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Fuchs V, Rieger B. A New Approach to the Treatment of Sacroiliac Joint Pain and First Patient-Reported Outcomes Using a Novel Arthrodesis Technique for Sacroiliac Joint Fusion. Orthop Res Rev 2024; 16:43-57. [PMID: 38318227 PMCID: PMC10840548 DOI: 10.2147/orr.s434566] [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] [Received: 09/30/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose To report the development of a new sacroiliac joint (SIJ) arthrodesis system that can be used for isolated fusion of the SIJ and, unlike known implant systems, in combination with lumbar instrumentation or as an alternative to existing sacropelvic fixation (SPF) methods, and the patient-reported outcomes in two cases. Materials and Methods After a comprehensive review of 207 pelvic computed tomography (CT) datasets, an implant body was designed. Its shape was modeled based on the SIJ recess. A screw anchored in the ilium secures the position of the implant and allows connection to lumbar instrumentation. Two patients with confirmed SIJ syndrome underwent surgery with the anatomically adapted implant. They were evaluated preoperatively, 6 months, and 12 months postoperatively. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Million Visual Analogue Scale (MVAS), Roland Morris Score (RMS), reduction of SIJ/leg pain, and work status were assessed. Bony fusion of the SIJ was evaluated by radiographs and CT 12 months after the procedure. Results Analysis of pelvic CT data revealed a wedge-shaped implant body in four different sizes. In the two patients, VAS decreased from 88 to 33 points, ODI improved from 67 to 35%, MVAS decreased from 80 to 36%, and RMS decreased from 18 to 9 points 12 months after surgery. SIJ pain reduction was 80% and 90%, respectively. Follow-up CT and radiographs showed solid bony integration. Conclusion The implant used takes into account the unique anatomy of the SIJ and also meets the requirements of a true arthrodesis. Initial results in two patients are promising. Biomechanical and clinical studies will have to show whether the considerable theoretical advantages of the new implant system over existing SIJ implants - in particular the possibility of connection to a lumbar stabilization system - and SPFs can be put into practice.
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Affiliation(s)
- Volker Fuchs
- Department of Orthopedics, AMEOS Hospital of Halberstadt, Halberstadt, Germany
| | - Bernhard Rieger
- Department of Neurosurgery, AMEOS Hospital of Halberstadt, Halberstadt, Germany
- Department of Neurosurgery, Technical University of Dresden, Dresden, Germany
- Department of Biomedical Engineering, Technical University of Kosice, Kosice, Slovakia
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Sherwood D, Yang A, Hunt C, Provenzano D, Kohan L, Hurley RW, Cohen SP, Shah V, McCormick ZL. Treating refractory posterior sacroiliac joint complex pain in the current healthcare ecosystem: a call to action. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1131-1132. [PMID: 37267220 PMCID: PMC10546476 DOI: 10.1093/pm/pnad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/04/2023]
Affiliation(s)
- David Sherwood
- Department of Orthopaedics, University Health Lakewood Medical Center, Kansas City, MO 64139, United States
| | - Aaron Yang
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, United States
| | - Christine Hunt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
| | - David Provenzano
- Pain Diagnostic and Interventional Care, Sewickley, PA 15143, United States
| | - Lynn Kohan
- Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, VA 22903, United States
| | - Robert W Hurley
- Departments of Anesthesiology, Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States
| | - Steven P Cohen
- Departments of Anesthesiology, Neurology, Physical Medicine & Rehabilitation, and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD 21205, United States
| | - Vinil Shah
- Department of Radiology, University of California San Francisco, San Francisco, CA 94143, United States
| | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84132, United States
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Abstract
An expanding array of image-guided spine interventions have the potential to provide immediate and effective pain relief. Innovations in spine intervention have proceeded rapidly, with clinical adoption of new techniques at times occurring before the development of bodies of evidence to establish efficacy. Although new spine interventions have been evaluated by clinical trials, acceptance of results has been hindered by controversies regarding trial methodology. This article explores controversial aspects of four categories of image-guided interventions for painful conditions: spine interventions for postdural puncture headache resulting from prior lumbar procedures, epidural steroid injections for cervical and lumbar radiculopathy, interventions for facet and sacroiliac joint pain, and vertebral augmentations for compression fractures. For each intervention, we summarize the available literature, with an emphasis on persistent controversies, and discuss how current areas of disagreement and challenge may shape future research and innovation. Despite the ongoing areas of debate regarding various aspects of these procedures, effective treatments continue to emerge and show promise for aiding relief of a range of debilitating conditions.
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Aranke M, McCrudy G, Rooney K, Patel K, Lee CA, Hasoon J, Kaye AD. Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature. Orthop Rev (Pavia) 2022; 14:34098. [PMID: 35769646 PMCID: PMC9235436 DOI: 10.52965/001c.34098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/06/2021] [Indexed: 04/05/2024] Open
Abstract
Sacroiliac joint (SIJ) pain is responsible for approximately 15-25% of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.
