A Consideration of the Pelvic Articulations from an Anatomical, Pathological and Clinical Standpoint

Goldthwait, Joel E.; Osgood, Robert B.

doi:10.1056/nejm190505251522101

Cited by 107 publications

(20 citation statements)

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“…The SI joint has been recognized as a pain generator since the early 1900s. 3 With the 1934 publication by Mixter and Barr 26 identifying the intervertebral disc as a source of low back and radicular pain, the SI joint seemed to have fallen from the collective conscience in the spine community. Recent publications, however, have reaffirmed the SI joint as a significant contributor to LBP.…”

Section: Discussionmentioning

confidence: 99%

“…In the early 1900s, the SI joint was often suspected as a cause of chronic lower back pain (LBP). 3 However, as increasingly sophisticated methods of diagnosing spinal pathologies (eg, facet arthropathy, lumbar spondylosis, and disc herniation) became available, less focus was placed on the SI joint. Nonetheless, SI joint pain is exceedingly common.…”

Section: Introductionmentioning

confidence: 99%

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Safety and 6-month effectiveness of minimally invasive sacroiliac joint fusion: a prospective study

Duhon¹,

Cher²,

Wine³

et al. 2013

MDER

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BackgroundSacroiliac (SI) joint pain is an often overlooked cause of low back pain. SI joint arthrodesis has been reported to relieve pain and improve quality of life in patients suffering from degeneration or disruption of the SI joint who have failed non-surgical care. We report herein early results of a multicenter prospective single-arm cohort of patients with SI joint degeneration or disruption who underwent minimally invasive fusion using the iFuse Implant System®.MethodsThe safety cohort includes 94 subjects at 23 sites with chronic SI joint pain who met study eligibility criteria and underwent minimally invasive SI joint fusion with the iFuse Implant System® between August 2012 and September 2013. Subjects underwent structured assessments preoperatively, immediately postoperatively, and at 1, 3, and 6 months postoperatively, including SI joint and back pain visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and EuroQoL-5D (EQ-5D). Patient satisfaction with surgery was assessed at 6 months. The effectiveness cohort includes the 32 subjects who have had 6-month follow-up to date.ResultsMean subject age was 51 years (n=94, safety cohort) and 66% of patients were women. Subjects were highly debilitated at baseline (mean VAS pain score 78, mean ODI score 54). Three implants were used in 80% of patients; two patients underwent staged bilateral implants. Twenty-three adverse events occurred within 1 month of surgery and 29 additional events occurred between 30 days and latest follow-up. Six adverse events were severe but none were device-related. Complete 6-month postoperative follow-up was available in 26 subjects. In the effectiveness cohort, mean (± standard deviation) SI joint pain improved from a baseline score of 76 (±16.2) to a 6-month score of 29.3 (±23.3, an improvement of 49 points, P<0.0001), mean ODI improved from 55.3 (±10.7) to 38.9 (±18.5, an improvement of 15.8 points, P<0.0001) and SF-36 PCS improved from 30.7 (±4.3) to 37.0 (±10.7, an improvement of 6.7 points, P=0.003). Ninety percent of subjects who were ambulatory at baseline regained full ambulation by month 6; median time to full ambulation was 30 days. Satisfaction with the procedure was high at 85%.ConclusionMinimally invasive SI joint fusion using the iFuse Implant System® is safe. Mid-term follow-up indicates a high rate of improvement in pain and function with high rates of patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety and 6-month effectiveness of minimally invasive sacroiliac joint fusion: a prospective study

Duhon¹,

Cher²,

Wine³

et al. 2013

MDER

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“…10,20,21 However, there is only modest evidence that any of these non-surgical treatments are effective for any length of time. 22 When these measures fail to provide significant and lasting symptom relief, surgical options may be considered.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of minimally invasive sacroiliac joint fusion utilizing a lateral transarticular technique

2015

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“…In 1905 Goldthwaite and Osgood first reported that the sacroiliac joint (SIJ) can be a source of low back and leg pain [1]. Today, SIJ pain affects 15%-30% of patients with chronic nonradicular low back pain [2].…”

Section: Introductionmentioning

confidence: 99%

Short‐Term Efficacy of Sacroiliac Joint Corticosteroid Injection Based on Arthrographic Contrast Patterns

Scholten

Patel

Christos

et al. 2014

PM&R

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Objective To determine the relationship between sacroiliac joint (SIJ) contrast dispersal patterns during SIJ corticosteroid injection and pain relief at 2 and 8 weeks after the procedure. The association between the number of positive provocative SIJ physical examination maneuvers (minimum of one in all patients undergoing SIJ injection) and the patient’s response to the intervention was also assessed. Design Retrospective chart review. Setting Academic outpatient musculoskeletal practice. Patients Fifty-four subjects who underwent therapeutic SIJ corticosteroid injection were screened for inclusion; 49 subjects were included in the final analysis. Methods A retrospective review of electronic medical records identified patients who underwent SIJ corticosteroid injection. Fluoroscopic contrast flow patterns were categorized as type I (intra-articular injection with cephalad extension within the SIJ) or type II (intra-articular injection with poor cephalad extension). Self-reported numeric pain rating scale (NPRS) values at the time of injection and 2 and 8 weeks after the procedure were recorded. The number of positive provocative SIJ physical examination maneuvers at the time of the initial evaluation was also recorded. Main Outcome Measures The primary outcome measure was the effect of contrast patterns (type I or type II) on change in NPRS values at 2 weeks and 8 weeks after the injection. The secondary outcome measure was the association between the number of positive provocative SIJ physical examination maneuvers and decrease in the level of pain after the procedure. Results At 2 weeks after the procedure, type I subjects demonstrated a significantly lower mean NPRS value compared with type II subjects (2.8 ± 1.4 versus 3.8 ± 1.6, respectively, P =.02). No statistically significant difference was observed at 8 weeks after the procedure. NPRS values were significantly reduced both at 2 weeks and 8 weeks, compared with baseline, in both subjects identified as having type I flow and those with type II flow (P < .0001 for all within-group comparisons). Conclusions Fluoroscopically guided corticosteroid injections into the SIJ joint are effective in decreasing NPRS values in patients with SIJ-mediated pain. Delivery of corticosteroid to the superior portion of the SIJ leads to a greater reduction in pain at 2 weeks, but not at 8 weeks. Patients with at least one positive provocative maneuver should benefit from an intra-articular corticosteroid injection.

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A Consideration of the Pelvic Articulations from an Anatomical, Pathological and Clinical Standpoint

Cited by 107 publications

References 0 publications

Safety and 6-month effectiveness of minimally invasive sacroiliac joint fusion: a prospective study

Safety and 6-month effectiveness of minimally invasive sacroiliac joint fusion: a prospective study

A systematic review of minimally invasive sacroiliac joint fusion utilizing a lateral transarticular technique

Short‐Term Efficacy of Sacroiliac Joint Corticosteroid Injection Based on Arthrographic Contrast Patterns

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