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Patients with low back pain caused by sacroiliac joint (SIJ) dysfunction have an impaired quality of life, due to reported pain, disability and activity limitations. There is increasing evidence that minimally invasive sacroiliac joint fusion (MISJF) results in improvement in pain, disability and quality of life in these patients. Some studies have reported improvements in daily physical activity following MISJF but based on bias-prone self-reports. Our aim was to provide objective data on daily physical activity in patients with SIJ dysfunction. Daily physical activity in daily life of participants was measured using a triaxial accelerometer for seven consecutive days, before surgery and 3 months after surgery. Recorded daily activities were the daily number of events and total time spent sitting or lying, standing, walking, cycling, high-activity and number of steps and sit-to-stand transfers. The quality of life was assessed by the validated Dutch EQ-5D-5 L-questionnaire. No statistical differences were observed between daily physical activity in patients with SIJ dysfunction before and 3 months after MISJF. As compared to matched controls, high-intensity physical activity was lower in both the pre- and postoperative period (p = 0.007) for patients with SIJ dysfunction. The quality of life improved significantly in patients after MSIJF, from 0.418 to 0.797 (p = 0.021) but did not reach the level of controls (1.000). Daily physical activity in patients with postpartum SIJ dysfunction does not improve 3 months following MISJF, while quality of life does improve significantly. The discrepancy between these two observations is food for new research.

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BACKGROUND: Sacroiliac joint (SIJ) dysfunction can occur as a result of injury, degeneration, or inflammation. This dysfunction presents symptoms of pain at various locations, including the low back, hips, buttocks, and legs. The diagnosis of SIJ dysfunction is challenging and cannot be achieved solely with imaging studies such as X-rays, MRI, or CT. The current gold standard diagnostic modality is intra-articular SIJ blocks using two differing local anesthetics. Current treatments for SIJ dysfunction may be beneficial for short-term relief but lack long-term efficacy. The purpose of our study was to examine the outcomes of patients who underwent minimally invasive, posterior SIJ fusion using allograft at a single center. METHODS: This was a retrospective study which received exemption from the WCG IRB. Data regarding preoperative and postoperative pain levels, surgical time, complications, and medication usage were obtained retrospectively from patient electronic medical records and prescription drug monitoring program reports. No mapping was completed prior to the procedure. Pain was assessed with the 11-point (0-10) Visual Analogue Scale (VAS) and medication usage was assessed using Morphine Milligram Equivalents (MME). Patients were included if they had been diagnosed with SIJ dysfunction using two intra-articular diagnostic blocks that resulted in at least an 80% decrease in pain and had failed conservative management. Patients with sacral insufficiency fractures were excluded. RESULTS: VAS scores reduced from 8.26 (SD = 1.09) at baseline to 2.59 (SD = 2.57), 2.55 (SD = 2.56), 2.71 (SD = 2.88), and 2.71 (SD = 2.88) at 3, 6, 9, and 12 months, respectively. MME reduced from 78.21 mg (SD = 51.33) to 58.95 mg (SD = 48.64), 57.61 mg (SD = 47.92), 61.71 mg (SD = 45.64), and 66.29 mg (SD = 51.65) at 3, 6, 9, and 12 months, respectively. All reductions in VAS scores and MME were statistically significant. No adverse events occurred, and the average operating room time was 40.16 min (SD = 6.27). CONCLUSION: Minimally invasive, posterior SIJ fusion using allograft is a safe and efficacious method for managing SIJ dysfunction.

