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Cocconi F, Maffulli N, Bell A, Memminger MK, Simeone F, Migliorini F. Sacroiliac joint pain: what treatment and when. Expert Rev Neurother 2024:1-8. [PMID: 39262128 DOI: 10.1080/14737175.2024.2400682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Spinal and non-spinal pathologies can cause low back pain. Non-spinal sources of low back pain include the sacroiliac joint (SIJ) and the hip. SIJ pain can be treated either conservatively or surgically. Current strategies for managing sacroiliac joint pain are debated, and limited evidence exists. AREAS COVERED The present expert opinion updates current evidence on conservative and surgical modalities for SIJ pain. EXPERT OPINION Surgical management for SIJ pain is effective. However, it exposes patients to surgery and, therefore, related complications. Conservative management may be implemented in patients with moderate SIJ pain, with less than six months of symptoms, or not eligible for surgery. Several noninvasive modalities are available, mostly centered on intra-articular injections. Corticosteroids, platelet-rich plasma, and stem cells have only midterm lasting effects, at most for nine months. Radiofrequency ablation is another methodology for pain relief. Both continuous and pulsatile radiofrequency ablation are associated with good outcomes. SIJ fusion can be performed using different techniques; however, a clear recommendation on the most appropriate modality for the management of SIJ pain is still debated.
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Affiliation(s)
- Federico Cocconi
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Medicine and Psychology, University La Sapienza, Roma, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, UK
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Michael Kurt Memminger
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Francesco Simeone
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Bolzano, Italy
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
- Department of Life Sciences, Health, and Health Professions, Link Campus University, Rome, Italy
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Tantawy MF, Nazim WM. Comparison between intra-articular and combined intra- and periarticular sacroiliac injection: a prospective randomized controlled clinical trial. J Neurosurg Sci 2024; 68:294-300. [PMID: 35766202 DOI: 10.23736/s0390-5616.22.05581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Sacroiliac joint dysfunction is one of the most common causes of low back pain. The aim of our study was to determine whether combined injection (intra and periarticular) of sacroiliac joint provides greater pain relief than intra-articular injection. METHODS This is a randomized controlled trial between two groups. The first group involved thirty patients treated with combined injection (intra- and periarticular) of a mixture of methylprednisolone acetate 40 mg and local anesthetic into a symptomatic sacroiliac joint. The second group (30 patients) received the same mixture only intra-articular. Diagnostic block was done for all cases. All patients failed to respond to medical treatment before proceeding to the injection procedure. RESULTS Over 6 months of follow-up, there were statistically significant improvements in patients who received combined sacroiliac joint injection according to pain Visual Analog Scale (VAS) compared with intra-articular group. Comparing both groups, there was significant difference in the 1-month VAS (one month after the procedure) as the P value was 0.010, and in the 6-month VAS (6 months after the procedure) as the P value was 0.007. There was no significant difference in the pre-VAS (P value was 0.795) and immediate post-VAS (one week after the procedure) as the P value were 0.145. No complications were reported after the procedure. CONCLUSIONS Although both groups provide statistically significant pain relief, patients who received combined sacroiliac joint injection have significantly greater clinical improvement as regard to those who received only intra-articular injection.
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Affiliation(s)
- Mostafa F Tantawy
- Department of Neurosurgery, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt -
| | - Wael M Nazim
- Department of Neurosurgery, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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Jedi F, Krysiak R, Hirsch JA, Ventura F, De Vivo E, Manfrè L. Chronic sacroiliac joint dysfunction and CT-guided percutaneous fixation: a 6-year experience. Neuroradiology 2023; 65:1527-1534. [PMID: 37289228 DOI: 10.1007/s00234-023-03171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/21/2023] [Indexed: 06/09/2023]
Abstract
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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Affiliation(s)
- F Jedi
- Minimal Invasive Spine Therapy Department, Mediterranean Institute of Oncology (IOM), Viagrande, Catania, Italy.
