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Ruffilli A, Cerasoli T, Barile F, Manzetti M, Viroli G, Traversari M, Filardo G, Faldini C. Injective Treatments for Sacroiliac Joint Pain: A Systematic Review and Meta-analysis. Indian J Orthop 2024; 58:637-649. [PMID: 38812868 PMCID: PMC11130093 DOI: 10.1007/s43465-024-01164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 04/18/2024] [Indexed: 05/31/2024]
Abstract
Background The most effective injective treatment approach for sacroiliac joint (SIJ) pain remains unclear. Aim of this study was to quantify the safety and effectiveness of the available injective strategies to address SIJ pain. Methods A systematic review and meta-analysis of the literature was conducted on PubMed, Scopus, and Embase databases from inception until January 2023. Inclusion criteria were studies written in English, comparative and non-comparative studies regardless of the minimum follow-up, and case series on SIJ injections. Safety and efficacy of the different injection therapies for the SIJ were quantified. A meta-analysis was conducted on the available data of the documented injective therapies. The "Checklist for Measuring Quality" by Downs and Black was used to assess the risk of bias and the quality of papers. Results The literature search retrieved 43 papers (2431 patients): 16 retrospective case series, 2 retrospective comparative studies, 17 prospective case series, 3 prospective comparative studies, and 5 randomized controlled trials. Of the selected studies, 63% examined the effect of steroid injections, 16% of PRP injections, while 21% reported other heterogeneous treatments. The failure rate was 26% in steroid injections and 14% in PRP injections. The meta-analysis showed a statistically significant reduction in pain with the VAS score for both steroids and PRP: steroids improvement at mid-term 3.4 points (p < 0.05), at long-term 3.0 (p < 0.05), PRP improvement at mid-term 2.2 (p = 0.007), at long-term 2.3 points of the VAS pain scale (p = 0.02). Conclusions Steroids are the most documented injective approach, with studies showing an overall safety and effectiveness. Still, the high number of failures underlined by some studies suggest the need for alternative procedures. Early PRP data showed promise, but the limitations of the current literature do not allow to clearly define the most suitable injective approach, and further studies are needed to identify the best injective treatment for SIJ patients.
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Affiliation(s)
- A. Ruffilli
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - T. Cerasoli
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - F. Barile
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - M. Manzetti
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - G. Viroli
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - M. Traversari
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - G. Filardo
- Applied and Translational Research Center (ATRc), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - C. Faldini
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
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Prolotherapy. Phys Med Rehabil Clin N Am 2023; 34:165-180. [DOI: 10.1016/j.pmr.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Giordano L, Murrell WD, Maffulli N. Prolotherapy for chronic low back pain: a review of literature. Br Med Bull 2021; 138:96-111. [PMID: 33884404 DOI: 10.1093/bmb/ldab004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Low back pain is common and imposes major societal burdens for patient suffering and costs. Prolotherapy injections are used for musculoskeletal conditions including tendinopathies, osteoarthritis and low back pain to enhance soft-tissue healing. This review aims to clarify the place of prolotherapy in chronic low back pain (CLBP). SOURCES OF DATA Using multiple databases, a systematic search was performed to identify studies detailing the use of prolotherapy to manage CLBP. A total of 12 articles was included in the present work. AREAS OF AGREEMENT Considering the level of evidence and the quality of the studies assessed using the modified Coleman Score, prolotherapy is an effective management modality for CLBP patients in whom conservative therapies failed. AREAS OF CONTROVERSY The presence of co-interventions and the clinical heterogeneity of the work contributes to confound the overall conclusions. GROWING POINTS AND AREAS FOR RESEARCH The analysis of the studies included in the review, using appropriate tools, showed how their quality has decreased over the years, reflecting the need for appropriately powered well planned and performed randomized control trials.
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Affiliation(s)
- Lorenzo Giordano
- Department of Trauma and Orthopaedic Surgery, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo 1, Salerno 84131, Italy
| | - William D Murrell
- Emirates-Integra Medical and Surgical Centre, Dubai, United Arab Emirates.,Department of Orthopaedics, Podiatry, and Rehabilitation, Fort Belvoir Community Hospital, 9300 Fort Belvoir, VA 22060, USA
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo 1, Salerno 84131, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thornburrow Drive, Stoke-on-Trent ST5 5B, England
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Panagos A. Dextrose Prolotherapy to Treat Pain, Improve Activities of Daily Living, and Improve Quality of Life in an Ewing's Sarcoma Patient Following Radiation and Chemotherapy Treatment. Cureus 2021; 13:e13549. [PMID: 33791172 PMCID: PMC8000706 DOI: 10.7759/cureus.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Advances in the treatment and survival of Ewing’s sarcoma patients create a need to treat underlying symptoms that limit activities of daily living and quality of life. This case describes the treatment of pain in a 25-year-old female pediatric nurse with Ewing’s sarcoma of the pelvis that was in remission following radiation and chemotherapy. She reported medication side effects and limitations in her activities of daily living and quality of life with the chronic use of topical and oral pain medications. A dextrose prolotherapy approach was used to treat her pain, which allowed her to discontinue her pain medication regimen, resulting in an improvement in her activities of daily living and quality of life. The improvement was sustained at the three-year follow-up after the last procedure.