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Introduction: Low back pain persisting after spine surgery presents diagnostic and treatment complexities for spine surgeons. Failed back syndrome is a term usually used to characterize chronic back or leg pain following spine surgery. Research has indicated a range of persistent pain occurrences after spine surgery. The sacroiliac joint (SIJ) has been recognized as a potential source of pain for a long time but has not received sufficient attention in subsequent years. Dysfunctions in the SIJ can result in a spectrum of clinical conditions, such as low back pain and lower limb radiculopathy. Traditional treatment approaches for SIJ disorders often involve conservative measures such as physical therapy, medications, intra-articular injections, and surgical options. In the past decade, endoscopic SIJ ablation has emerged as a minimally invasive alternative for managing SIJ pain and dysfunction. This approach combines minimal invasiveness with precise targeting, potentially reducing morbidity and enabling quicker recovery compared to open surgical procedures. Case Report: A 60-year-old female patient with grade 2 L5-S1 lytic listhesis initially underwent lumbar interbody fusion to address chronic low back pain and radiculopathy, resulting in significant symptom resolution for a brief period. The patient experienced a resurgence of symptoms within a short duration that proved refractory to conventional medical management and interventional pain management procedures. Ultimately, the patient achieved sustained relief after undergoing endoscopic SIJ ablation. Conclusion: This case report highlights the importance of endoscopic SIJ ablation as an innovative treatment for recurrent lower limb radiculopathy. Focusing on the SIJ, often neglected in lumbar spine surgery, this minimally invasive procedure shows promise in alleviating symptoms and enhancing patient outcomes.

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INTRODUCTION: Degenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion. MATERIALS AND METHODS: We carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2years' follow-up. The primary outcome was the improvement in lumbar and radicular pain on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59years (27-88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1-7) before the SI fusion. RESULTS: The lumbar and radicular NRS were 8.4 (7-10) and 5.1 (2-10) preoperatively and 5.2 (0-8) and 3.0 (0-8) at 2years postoperatively, which was a reduction of 37% and 42% (p<0.001), respectively. The Oswestry score went from 69.4 (52-86) preoperatively to 45.6 (29-70) at 2years, which was a 33% improvement (p<0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery. DISCUSSION: After minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included. CONCLUSION: Minimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally. LEVEL OF EVIDENCE: IV, retrospective study.

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Rheumatoid arthritis (RA) is a systemic autoimmune disease with profound effects on joints and extra-articular organs. This case report explores the complex treatment approach for a 54-year-old female patient who is dealing with the dual diagnosis of RA and Sjogren's syndrome (SS). RA primarily involves joint inflammation and morning stiffness leading to significant disability, while SS, another autoimmune condition, manifests with autoantibodies and lymphocytic infiltration affecting exocrine glands. The patient presented with joint and low back pain, alongside reduced mobility, portraying a complex clinical picture. Physiotherapy played a crucial role in addressing the diverse symptoms exhibited by the patient. Treatment involved Mulligan mobilization targeting sacroiliac joint dysfunction, laser therapy for pain relief, and tailored exercises focusing on joint mobility and muscle strength. Progress was monitored using the Rheumatoid Arthritis Disease Activity Index (RADAI-5) and overall quality of life assessments. Significant improvements were observed post-rehabilitation including reduced pain levels, increased joint range of motion, increased muscle strength, and enhanced sacroiliac mobility. These positive outcomes highlight the efficacy of physiotherapy in managing autoimmune rheumatic disorders. Collaboration between healthcare professionals particularly rheumatologists and physiotherapists is essential for comprehensive patient care. This case emphasizes the importance of adopting a holistic approach to managing autoimmune disorders. Physiotherapy emerges as a pivotal component in alleviating symptoms and enhancing physical function underscoring its integration into the multidisciplinary care framework for individuals facing the challenges of autoimmune rheumatic disorders.

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This case report details an integrated rehabilitation plan implemented for a professional badminton player who presented with issues of sacroiliac joint (SIJ) dysfunction and a lateral ankle sprain. The integrated approach aimed to address both musculoskeletal issues, considering their potential reciprocal influences on biomechanics and functional performance. The athlete underwent a thorough initial assessment, including clinical examination, imaging, and biomechanical analysis. Treatment began with targeted interventions for acute ankle sprain management, such as rest, ice, compression, and elevation (RICE) followed by progressive exercises to restore ankle stability and range of motion (ROM). Concurrently, a specialized program was devised to address the underlying sacroiliac joint dysfunction through manual therapy, therapeutic exercises, and core stabilization routines. Throughout the rehabilitation process, the focus remained on integrated exercises that targeted both the ankle and sacroiliac joint, promoting optimal neuromuscular coordination and joint function specific to badminton demands. Regular reassessments guided the progression of interventions, ensuring a personalized and athlete-centric approach. The positive outcome highlights the importance of a holistic rehabilitation strategy in managing complex musculoskeletal conditions in athletes, facilitating efficient recovery, and reducing the risk of recurrence. This case report highlights the effectiveness of an integrated approach in enhancing performance and preventing reinjury in badminton athletes facing multifaceted musculoskeletal challenges.