| | - R Krysiak
- Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - J A Hirsch
- Department of Radiology, Division of Neurointerventional Imaging, Massachusetts General Hospital, Boston, USA
| | - F Ventura
- Minimal Invasive Spine Therapy Department, Mediterranean Institute of Oncology (IOM), Viagrande, Catania, Italy
| | - E De Vivo
- Minimal Invasive Spine Therapy Department, Mediterranean Institute of Oncology (IOM), Viagrande, Catania, Italy
| | - L Manfrè
- Minimal Invasive Spine Therapy Department, Mediterranean Institute of Oncology (IOM), Viagrande, Catania, Italy
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Alkosha HM. Interventional non-operative management of low back and neck pain. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract
Background
Chronic neck and back pain are among the most commonly encountered health problems in neurosurgical practice. Many cases fail prolonged pharmacological and physical therapy and are not proper candidates for surgical interventions, or had refused proposed surgical treatment.
Objective
To provide an informative critical summary of the literature about the topic of interventional management of axial neck and low back pain and highlighting the new trends and pieces of evidence.
Methods
The English literature published over the last two decades was reviewed by the author for recent and relevant data about the principles of interventional management of chronic neck and low back pain. A PubMed search was performed through phrase searching and combined searching using Boolean operators. The articles thought to be most relevant to the study aim and the neurosurgeons’ practice were extracted.
Results
Neck and low back pain continue to be among the most common musculoskeletal health problems and the most common cause of disability worldwide. A detailed understanding of relevant spine anatomy is crucial for interventionists who should deal with the concept of “functional spine unit” with multiple potential pain generators. Chronic spinal pain is best managed through a dedicated multidisciplinary team in well-equipped healthcare facilities. An algorithmic approach for the diagnosis and management of spinal pain is the mainstay of providing the best patient care and should be based on the commonality and treatability of pain generators, values of patients and available resources.
Conclusion
Management of chronic neck and back pain can represent a clinical dilemma due to the multiplicity of pain generators that may coexist in the same individual resulting in a complex type and pattern of pain. Approach to these patients requires contributions from the members of a multidisciplinary team, implementing a standardized approach in a well-equipped healthcare facility.
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Chen CM, Lee JH, Yang MY, Jhang SW, Chang KS, Ou SW, Sun LW, Chen KT. Navigation-Assisted Full-Endoscopic Radiofrequency Rhizotomy Versus Fluoroscopy-Guided Cooled Radiofrequency Ablation for Sacroiliac Joint Pain Treatment: Comparative Study. Neurospine 2023; 20:141-149. [PMID: 37016862 PMCID: PMC10080431 DOI: 10.14245/ns.2346058.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/26/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: Sacroiliac joint (SIJ) pain is a common cause of chronic low back pain. Full-endoscopic rhizotomy of lateral branches of dorsal rami innervating SIJ is a potential option for patients’ refractory to medical treatment. The full-endoscopic rhizotomy is sometimes challenging under fluoroscopic guidance. This study is to evaluate the effectiveness of the navigation-assisted full-endoscopic rhizotomy for SIJ pain.Methods: The study was a retrospective match-paired study that enrolled consecutive patients undergoing navigation-assisted full-endoscopic rhizotomy for SIJ pain. The patient demographics, clinical outcomes, and operative parameters of endoscopic rhizotomy were compared with conventional cooled radiofrequency ablation (RFA) treatment.Results: The study enrolled 72 patients, including 36 patients in the endoscopic group. Thirty-six patients in the cooled RFA group were matched by age as the control. The follow-up time was at least 1 year. Patient characteristics were similar between the groups. The navigation-assisted endoscopic rhizotomy operation time was significantly longer than the cooled RFA. The visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) significantly decreased after each treatment. However, the between-group comparison revealed that the VAS and ODI of the patients after endoscopic rhizotomy were significantly lower than those after the cooled RFA group. There were no postoperative complications in the study.Conclusion: Navigation-assisted full-endoscopic rhizotomy is an alternative to SIJ pain treatment. Integrating intraoperative navigation can ensure accurate full-endoscopic rhizotomy to provide better durability of pain relief than the cooled RFA.