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Affiliation(s)
- Andre Panagos
- Rehabilitation Medicine, New York University (NYU) Grossman School of Medicine, New York, USA.,Rehabilitation Medicine, New York City (NYC) Health + Hospitals/Bellevue, New York, USA.,Physical Medicine and Rehabilitation, Spine & Sports Medicine of New York, New York, USA
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Yang J, Zhao G, Xu H, Wang F. Three-Dimensional Finite Element Analysis of the Effects of Ligaments on Human Sacroiliac Joint and Pelvis in Two Different Positions. J Biomech Eng 2020; 142:1074594. [PMID: 32060536 DOI: 10.1115/1.4046361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Indexed: 12/27/2022]
Abstract
To present the ligament effects on sacroiliac joint (SIJ) stability and human pelvis biomechanical characteristics in two different positions by using three-dimensional (3D) finite element (FE) models of pelvis. Based on the computed tomography (CT) data of human pelvis, three-dimensional FE models of human pelvis in sitting and standing positions were established, which include the bone (sacrum, ilium, and coccyx) and six ligaments (sacroiliac, sacrospinous, sacrotuberous, inguinal, superior pubic, and arcuate pubic ligaments). 600 N vertical load was applied at the upper surface of sacrum to analyze the stress and displacement distribution of pelvis and SIJ. The simulation results demonstrated that the maximum stresses of sacrum and ilium on SIJ contact surface were 5.63 MPa and 7.40 MPa in standing position and 7.44 MPa and 7.95 MPa in sitting position. The stresses of ligament dysfunction group were higher than that of health group, which increased by 22.6% and 35.7% in standing position and 25.2% and 43.6% in sitting position in sacrum and ilium. The maximum displacements located on the upper surface of sacrum, which were 0.13 mm and 1.04 mm in standing and sitting positions. Ligaments dysfunction group increased 30.7% and 9.6% than health group in standing and sitting positions. The integral displacement of pelvis was greater in sitting position. The location of stress concentration and displacement distribution of pelvic bone are closely resembled previous research results in two different positions. The simulation results may provide beneficial information and theoretical models for clinical research of pelvic fracture, joint movement, and ligament functional injuries, and so on.
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Affiliation(s)
- Jiajing Yang
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Gaiping Zhao
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 516 Jungong Road, Yangpu District, Shanghai 200093, China
| | - Haifei Xu
- Department of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Fei Wang
- Changhai Hospital of Shanghai, 168 Changhai Road, Yangpu District, Shanghai 200433, China
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Desai MJ, Mansfield JT, Robinson DM, Miller BC, Borg-Stein J. Regenerative Medicine for Axial and Radicular Spine-Related Pain: A Narrative Review. Pain Pract 2020; 20:437-453. [PMID: 31869517 DOI: 10.1111/papr.12868] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/03/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Regenerative injection-based therapy has established itself as a therapeutic option for the management of a variety of painful musculoskeletal conditions. The aim of this work was to review the current literature regarding regenerative injection therapy for axial/radicular spine pain. METHODS A comprehensive literature review was conducted on the use of regenerative medicine for axial/radicular spine pain. Eligible articles analyzed the therapeutic injection effects of platelet-rich plasma (PRP), prolotherapy, or mesenchymal signaling cells (MSCs) via intradiscal, facet joint, epidural, or sacroiliac joint delivery. RESULTS Regarding intradiscal PRP, there are level I/IV studies supporting its use. Regarding intradiscal prolotherapy, there are level III to IV studies supporting its use. Regarding intradiscal MSCs, there are level I/IV studies supporting its use with the exception of one level IV study that found no significant improvement at 12 months. Regarding facet joint injections with PRP, there are level I/IV studies supporting its use. Regarding facet joint injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate any statistical significance supporting its use. Regarding epidural injections with PRP, there are level I/IV studies supporting its use. Regarding epidural injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate statistical significance beyond 48 hours. Regarding sacroiliac joint injections with PRP, there are level I/IV studies supporting its use. Regarding sacroiliac joint injections with prolotherapy, there are level I/III studies supporting its use. CONCLUSIONS Currently, there are level I studies to support the use of PRP and MSC injections for discogenic pain; facet joint injections with PRP; epidural injections of autologous conditioned serum and epidural prolotherapy; and PRP and prolotherapy for sacroiliac joint pain. One level I study showed that facet joint prolotherapy has no significant benefit. Notably, no intervention has multiple published level I studies.
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Affiliation(s)
- Mehul J Desai
- International Spine, Pain & Performance Center, Washington, DC, U.S.A.,George Washington University, Washington, DC, U.S.A.,Division of Pain Medicine, Virginia Hospital Center, Arlington, Virginia, U.S.A
| | - John Taylor Mansfield
- Department of Physical Medicine and Rehabilitation, MedStar Georgetown University Hospital, Washington, DC, U.S.A
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, U.S.A
| | - Benjamin C Miller
- Department of Physical Medicine and Rehabilitation, MedStar Georgetown University Hospital, Washington, DC, U.S.A
| | - Joanne Borg-Stein
- Division of Sports and Musculoskeletal Rehabilitation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, U.S.A
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