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BACKGROUND: Sacroiliac joints are affected by mechanical environments; the joints are formed under mechanical stimulation, receive impact of walking between the upper and lower parts of the bodies and can be a cause of pain due to non-physiological loads. However, there are so far very few studies that reviewed biomechanics of physiological and pathological sacroiliac joints. This review article aims to describe the current sacroiliac joint biomechanics. METHODS: Previous original papers have been summarized based on three categories: articular surface structure, sacroiliac joint motion and sacroiliac joint dysfunction and treatments. FINDINGS: Although the articular surface morphologies vary greatly from individual to individual, many researchers have tried to classify the joints into several types. It has been suggested that the surface morphologies may not change regardless of joint dysfunction, however, the relationship between the joint structure and pain are still unclear. The range of sacroiliac joint motion is demonstrated to be less than 1 mm and there is no difference between physiological and pathological joints. The sacroiliac joint absorbs shock within the pelvis by the joint structures of pelvic morphology, ligaments and fat tissues. The morphology and motion of the sacroiliac joints may be optimized for upright bipedal walking. INTERPRETATION: There is no doubt that pelvic mechanical environments affect pain induction and treatment; however, no one has yet provided a concrete explanation. Future research could help develop treatments based on sacroiliac joint biomechanics to support joint function.

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OBJECTIVE: To investigate the effectiveness of focused extracorporeal shock wave therapy (FESWT) in treating postpartum sacroiliac joint (SIJ) dysfunction. METHODS: A total of 90 patients with SIJ dysfunction were included and randomly assigned to FESWT, manual therapy (MT), or combination therapy (CT) groups. Pain intensity and Oswestry Disability Index (ODI) score were measured upon admission, after 1 and 2 weeks of treatments. The treatment efficacy and adverse events of each group were also assessed. RESULTS: There were no significant differences among three groups regarding clinical data, pain intensity, and ODI score on admission (all P > 0.05). After 1 week of treatment, FESWT exhibited similar pain intensity and lower ODI score (P < 0.001) compared to MT. After 2 weeks of treatment, the pain and ODI in FESWT were similar with MT. The pain in CT was lower than MT after 1 week, but lower than FESWT after 2 weeks. Furthermore, we identified interaction effects between treatment method and duration in relation to pain intensity (Fgroup*time = 5.352, P = 0.001) and ODI score (Fgroup*time = 5.902, P < 0.001). FESWT group exhibited the highest improvement rate of 66.7%, while CT group achieved the highest cure rate of 73.3%. No adverse events were observed in any of the patients during 2 months follow-up period. CONCLUSIONS: Compared to MT, FESWT mainly reduced the ODI score rather than pain after 1 week of treatment. After 2 weeks, the effect of FESWT in relieving the pain was inferior to the MT.

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BACKGROUND: Sacroiliac joint dysfunction (SIJD) after lumbar/lumbosacral fusion has become increasingly recognized as the utilization of lumbar fusion has grown. Despite the significant morbidity associated with this condition, uncertainty regarding its diagnosis and treatment remains. We aim to update the current knowledge of the etiology, diagnosis, and treatment of post-lumbar surgery SIJD. METHODS: PRISMA guidelines were used to search the PubMed/Medline, Web of Science, Cochrane Reviews, Embase, and OVID databases for literature published in the last 10 years. The ROBIS tool was utilized for risk of bias assessment. Statistical analyses were performed using the R foundation. A Fisher's exact test was performed to determine the risk of SIJD based on operative technique, gender, and symptom onset timeline. Odds ratios were reported with 95% confidence intervals. A p-value [Formula: see text] 0.05 was considered statistically significant. RESULTS: Seventeen publications were included. The incidence of new onset SIJD was 7.0%. The mean age was 56 years, and the follow-up length was 30 months. SIJD was more common with fixed lumbar fusion vs floating fusion (OR = 1.48 [0.92, 2.37], p = 0.083), fusion of [Formula: see text] 3 segments (p < 0.05), and male gender increased incidence of SIJD (OR = 1.93 [1.27, 2.98], p = 0.001). Intra-articular injection decreased the Visual Analogue Scale (VAS) score by 75%, while radiofrequency ablation (RFA) reduced the score by 90%. An open approach resulted in a 13% reduction in VAS score versus 68 and 29% for SIJ fixation using the iFuse and DIANA approaches, respectively. CONCLUSIONS: Lumbar fusion predisposes patients to SIJD, likely through manipulation of the SIJ's biomechanics. Definitive diagnosis of SIJD remains multifaceted and a newer modality such as SPECT/CT may find a future role. When conservative measures are ineffective, RFA and SIJ fixation using the iFuse System yield the greatest improvement VAS and ODI.

