Does Level of Response to SI Joint Block Predict Response to SI Joint Fusion?

Polly, David W.; Cher, Daniel; Whang, Peter G.; Frank, Clay; Sembrano, Jonathan N.

doi:10.14444/3004

Cited by 24 publications

(18 citation statements)

References 35 publications

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“…Subgroup analysis in the SIJF group showed no baseline predictors of improved pain or disability responses to SIJF with the exception of ≥75% acute reduction in pain at 30 or 60 minutes after an SIJ block, which, in our study, predicted small increases in mean long-term responses to SIJF. Previously we reported that mean responses during an SIJ block were not predictive of responses to SIJF; 55 an additional analysis done here, defining a "responder" as a reduction of at least 75% at 30 or 60 minutes, showed statistically significant but clinically unimportant differences in pain and disability responses across responder groups.…”

Section: Discussioncontrasting

confidence: 43%

Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction

et al. 2016

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Background Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. Objective To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. Methods One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n=102) or non-surgical management (NSM, n=46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. Results In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. Conclusions In this Level 1 multicenter prospective randomized controlled trial, minimally invasive SIJF with triangular titanium implants provided larger improvements in pain, disability and quality of life compared to NSM. Improvements after SIJF persisted to 24 months. This study was approved by a local or central IRB before any subjects were enrolled. All patients provided studyspecific informed consent prior to participation.

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Section: Discussioncontrasting

confidence: 43%

Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction

et al. 2016

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“…A systematic review by Szadek et al [ 15 ] concluded that three positive provocation tests had significant discriminative power (diagnostic odds ratio, 17.16) for diagnosing SIJ pain using the reference standard of two positive blocks. When looking at a guided block alone, Polly et al [ 27 ] found a 50% reduction in pain to correlate well with excellent postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

Patient Reported Outcomes from Sacroiliac Joint Fusion

Kancherla¹,

McGowan²,

Audley³

et al. 2017

Asian Spine J

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Study DesignRetrospective, case series.PurposeThe purpose of this study is to determine morbidity, complications, and patient reported outcomes from minimally invasive sacroiliac joint (SIJ) fusion.Overview of LiteratureLumbar back pain emanating from the SIJ can be surgically treated via a percutaneous approach in the appropriately selected patient with minimal morbidity and acceptable functional outcomes.MethodsPatients diagnosed by >2 physical examination maneuvers and subjective relief from a computed tomography–guided lidocaine-bupivacaine-steroid injection underwent SIJ fusion after failing conservative management with a combination of oral anti-inflammatory medications, physical therapy, and pelvic belt stabilization. Perioperative data collected include estimated blood loss (EBL) and operative time. Oswestry disability index, 12-item short form health survey (SF-12), visual analogue score, and functional status were analyzed. All complications were noted.ResultsThe study cohort of 45 cases (69% female) achieved postoperative survey follow-up at 9.9 and 32.3 months. SF-12 physical component summary statistically improved while all other scores were equivalent. Mean EBL and operative time were 22 mL and 36 minutes, respectively. Initial survey showed that 64% of patients discontinued narcotics (29/45), 71% do not use an assistive device (32/45), and 15.6% do not work due to pain (7/45). 73% of patients stated they would have the surgery again (33/45). For the second survey, 65% of patients discontinued narcotics (26/40), 70% did not use an assistive device (28/40), and 17.5% did not work due to pain (7/40). A history of thoracolumbar instrumentation (16/45) did not significantly affect outcomes. Three complications described by screw malposition with neurologic deficit (6.7%) were treated with screw repositioning (1 case) and removal of a single superior implant (2 cases) with time to revision of 2.2 months. All three ultimately had resolution of radicular pain.ConclusionsPercutaneous SIJ fusion offers minimal morbidity and acceptable functional outcomes. While women and those with a prior history of lumbar instrumentation may be at increased risk of having SIJ dysfunction requiring surgical intervention, it was not found to affect postoperative functional outcomes when compared to the non-instrumented group.

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“…Prospective trials have shown that patients with SIJ pain responses of 50-75% respond to MIS SIJ fusion as well as those with 75-100% acute responses. 12 • Failure to respond to at least 6 months of nonsurgical treatment consisting of non-steroidal antiinflammatory drugs and physical therapy. Failure to respond means continued pain that interferes with activities of daily living and/or results in functional disability;…”

Section: Indications/limitations Of Coveragementioning

confidence: 99%

“…The degree of improvement at 6 and 12 months after SIJ fusion was unrelated to the degree of acute pain relief during the block. 12 In a retrospective analysis of predictors of outcome success after RF ablation of lateral branches of the sacral nerve roots in patients with SIJ pain, no relationship was observed between response to lateral branch block or SIJ anesthesia and response to RF ablation. 13 Randomized trials of RF ablation of lateral branches of the sacral nerve roots excluded patients with <75% pain reduction after lateral branch block (one block in Cohen et al 14 and two blocks in Patel et al 15 ), leaving open the question of whether the selected threshold was appropriate.…”

Section: Introductionmentioning

confidence: 97%