Minimally Invasive Sacroiliac Joint Fusion, Radiofrequency Denervation, and Conservative Management for Sacroiliac Joint Pain: 6-Year Comparative Case Series
Neurosurgery. 2017 Apr 20. doi: 10.1093/neuros/nyx185. [Epub ahead of print]
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Vicente Vanaclocha, MD, PhD∗
Juan Manuel Herrera,MD∗
Nieves Sáiz-Sapena, MD, PhD‡
Francisco Verdú-López, MD∗
∗Department of Neurosurgery, Hospital 9 de Octubre, Valencia, Spain;
‡Department of Anesthesiology, Hospital 9 de Octubre, Valencia, Spain
BACKGROUND: Sacroiliac joint (SIJ) pain is an under-recognized condition. Substantial information supports the safety and effectiveness of SIJ fusion (SIJF). Long-term follow-up after SIJF has not been reported.
OBJECTIVE: To determine responses to conservative management (CM), SIJ denervation, and SIJF in patients with SIJ pain unresponsive to CM.
METHODS: Retrospective study with long-term (up to 6 yr) follow-up of 137 patients with SIJ pain seen in an outpatient neurosurgery clinic who received either CM (n = 63), sacroiliac denervation (n = 47), or minimally invasive SIJF (n = 27). At each routine clinic visit, patients completed pain scores and Oswestry Disability Index. Additional data were extracted from medical charts.
RESULTS: Patients treated with continued CM had no long-term improvement in pain (mean worsening of 1 point) or disability (mean Oswestry Disability Index worsened by 4-6 points), increased their use of opioids, and had poor long-term work status. SIJF patients had large improvements in SIJ pain (mean 6 points), large improvements in disability (mean 25 points), a decrease in opioid use, and good final work status. Sacroiliac denervation patients had intermediate responses (0-1 and 1-2 points, respectively).
CONCLUSION: In patients with SIJ pain unresponsive to CM, SIJF resulted in excellent longterm clinical responses, with low opioid use and better work status compared to other treatments.
KEYWORDS: Low back pain, Sacroiliac joint pain, Sacroiliac joint fusion, Sacroiliac joint denervation