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Low back pain is one of the most common complaints in primary care. This pain is usually nonspecific and musculoskeletal. However, identification and exclusion of specific causes of pain as early as possible are important for specialists since their underestimation can sometimes lead to life-threatening consequences. The authors analyze literature data on the key facts of anamnesis («red flags¼), management of patients with low back pain with emphasis on modern concepts and recommendations for diagnostics, identifying the dominant nature and cause of pain, differential diagnosis, and diagnostic significance of neuroimaging. Special attention is paid to existing options for conservative (drug and non-drug therapy) and interventional treatment methods, which have become increasingly popular in recent years.

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BACKGROUND AND OBJECTIVES: Chronic low back pain, frequently attributed to Sacroiliac Joint Dysfunction (SIJD), remains a prevalent concern in orthopedic and physiotherapy arenas. Despite the recognition of motor control exercises (MCEs) and balance training (BT) as potential rehabilitative measures, studies elucidating their combined efficiency for SIJD are scarce. This research study aimed to ascertain the combined and individual efficacies of MCE and BT in alleviating SIJD symptoms. METHODS: A double-blinded randomized controlled trial was conducted, enrolling 120 SIJD-diagnosed patients aged 30-60 years. Participants were randomly allocated into four groups: MCEs alone, BT alone, combined MCEs and BT, and a control group receiving usual care. Interventions spanned 12 weeks, with evaluations at the start and end and a 24-week follow-up. Primary outcomes encompass pain intensity (assessed via Visual Analog Scale), functional disability (utilizing the Oswestry Disability Index), and life quality (using the Short Form-36). RESULTS: Post a 12-week intervention, participants receiving combined MCE and BT demonstrated substantial improvements in VAS (Median: 3.5, IQR: 2-5; p = 0.0035), ODI (Median: 15%, IQR: 10-20%; p = 0.0035), and SF-36 scores (Median: 70, IQR: 65-75; p = 0.0035) compared to baseline. In contrast, standalone MCE or BT and control groups exhibited lesser efficacy. By the 24-week follow-up, the combined group maintained their gains, outperforming the other groups. The research tools employed showed high reliability with Cronbach's alpha >0.85. CONCLUSIONS: Our findings underscore the superior efficacy of integrating motor control exercises (MCEs) and balance training (BT) for Sacroiliac Joint Dysfunction (SIJD)-related chronic low back pain. This combined approach promises enhanced patient outcomes, highlighting its potential as a primary strategy in SIJD management. Future studies should further explore its long-term benefits and integration with other therapeutic modalities.

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Background: Sacroiliac joint fusion (SIF) has been shown to effectively alleviate pain and improve functional deficits associated with sacroiliac joint dysfunction (SIJD). Previous studies have demonstrated significant improvements in gait function, however, none have reported both over-ground walking and quiescent standing, and additionally, none have included analysis of pelvic kinematics which may contain important information regarding pain avoidant compensatory behaviors. The purpose of this study was to identify objective functional differences between symptomatic and asymptomatic sides of unilateral sacroiliac joint dysfunction (SIJD) patients and to demonstrate the effectiveness of unilateral sacroiliac fusion (SIF) to improve gait and balance function compared to matched controls. Methods: Thirteen unilateral SIJD patients were evaluated before and 6 months after SIF and were compared to matched asymptomatic controls. Pain and disability were assessed using visual analog scales and the Oswestry disability index respectively. Over ground walking and standing balance were assessed using 3D joint kinematics and kinetic ground reaction force analyses. Results: Preoperatively, SIJD patients reported high levels of pain and disability and exhibited significant deficits in gait including elevated step width, reduced hip flexion/extension, and elevated pelvic motion as well as elevated center of pressure sway characteristics during standing. After unilateral SIF, patients reported significant reductions in pain and demonstrated significant improvements in gait including normalization of step width between sides and improved hip motion however elevated pelvic obliquity and rotation motion remained. Improvements in standing balance included reduced coronal sway characteristics and normalization of loading symmetry between sides. Conclusion: Unilateral SIF resulted in significant improvements in both gait and balance function among SIJD patients to levels comparable to matched controls, however elevated pelvic motion remained. These findings help inform surgeons on the effectiveness of SIF for unilateral SIJD and provide important information regarding interpretation of functional outcomes.