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Affiliation(s)
- Mayank Aranke
- Department of Anesthesiology, University of Texas Health Science Center
| | - Grace McCrudy
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kelsey Rooney
- LSU Health Sciences Center Shreveport School of Medicine
| | - Kunaal Patel
- LSU Health Sciences Center Shreveport School of Medicine
| | - Christopher A Lee
- Department of Internal Medicine, Creighton University School of Medicine-Phoenix Regional Campus
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport
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Vorobeychik Y, Shah B, Gordin V, Giampetro D, Khunsriraksakul C, Vu TN. Assessment of technical adequacy of sacral lateral branches cooled radiofrequency neurotomy. INTERVENTIONAL PAIN MEDICINE 2022; 1:100069. [PMID: 39238816 PMCID: PMC11372988 DOI: 10.1016/j.inpm.2022.100069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 09/07/2024]
Abstract
Objective There were two primary objectives of the study: 1. assessment of the association between diagnostic sacral lateral branches (SLB) blocks and the ensuing numbness in the middle cluneal nerves (MCN) distribution, irrespective of whether the patients had positive or negative responses to blocks. 2. If the consistency of this causal relationship was established, we wanted to investigate a further correlation - hypoesthesia from local anesthetic blocks vs. hypoesthesia from radiofrequency neurotomy (RFN) vs. outcomes. Design This is a prospective observational study of sixty consecutive patients with sacroiliac (SI) joint complex pain and failure of previous intraarticular SI joint injection. The patients who had two positive diagnostic SLB blocks defined as ≥ 75% reduction in NRS scores were treated with cooled RFN of the L5 dorsal ramus and S1-S3 lateral branches. The patients were interviewed and evaluated at a one-month post-neurotomy follow-up appointment. Seven patients were also evaluated at a six-month follow-up visit after the procedure. Methods The primary outcomes of the study were absence/presence of post-procedural buttock hypoesthesia after diagnostic blocks and absence/presence of post-procedural buttock hypoesthesia at one month after a cooled RFN procedure. The secondary outcome measures related to the effectiveness of this procedure and included: pre- and post-procedure NRS scores; ODI scores initially, and at post RFN follow-up; analgesic consumption initially, and at one-month RFN follow-up; patient satisfaction with the cooled RFN treatment. A procedure was considered categorically successful if the patient gained ≥50% pain relief and was satisfied with its results. Results 81/84 (96.4%; 95% CI [89.9%, 99.3%]) of the diagnostic SLB blocks lead to temporary sensory deficit to pinprick in the MCN distribution. If the block was positive, 58/58 (100.00%; 95% CI [93.8, 100.00%]) of the procedures led to hypoesthesia. For negative diagnostic blocks, 3/26 (11.5%; 95% CI [2.4%, 30.2%]) procedures lead to no hypoesthesia. The buttock hypoesthesia persisted in all patients with successful cooled RFN one month after this intervention. Among the patients with unsuccessful RFN, only 2/9 (22.2%, 95%CI [2.8%, 60.0]) still had hypoesthesia, but the rest of this group had no sensory deficit on pinprick examination. At 6-months follow-up buttock hypoesthesia had no association with the success of the procedure.The patients' average NRS scores decreased from baseline 7.1 (SD 1.7) to 4.3 (SD 3.3) at 1-month follow-up after RFN. Categorical success, based on ≥50% pain relief coupled with patients' satisfaction, was achieved in 12/21 (57.1%; 95% CI [34.0%, 78.2%]) of the subjects. Average ODI percentage score decreased from 41.7% (SD 15.1%) to 31.8% (SD 17.8%) at the primary endpoint of the study. Conclusion MCNs provide regular and clinically detectable innervation to the skin area overlaying posterior-medial aspects of the gluteus maximums muscle. Therefore, any technically accurate diagnostic block, irrespective of whether the patients have positive or negative responses, should result in the development of hypoesthesia in the area supplied by the MCNs. Immediately after the completion of the diagnostic procedure, the adequacy of the block should be tested. Absence of hypoesthesia suggests that the block may have been technically inadequate. Numbness in the buttock area innervated by the MCNs may serve as a marker of an adequately performed RFN procedure. If this procedure is unsuccessful in patients who do not develop post-neurotomy numbness in the area supplied by the MCNs, the failure of the intervention may stem from its inaccurate implementation rather than from its inherent ineffectiveness.
