Sacroiliac joint arthrodesis bests conservative management

  • Dengler J & al.
  • J Bone Joint Surg Am
  • 6 Mar 2019

  • International Clinical Digest
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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. 

Limitations

  • No blinding of participant or assessor for obvious reasons.
  • Involved sacroiliac joint arthrodesis with a single system used; effects with others unknown.

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