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Abstract: The study intended to evaluate the incidence and evolution of sacroiliac joint dysfunction (SIJD). To reach 50 patients with SIJD diagnosis, 192 patients with low back pain and failure in conservative approach were consecutively examined (26% incidence). Initially patients underwent intra-articular (IA) corticosteroid sacroiliac joint (SIJ) block followed, if necessary, by cooled SIJ radiofrequency or referred to surgical intervention, in order of complexity. From the 50 patients submitted to IA SI block, 41 (82%) referred pain and quality of life improvement and lesser rescue analgesics consumption for 25 weeks. The block induced a prompt onset of pain relief and there was a drop in mean pain score from 8 to 2 cm (p < 0.001) maintained up to 25 weeks. Rescue analgesic consumption also significantly dropped (p < 0.05). However, nine patients (18%) did not refer long lasting improvement in the third week evaluation and underwent cooled radiofrequency. From this population of nine, seven were successful (78%) while two were recommended surgery. In view of the 50 patients, 82% were comfortable after IA block, 18% were submitted to radiofrequency, with a success rate of 78%. The final incidence of surgery suggestion was 4%.

Resumen: El estudio pretende evaluar la incidencia y evolución de la disfunción de la articulación sacroilíaca (DASI). Para llegar a 50 pacientes con diagnóstico de DASI, se examinaron consecutivamente 192 pacientes con dolor lumbar y fracaso en el abordaje conservador (26% de incidencia). Inicialmente, los pacientes se sometieron a un bloqueo de la articulación sacroilíaca (ASI) con corticosteroides intraarticulares (IA) seguido, si era necesario, de radiofrecuencia ASI enfriada o remitidos a una intervención quirúrgica, en orden de complejidad. De los 50 pacientes sometidos al bloqueo IA SI, 41 (82%) refirieron mejoría del dolor y de la calidad de vida y menor consumo de analgésicos de rescate durante 25 semanas. El bloqueo indujo un rápido inicio del alivio del dolor y hubo una caída en la puntuación media del dolor de 8 a 2 cm (p < 0.001) mantenida hasta 25 semanas. El consumo de analgésicos de rescate también disminuyó significativamente (p < 0.05). Sin embargo, nueve pacientes (18%) no refirieron una mejoría duradera en la evaluación de la tercera semana y se sometieron a radiofrecuencia fría. De esta población de nueve, siete tuvieron éxito (78%), mientras que a dos se les recomendó cirugía. De los 50 pacientes, 82% se sintió cómodo después del bloqueo IA, 18% fue sometido a radiofrecuencia, con una tasa de éxito de 78%. La incidencia final de sugerencia de cirugía fue de 4%.

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PURPOSE: Reporting the clinical outcomes, patient satisfaction, and complications following an imaging-guided percutaneous screw fixation in the treatment of sacroiliac joint dysfunction and evaluating the safety and effectiveness of this method. METHODS: We performed a retrospective study on a prospectively gathered cohort of patients with physiotherapy-resistant pain due to sacroiliac joint incompetence that underwent percutaneous screw fixation, between 2016 and 2022 in our center. A minimum of two screws were used in all patients to obtain fixation of the sacroiliac joint, using percutaneous screw insertion under CT guidance, coupled with a C-arm fluoroscopy unit. RESULTS: The mean visual analog scale significantly improved at 6 months of follow-up (p < 0.05). One hundred percent of the patients reported significant improvement in pain scores at the final follow-up. None of our patients experienced intraoperative or postoperative complications. CONCLUSION: The use of percutaneous sacroiliac screws provides a safe and effective technique for the treatment of sacroiliac joint dysfunction in patients with chronic resistant pain.

