- For sacroiliac joint pain from degeneration or disruption, minimally invasive joint arthrodesis with triangular titanium implants offers safety and lasting effect (up to 2 years) vs conservative management.
Why this matters
- This cause of low back pain is on the increase, but how nonsurgical vs surgical treatments compare for safety, effect, and durability of improvement is not clear.
- At 2 years with surgery vs conservative management:
- Mean low back pain improvement: mean difference, 34 points, favoring surgery (P<.0001>
- Disability index: mean difference, 18 points, favoring surgery (P<.0001>
- Opioid use: decreased significantly with surgery (P=.009) but barely budged with conservative management.
- Patients also fared better with surgery for walking distance, overall satisfaction, work status improvement.
- Adverse event rates were similar.
- Prospective, multicenter, randomized controlled trial, 51 patients having conservative management compared with 52 having surgery.
- Outcome: self-rated low back pain (visual analog scale), back dysfunction (Oswestry Disability Index), QoL. 90% of subjects in both groups completed the study.
- Funding: SI-BONE (Santa Clara, California), which makes the iFuse Implant System used.
- No blinding of participant or assessor for obvious reasons.
- Involved sacroiliac joint arthrodesis with a single system used; effects with others unknown.