; 162(7):465-73. PMC: 6252248. DOI: 10.7326/M14-1420. View

Luukkainen R, Nissila M, Asikainen E, Sanila M, Lehtinen K, Alanaatu A . Periarticular corticosteroid treatment of the sacroiliac joint in patients with seronegative spondylarthropathy. Clin Exp Rheumatol. 1999; 17(1):88-90. View

Scherrer J, Salas J, Lustman P, Burge S, Schneider F . Change in opioid dose and change in depression in a longitudinal primary care patient cohort. Pain. 2015; 156(2):348-355. PMC: 4299879. DOI: 10.1097/01.j.pain.0000460316.58110.a0. View

Mens J, Vleeming A, Snijders C, Koes B, Stam H . Validity of the active straight leg raise test for measuring disease severity in patients with posterior pelvic pain after pregnancy. Spine (Phila Pa 1976). 2002; 27(2):196-200. DOI: 10.1097/00007632-200201150-00015. View

Chaparro L, Furlan A, Deshpande A, Mailis-Gagnon A, Atlas S, Turk D . Opioids compared with placebo or other treatments for chronic low back pain: an update of the Cochrane Review. Spine (Phila Pa 1976). 2014; 39(7):556-63. DOI: 10.1097/BRS.0000000000000249. View

Cher D, Polly D, Berven S . Sacroiliac joint pain: burden of disease. Med Devices (Auckl). 2014; 7:73-81. PMC: 3990391. DOI: 10.2147/MDER.S59437. View

Ledonio C, Polly Jr D, Swiontkowski M . Minimally invasive versus open sacroiliac joint fusion: are they similarly safe and effective?. Clin Orthop Relat Res. 2014; 472(6):1831-8. PMC: 4016421. DOI: 10.1007/s11999-014-3499-8. View

10.

Cher D, Carlton Reckling W . Quality of life in preoperative patients with sacroiliac joint dysfunction is at least as depressed as in other lumbar spinal conditions. Med Devices (Auckl). 2015; 8:395-403. PMC: 4577259. DOI: 10.2147/MDER.S92070. View

11.

Luukkainen R, Wennerstrand P, Kautiainen H, Sanila M, Asikainen E . Efficacy of periarticular corticosteroid treatment of the sacroiliac joint in non-spondylarthropathic patients with chronic low back pain in the region of the sacroiliac joint. Clin Exp Rheumatol. 2002; 20(1):52-4. View

12.

Lingutla K, Pollock R, Ahuja S . Sacroiliac joint fusion for low back pain: a systematic review and meta-analysis. Eur Spine J. 2016; 25(6):1924-31. DOI: 10.1007/s00586-016-4490-8. View

13.

Rudolf L . Sacroiliac Joint Arthrodesis-MIS Technique with Titanium Implants: Report of the First 50 Patients and Outcomes. Open Orthop J. 2013; 6:495-502. PMC: 3529399. DOI: 10.2174/1874325001206010495. View

14.

Mason L, Chopra I, Mohanty K . The percutaneous stabilisation of the sacroiliac joint with hollow modular anchorage screws: a prospective outcome study. Eur Spine J. 2013; 22(10):2325-31. PMC: 3804714. DOI: 10.1007/s00586-013-2825-2. View

15.

Marbacher S, Mannion A, Burkhardt J, Schar R, Porchet F, Kleinstuck F . Patient-Rated Outcomes of Lumbar Fusion in Patients With Degenerative Disease of the Lumbar Spine: Does Age Matter?. Spine (Phila Pa 1976). 2015; 41(10):893-900. DOI: 10.1097/BRS.0000000000001364. View

16.

DePalma M, Ketchum J, Saullo T . Etiology of chronic low back pain in patients having undergone lumbar fusion. Pain Med. 2011; 12(5):732-9. DOI: 10.1111/j.1526-4637.2011.01098.x. View

17.

. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010; 112(4):810-33. DOI: 10.1097/ALN.0b013e3181c43103. View

18.

Maigne J, Aivaliklis A, Pfefer F . Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine (Phila Pa 1976). 1996; 21(16):1889-92. DOI: 10.1097/00007632-199608150-00012. View

19.

Manchikanti L, Abdi S, Atluri S, Benyamin R, Boswell M, Buenaventura R . An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013; 16(2 Suppl):S49-283. View

20.

Weinstein J, Lurie J, Tosteson T, Hanscom B, Tosteson A, Blood E . Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007; 356(22):2257-70. PMC: 2553804. DOI: 10.1056/NEJMoa070302. View