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BACKGROUND: Traditional sacroiliac joint (SIJ) provocation tests have been used to diagnose SIJ pain. However, this can simply be changed to chronic SIJ dysfunction (cSIJD) manifests as mechanical changes in the pelvis and lower extremities in addition to pain. A novel composite of physical examinations based on the iliac pronation, pubic tubercle tenderness, and plantar fascia tenderness tests (IPP triple tests) was designed for the diagnosis of cSIJD. OBJECTIVES: To evaluate IPP triple tests in the diagnosis of cSIJD and differential diagnosis from lumbar disc herniation (LDH) in comparison with traditional provocation tests. STUDY DESIGN: Prospective single-blind controlled study. SETTING: This study was conducted at the Department of Spine and Spinal Cord Surgery of China Rehabilitation Research Center in Beijing, China. METHODS: One hundred and sixty-six patients were assigned into the cSIJD group, LDH group, or healthy control group. The cSIJD diagnosis was confirmed by SIJ injection. The diagnosis of LDH was confirmed according to the 2014 North American Spine Association diagnosis and treatment guidelines for LDH. All patients were examined with IPP triple tests and traditional provocation tests. The sensitivity, specificity, positive and negative likelihood ratios, and areas under the curve (AUCs) were used to evaluate the diagnostic accuracy of the composites or single of the IPP triple tests, and traditional provocation tests. The Delong's test was used for the comparison among AUCs. The kappa analysis was used for the IPP triple tests and traditional provocation tests compared with the reference standard (REF). The independent t test and chi-square test were used to analyze the influence factors (i.e., age, gender), and group on diagnostic accuracy. RESULTS: There was no statistical difference in gender (chi-squared = 0.282, P = 0.596) and age (F = 0.096, P = 0.757) between the 3 groups. The AUC of the iliac pronation test was 0.903 when it was used alone; the AUC of the novel composites of the IPP triple tests was 0.868 (95% confidence interval [CI] = 0.802-0.919); and the diagnostic accuracy of the traditional provocation test was relatively low (AUC = 0.597, 95% CI = 0.512-0.678). The diagnostic accuracy of the IPP triple tests was higher than that of the traditional provocation test, P < 0.05. Kappa consistency comparison showed that the kappa value between the IPP triple tests and the REF was 0.229, the kappa between the traditional provocation test and the REF was 0.052. The age of the patients with inaccurate diagnosis was higher than that of the patients with accurate diagnosis in both methods (traditional tests, P = 0.599; IPP:P = 0.553). Different types of diseases (groups) affect the accuracy of diagnosis, the proportion of inaccuracy of traditional provocation tests was higher than that of the IPP triple tests (77.8% vs 23.6%) in cSIJD, while the 2 methods have high differential diagnostic accuracy in LDH (96.77%) and control groups (97.56%). LIMITATIONS: Small size of LDH patients and differences in physical tests among examiners. CONCLUSIONS: The novel composites of IPP triple tests have higher accuracy than the traditional provocation tests in diagnosing cSIJD and both have good accuracy in differentiating cSIJD from LDH. IPP triple tests may be an alternative physical examination for clinical screening of cSIJD.

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Aim: We aimed to expound upon previous research examining the effect of platelet rich plasma in the treatment of sacroiliac joint (SIJ) dysfunction and pain. Materials & methods: A systematic review was employed in conjunction with a pooled analysis of the efficacy of platelet-rich plasma (PRP) in SIJ dysfunction and pain. Results: A total of 259 articles were retrieved following database systematic review. As a result, four clinical trials and two case studies were subjected to full text appraisal. The dates of publication ranged from 2015 to 2022. Conclusion: Although a unique modality, there is not enough evidence to support the employment of PRP injections over current steroid standard of care. Further double-blinded, randomized control trials are required to elucidate PRP role in SIJ dysfunction.