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Affiliation(s)
- Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Jae Hwan Lee
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Meng-Yin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung Taiwan
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shang-Wun Jhang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Kai-Sheng Chang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Su-Wei Ou
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Li-Wei Sun
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Kuo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, Puzi, Taiwan
- Corresponding Author Kuo-Tai Chen Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, No. 6, W. sec., Jiapu Rd., Puzi City, Chiayi County 613, Taiwan
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Far-Contralateral Oblique (FCO) Sacroiliac Joint Injection: Description of a Novel Technique. Pain Res Manag 2022; 2022:3312589. [PMID: 36045876 PMCID: PMC9423991 DOI: 10.1155/2022/3312589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/01/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Abstract
Sacroiliac (SI) joint arthropathy is the primary pain generator in approximately 15–25% of patients with axial low back pain and traditionally diagnosed with >50% pain reduction following an intra-articular injection localized to the inferior 1/3 of the SI joint. The conventional technique for accessing the SI joint encompasses a posterior approach with fluoroscopic guidance at 10–20⁰ contralateral oblique angulation, and minor adjustments to this approach have been implemented with varying degrees of success. The authors present a novel technique for SI joint injection, infiltrating the middle third of the joint through an alternative far-contralateral oblique (FCO) approach, angulation between 20–40⁰. This approach theoretically endows easier access to the SI joint and at the very least provides another option for interventionalists in the diagnosis and treatment of sacroiliac joint pain. It can also be utilized to determine if a patient is a candidate for posterior percutaneous SI joint fusion. The authors sought to document this approach to ensure that it was both reproducible and safe, while recognizing the need for future studies.
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Pan Z, Xi Y, Huang W, Kim KN, Yi S, Shin DA, Huang K, Chen Y, Huang Z, He D, Ha Y. Independent Correlation of the C1-2 Cobb Angle With Patient-Reported Outcomes After Correcting Chronic Atlantoaxial Instability. Neurospine 2019; 16:267-276. [PMID: 31261466 PMCID: PMC6603837 DOI: 10.14245/ns.1836268.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 12/29/2018] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate three-planar radiographic results and patient-reported outcomes (PROs) after correcting chronic atlantoaxial instability (AAI) by translaminar screw (TLS) and pedicle screw (PS) fixation, and to explore the potential association of atlantoaxial realignment with PRO improvements.
Methods Twenty-three patients who underwent C1 lateral mass screw (LMS)-C2 TLS and 29 who underwent C1 LMS-C2 PS with ≥ 2 years of follow-up were retrospectively analyzed. Three-planar (sagittal, coronal, and axial) radiographic parameters were measured. PROs including the Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score and the Short Form 36 Physical Component Summary (SF-36 PCS) were documented. Factors potentially associated with PROs were identified.
Results The radiographic parameters significantly changed postoperatively except the C1–2 midlines’ intersection angle in the TLS group (p = 0.073) and posterior atlanto-dens interval in both groups (p = 0.283, p = 0.271, respectively). The difference in bilateral odontoid lateral mass interspaces at last follow-up was better corrected in the TLS group than in the PS group (p = 0.010). Postoperative PROs had significantly improved in both groups (all p < 0.05). Thereinto, NDI at last follow-up was significantly lower in the TLS group compared with PS group (p = 0.013). In addition, blood loss and operative time were obviously lesser in TLS group compared with PS group (p = 0.010, p = 0.004, respectively). Multivariable regression analysis revealed that a change in C1–2 Cobb angle was independently correlated to PROs improvement (NDI: β = -0.435, p = 0.003; JOA score: β = 0.111, p = 0.033; SF-36 PCS: β = 1.013, p = 0.024, respectively), also age ≤ 40 years was independently associated with NDI (β = 5.40, p = 0.002).
Conclusion Three-planar AAI should be reconstructed by C1 LMS-C2 PS fixation, while sagittal or coronal AAI could be corrected by C1 LMS-C2 TLS fixation. PROs may improve after atlantoaxial reconstruction in patients with chronic AAI. The C1–2 Cobb angle is an independent predictor of PROs after correcting chronic AAI, as is age ≤ 40 years for postoperative NDI.
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Affiliation(s)
- Zhimin Pan
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Department of Spine Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Yanhai Xi
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wei Huang
- Department of Clinical Laboratory, Jiangxi Province Children's Hospital, Nanchang, China
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kai Huang
- Department of Orthopedics, Zhabei Central Hospital of Jing'an District, Shanghai, China
| | - Yu Chen
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhongren Huang
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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