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Affiliation(s)
- Yakov Vorobeychik
- Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Department of Anesthesiology and Perioperative Medicine, HU32, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA
| | - Bunty Shah
- Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Department of Anesthesiology and Perioperative Medicine, HU32, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA
| | - Vitaly Gordin
- Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Department of Anesthesiology and Perioperative Medicine, HU32, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA
| | - David Giampetro
- Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Department of Anesthesiology and Perioperative Medicine, HU32, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA
| | | | - To-Nhu Vu
- Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Department of Anesthesiology and Perioperative Medicine, HU32, 500 University Drive, P.O. Box 850, Hershey, PA, 17033-0850, USA
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Prather H, Bonnette M, Hunt D. Nonoperative Treatment Options for Patients With Sacroiliac Joint Pain. Int J Spine Surg 2020; 14:35-40. [PMID: 32123656 DOI: 10.14444/6082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sacroiliac joint (SIJ) pain is thought to be a component of low back pain in 20% of people who suffer with it chronically. There is no consistent objective diagnostic testing that includes SIJ pain as the diagnosis and thereby it can become a diagnosis of exclusion. Treatment of SIJ pain is variable, and no set method or protocol of treatment has been found to be efficacious or reliable. Thus, the healthcare provider is often left to create an individual treatment plan based on their own experiences and expertise. The purpose of this narrative review is to describe and discuss nonoperative treatment options for patients with SIJ pain. Further, coordination of treatment options and progression of treatment will be offered.
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Affiliation(s)
- Heidi Prather
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Bonnette
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Devyani Hunt
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Successful Thermal Neurotomy of the Painful Sacroiliac Ligament/Joint Complex—A Comparison of Two Techniques. PAIN MEDICINE 2019; 21:561-569. [DOI: 10.1093/pm/pnz282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
There are many physical, pharmacological, and interventional therapies aimed at alleviating sacroiliac ligament/joint complex pain, including thermal neurotomy. Sacroiliac joint (SIJ) innervation, as opposed to posterior sacroiliac ligament complex innervation, remains uncertain; thus lateral branch thermal neurotomy to alleviate sacroiliac joint pain remains controversial.
Objective
This study aimed to compare the success rates of two lateral branch neurotomy techniques, large continuous-lesion multi-electrode radiofrequency neurotomy (RFN; Simplicity, Neurotherm Inc.) and small-lesion monopolar periforaminal, to relieve pain from sacroiliac joints, as well as whether these would alter physical and psychological health.
Design
Retrospective clinical audit of prospectively gathered consecutive data.
Setting
A private community-based multidisciplinary pain clinic.
Subjects
Referred from primary care environments.
Methods
Of 96 consecutive thermal neurotomies with baseline data completed, follow-up data were found in 73 patients during the period 2011–2017. After diagnosis by dual-positive fluoroscopic intra-articular injections, 41 patients underwent 47 monopolar periforaminal neurotomies, and 32 underwent 49 large continuous-lesion multi-electrode RFNs, with >12-month follow-up. The primary outcome was 50–100% relief of pain for more than six months. Results are presented as success rates. Secondary outcomes were Functional Rating Index Depression Anxiety and Stress Scale and Patient Specific Functional Scale.
Results
Follow-up data were available for 80 (83%) of the 96 procedures. Success occurred in 69% of all procedures (39% complete >75% relief and 30% good 50–75% relief). Success was 57% with worst-case analysis. Success rates were 71% in the large continuous-lesion multi-electrode RFN group and 65% in the periforaminal group, with overlapping confidence intervals. Significant improvements also occurred in the secondary measures.
Conclusions
Thermal neurotomy demonstrated a 69% success rate in reduction of sacroiliac ligament/joint complex pain for more than six months equally by large continuous-lesion multi-electrode RFN and periforaminal monopolar techniques, with attendant improvement in physical and psychological function.
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Zheng P, Schneider BJ, Yang A, McCormick ZL. Image‐Guided Sacroiliac Joint Injections: an Evidence‐based Review of Best Practices and Clinical Outcomes. PM R 2019; 11 Suppl 1:S98-S104. [DOI: 10.1002/pmrj.12191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Patricia Zheng
- Department of Orthopaedic SurgeryUniversity of California San Francisco San Francisco CA
| | - Byron J. Schneider
- Department of Physical Medicine and RehabilitationVanderbilt University Nashville TN
| | - Aaron Yang
- Department of Physical Medicine and RehabilitationVanderbilt University Nashville TN
| | - Zachary L. McCormick
- Department of Physical Medicine and RehabilitationUniversity of Utah Salt Lake City UT
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Clinical Diagnosis of Sacroiliac Joint Pain. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bogduk N. A Commentary on Appropriate Use Criteria for Sacroiliac Pain. PAIN MEDICINE 2019; 18:2055-2057. [PMID: 29092066 DOI: 10.1093/pm/pnx234] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bogduk N. In Reply to Letter by Dr. Laslett. PAIN MEDICINE 2018; 19:2329-2330. [DOI: 10.1093/pm/pny069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Carr DB. Evidence-Based Pain Medicine: Inconvenient Truths. PAIN MEDICINE 2017; 18:2049-2050. [DOI: 10.1093/pm/pnx252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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