Platelet rich plasma is an injection derived from separating blood components in a centrifuge. Injection of platelet rich plasma into the sacroiliac joint has often been touted as highly beneficial for pain and disability, and superior to other modalities. Our systematic review and pooled analysis show that platelet rich plasma injections are beneficial, albeit not to the degree previously reported.

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BACKGROUND: Sacroiliac joint fusion (SIJF) has been established as an effective treatment for sacroiliac joint dysfunction. However, failure necessitating revision has been reported in up to 30% of cases. Little is known regarding outcomes of revision SIJF. METHODS: We retrospectively reviewed all revision SIJF at a single academic center between 2017 and 2020. Revision surgery was performed using the principles of joint decortication, bone grafting, compression, and rigid internal fixation. Outcomes were assessed at 6 months and 1 year after surgery using the Oswestry Disability Index (ODI), Numeric Pain Rating Scale (NPRS), and Single Assessment Numeric Evaluation (SANE) scale. Fusion was assessed using computed tomography at 12 months postoperatively. RESULTS: Eighteen revision SIJFs in 13 patients were included. The mean age was 55.8 years (range 35-75). Mean body mass index was 27.9 (range 21.7-36.7). Sixty-two percent of the patients were women. The indications for revision were pseudarthrosis without fixation failure in 14 cases (77.8%), hardware failure (loosening) in 3 cases (16.7%), and continued pain after partial fusion in 1 case (5.6%). ODI and NPRS scores demonstrated significant statistical and clinical improvements at all timepoints. Mean (SD) ODI scores improved from 53.8 (19.9) preoperative to 37.5 (19.8) at 6 months and 32.9 (21.7) at 12 months. Improvement in ODI was found in 15 joints (83.3%), and the minimal clinically important difference (MCID) was achieved in 12 joints (66.7%). Mean (SD) NPRS scores improved from 6.5 (1.4) preoperative to 3.2 (2.8) at 6 months and 3.4 (2.6) at 12 months. Improvement in NPRS was also identified in 17 joints (94.4%), and 10 joints (55.6%) achieved MCID for NPRS. Mean (SD) SANE score was 72.0% (30.8) at 6 months and 70.0% (33.8) at 12 months. There were no radiographic lucencies, implant subsidence, or implant fractures at final follow-up. We identified an 88.9% fusion rate with definitive bridging bone across the sacroiliac joint. CONCLUSION: Utilizing a principles-based technique of joint decortication, compression, and rigid internal fixation, revision SIJF showed an improvement in patient-reported outcomes as well as high rate of fusion at 12 months. The most common indications for revision SIJF are symptomatic pseudarthrosis and implant loosening. This is the largest series of revision SIJF to date.

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BACKGROUND: Pain related to the sacroiliac joint (SIJ) accounts for low back pain in 15%-30% of patients. One of the most common treatment options is the use of pelvic belts. Various types of pelvic belts exist; however, the mechanisms underlying treatment and their effectiveness remain unclear to date. OBJECTIVE: To analyze stress distribution in the pelvis when a pelvic rubber belt or a padded pelvic belt is applied, to assess the effectiveness of treatment from a numerical biomechanical perspective. METHODS: The pressure distribution at the pelvic belts was measured using a device and subsequently modeled with the finite element method of a pelvis with soft tissues. The stress environment when wearing a pelvic belt in a double-leg stance was simulated. RESULTS: With the application of pelvic belts, the innominate bone rotated outward, which was termed an out-flare. This caused the SIJ to compress and cause reduction in sacrotuberous, sacrospinous, interosseous, and posterior sacroiliac ligament loading. Padded pelvic belts decreased the SIJ displacement to a greater extent than in pelvic rubber belts. CONCLUSION: Pelvic belts aid in compressing the SIJ and reduce its mobility.

