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Introduction Sacroiliac (SI) joint dysfunction is a prevalent cause of unremitting low back pain. Does minimally invasive SIJ fusion provide superior outcomes compared with nonsurgical treatment? Methods 148 subjects with SI joint dysfunction were randomly assigned at 19 US centers to minimally invasive SI joint fusion with triangular titanium implants (N = 102) or nonsurgical management (NSM, n = 46). Pain, disability and quality of life scores were collected at baseline and at 1, 3, 6 and 12 months. Success rates were compared using Bayesian methods. Crossover from nonsurgical to surgical care was allowed after the 6month study visit was complete. Results Sixmonth success rates were higher in the surgical group (81.4% versus 26.1%, posterior probability of superiority > 0.9999). Clinically important (≥15 point) ODI improvement at 6 months occurred in 73.3% of the SIJ fusion group versus 13.6% of the NSM group (p < 0.0001). Improvements in SIJ pain and ODI were sustained at 12 months in the surgical group. Subjects who crossed over had improvements in pain, disability and quality of life similar to those in the original surgical group. Adverse events were slightly more common in the surgical group (1.3 versus 1.1 events per subject, p = 0.3063). One patient underwent immediate revision surgery for neuropathic pain related to implant malposition. 77 and 78% of subjects assigned to SIJ fusion were “very satisfied” with SIJ fusion at 6 and 12 months, respectively. Conclusions In this study, minimally invasive SI joint fusion using triangular titanium implants was more effective than nonsurgical management at one year in relieving pain, improving function and improving quality of life in patients with SI joint dysfunction.

BackgroundSacroiliac joint (SIJ) fusion (SIJF), first performed 95 years ago, has become an increasingly accepted surgical option for chronic SIJ dysfunction. Few studies have reported intermediate- or long-term outcomes after SIJF.ObjectiveThe objective of this study is to determine patient-based outcomes after SIJF for chronic SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption at ≥3 years of follow-up.MethodsConsecutive patients who underwent SIJF prior to December 2012 were contacted over phone or through email. Participants completed questionnaires in clinic, over phone or by email, regarding SIJ pain, activities related to SIJ dysfunction, and the Oswestry Disability Index. Charts were reviewed to extract baseline parameters and the clinical course of follow-up.ResultsOne hundred seven patients were eligible and participated in this study. Mean (standard deviation) preoperative SIJ pain score was 7.5 (1.7). At mean follow-up of 3.7 years, the mean SIJ pain score was 2.6 (representing a 4.8-point improvement from baseline, P<0.0001) and the mean Oswestry Disability Index was 28.2. The ability to perform activities commonly impaired by SIJ dysfunction showed positive improvements in most patients. SIJ revision surgery was uncommon (five patients, 4.7%). Fourteen patients (13.1%) underwent contralateral SIJF during follow-up, 25.2% of patients had additional non-SIJ-related lumbar spine or hip surgeries during follow-up.ConclusionIn intermediate- to long-term follow-up, minimally invasive transiliac SIJF was associated with improved pain, low disability scores, and improved ability to perform activities of daily living.

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ObjectivesLimited research has examined the effects of fenugreek (Trigonella foenum-graecum L.) supplementation to improve healthy younger men's aging male symptoms. The study objective was to examine whether a fenugreek seed extract would improve healthy men's aging male symptoms, health-related quality of life (HRQoL), grip strength, and anxiety.MethodsRandomized double-blind placebo-controlled trial was employed, using a parallel design, with assessments at baseline, Day 30, and Day 60. Healthy male volunteers (n = 57, mean age = 26.1 years) were randomized to: fenugreek 400 mg/d (n = 19), fenugreek 500 mg/d (n = 19), or placebo group (n = 19).ResultsThe fenugreek groups reported significant improvements in aging male symptoms, anxiety levels, grip strength, and indicators of HRQoL compared to the placebo group, p's < 0.05. No adverse events were reported.ConclusionFenugreek supplementation is an effective nutritional intervention for improving aging male symptoms, anxiety levels, grip strength, and aspects of HRQoL in healthy recreationally active men. Future researchers are encouraged to examine the health and ergogenic effects of fenugreek supplementation in hypogonadal and older populations.Trial registrationClinicaltrials.gov identifier NCT03528538.

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