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The study intended to evaluate the incidence and evolution of sacroiliac joint dysfunction (SIJD). To reach 50 patients with SIJD diagnosis, 192 patients with low back pain and failure in conservative approach were consecutively examined (26% incidence). Initially patients underwent intra-articular (IA) corticosteroid sacroiliac joint (SIJ) block followed, if necessary, by cooled SIJ radiofrequency or referred to surgical intervention, in order of complexity. From the 50 patients submitted to IA SI block, 41 (82%) referred pain and quality of life improvement and lesser rescue analgesics consumption for 25 weeks. The block induced a prompt onset of pain relief and there was a drop in mean pain score from 8 to 2 cm (p < 0.001) maintained up to 25 weeks. Rescue analgesic consumption also significantly dropped (p < 0.05). However, nine patients (18%) did not refer long lasting improvement in the third week evaluation and underwent cooled radiofrequency. From this population of nine, seven were successful (78%) while two were recommended surgery. In view of the 50 patients, 82% were comfortable after IA block, 18% were submitted to radiofrequency, with a success rate of 78%. The final incidence of surgery suggestion was 4%.

El estudio pretende evaluar la incidencia y evolución de la disfunción de la articulación sacroilíaca (DASI). Para llegar a 50 pacientes con diagnóstico de DASI, se examinaron consecutivamente 192 pacientes con dolor lumbar y fracaso en el abordaje conservador (26% de incidencia). Inicialmente, los pacientes se sometieron a un bloqueo de la articulación sacroilíaca (ASI) con corticosteroides intraarticulares (IA) seguido, si era necesario, de radiofrecuencia ASI enfriada o remitidos a una intervención quirúrgica, en orden de complejidad. De los 50 pacientes sometidos al bloqueo IA SI, 41 (82%) refirieron mejoría del dolor y de la calidad de vida y menor consumo de analgésicos de rescate durante 25 semanas. El bloqueo indujo un rápido inicio del alivio del dolor y hubo una caída en la puntuación media del dolor de 8 a 2 cm (p < 0.001) mantenida hasta 25 semanas. El consumo de analgésicos de rescate también disminuyó significativamente (p < 0.05). Sin embargo, nueve pacientes (18%) no refirieron una mejoría duradera en la evaluación de la tercera semana y se sometieron a radiofrecuencia fría. De esta población de nueve, siete tuvieron éxito (78%), mientras que a dos se les recomendó cirugía. De los 50 pacientes, 82% se sintió cómodo después del bloqueo IA, 18% fue sometido a radiofrecuencia, con una tasa de éxito de 78%. La incidencia final de sugerencia de cirugía fue de 4%.

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Objective: The goal of this project is to evaluate the therapeutic effectiveness of fluoroscopically guided intra-articular sacroiliac (SI) joint injections in patients with diagnosed SI joint dysfunction. Patient reported outcomes related to pain and quality of life measures were evaluated. Design: This is a retrospective observational study of patients receiving intra-articular SI joint injections under a single provider at the Cleveland Clinic from September 2013 to April 2019. Three hundred fifty-one patients received injections and were administered patient reported outcomes (PROs) including the Numeric Rating Scale, Patient Health Questionnaire, Pain Disability Questionnaire, EuroQol-5 Dimensions Questionnaire, and PROMIS-GH Physical and Mental Health at baseline and approximately 1-, 3-, 6-, 12-, and 24-month time points during follow-up appointments. The primary outcome measure was the percentage of patients receiving their first injection who achieved minimal clinically important difference (MCID) in these PROs at each follow-up time point. Secondary outcomes were the percentage of patients achieving MCID in each PRO for each injection analyzed (including patients who received repeat injections) and average change in these PROs at each time point for first and all injections. Results: A total of 351 patients were included in the analysis, with varying time points of follow-up. The average patient age was 52.3 (±14.9) years with 74.9% female and 59.0% white. For first time injections, the MCID was achieved for Numeric Rating Scale in 60.6%, 42.1%, 47.5%, and 32.5% of patients at 1-, 3-, 6-, and 12-month follow-up, respectively. There was significant improvement in PROMIS-GH Physical Health at 3-month, 6-month, and 1-year follow-up. There was no significant improvement in PROMIS-GH Mental Health at any follow-up time points. Conclusions: Fluoroscopically guided intra-articular SI joint injection for SI joint dysfunction is effective in providing therapeutic pain relief exceeding MCID values in greater than 60% of patients at 1 month and greater than 40% at 3- and 6- months after injection. However, while this intervention may provide significant pain relief and improvement in function, it may not address the psychosocial aspect of chronic pain to the same extent.