TY - JOUR
T1 - Sacroiliac joint fusion using triangular titanium implants vs. Non-surgical management
T2 - Six-month outcomes from a prospective randomized controlled trial
AU - On behalf of the INSITE Study Group
AU - Whang, Peter
AU - Cher, Daniel
AU - Polly, David
AU - Frank, Clay
AU - Lockstadt, Harry
AU - Glaser, John
AU - Limoni, Robert
AU - Sembrano, Jonathan
AU - Cummings, John T.
AU - Pertile, Elizabeth
AU - Mente, Tracy
AU - Kitchel, Scott
AU - Potts, Shawn
AU - Patel, Nilesh
AU - McGinnis, Taylor
AU - Peterson, Nicholas
AU - Wilhite, Elaine
AU - Farris, James
AU - Kovalsky, Don
AU - Pestka, Laura
AU - Thomas, Donna Ann
AU - Samperi, Bethany
AU - Lombardi, Stacey
AU - Glaser, John A.
AU - Darr, Emily A.
AU - Fields, Laura
AU - Philp, Jennifer
AU - Harvey, Charles
AU - Peterman, Jason
AU - Bouferrache, Karim
AU - Latham, Lori
AU - Nunley, Pierce
AU - Utter, Andrew
AU - Stone, Marcus
AU - Rivera, Norma
AU - Santos, Ed
AU - Ledonio, Charles
AU - Yson, Sharon
AU - Ploska, Philip
AU - Price, Terry
AU - Oh, Michael
AU - Schmidt, Gary
AU - Yeager, Matthew
AU - Stringer, Merle
AU - Stringer, Douglas
AU - Henderson, Carolyn
AU - Ahadian, Farshad
AU - Lee, Yu Po
AU - Lam, Katie
AU - Thaiyananthan, Gowriharan
N1 - Funding Information:
All authors conduct clinical research for SI-BONE. The study was sponsored by SI-BONE (San Jose, CA). Peter Whang is a paid SI-BONE consultant participating primarily in educational events. Clay Frank is an SI-BONE consultant participating primarily in educational events, but receives only reasonable expense reimbursement as compensation. Harry Lock-stadt has a consulting agreement with SI-BONE, but has not provided or been paid for services as of the date of this article. Daniel Cher is an SI-BONE employee.
Publisher Copyright:
© 2017 ISASS.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background Sacroiliac (SI) joint pain is a prevalent, underdiagnosed cause of lower back pain. SI joint fusion can relieve pain and improve quality of life in patients who have failed nonoperative care. To date, no study has concurrently compared surgical and non-surgical treatments for chronic SI joint dysfunction. Methods We conducted a prospective randomized controlled trial of 148 subjects with SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint disruptions who were assigned to either minimally invasive SI joint fusion with triangular titanium implants (N=102) or non-surgical management (NSM, n=46). SI joint pain scores, Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and EuroQol-5D (EQ-5D) were collected at baseline and at 1, 3 and 6 months after treatment commencement. Six-month success rates, defined as the proportion of treated subjects with a 20-mm improvement in SI joint pain in the absence of severe device-related or neurologic SI joint-related adverse events or surgical revision, were compared using Bayesian methods. Results Subjects (mean age 51, 70% women) were highly debilitated at baseline (mean SI joint VAS pain score 82, mean ODI score 62). Six-month follow-up was obtained in 97.3%. By 6 months, success rates were 81.4% in the surgical group vs. 23.9% in the NSM group (difference of 56.6%, 95% posterior credible interval 41.4-70.0%, posterior probability of superiority > 0.999). Clinically important (=15 point) ODI improvement at 6 months occurred in 75% of surgery subjects vs. 27.3% of NSM subjects. At six months, quality of life improved more in the surgery group and satisfaction rates were high. The mean number of adverse events in the first six months was slightly higher in the surgical group compared to the non-surgical group (1.3 vs. 1.0 events per subject, p=0.1857). Conclusions Six-month follow-up from this level 1 study showed that minimally invasive SI joint fusion using triangular titanium implants was more effective than non-surgical management in relieving pain, improving function and improving quality of life in patients with SI joint dysfunction due to degenerative sacroiliitis or SI joint disruptions. Clinical relevance Minimally invasive SI joint fusion is an acceptable option for patients with chronic SI joint dysfunction due to degenerative sacroiliitis and sacroiliac joint disruptions unresponsive to non-surgical treatments.
AB - Background Sacroiliac (SI) joint pain is a prevalent, underdiagnosed cause of lower back pain. SI joint fusion can relieve pain and improve quality of life in patients who have failed nonoperative care. To date, no study has concurrently compared surgical and non-surgical treatments for chronic SI joint dysfunction. Methods We conducted a prospective randomized controlled trial of 148 subjects with SI joint dysfunction due to degenerative sacroiliitis or sacroiliac joint disruptions who were assigned to either minimally invasive SI joint fusion with triangular titanium implants (N=102) or non-surgical management (NSM, n=46). SI joint pain scores, Oswestry Disability Index (ODI), Short-Form 36 (SF-36) and EuroQol-5D (EQ-5D) were collected at baseline and at 1, 3 and 6 months after treatment commencement. Six-month success rates, defined as the proportion of treated subjects with a 20-mm improvement in SI joint pain in the absence of severe device-related or neurologic SI joint-related adverse events or surgical revision, were compared using Bayesian methods. Results Subjects (mean age 51, 70% women) were highly debilitated at baseline (mean SI joint VAS pain score 82, mean ODI score 62). Six-month follow-up was obtained in 97.3%. By 6 months, success rates were 81.4% in the surgical group vs. 23.9% in the NSM group (difference of 56.6%, 95% posterior credible interval 41.4-70.0%, posterior probability of superiority > 0.999). Clinically important (=15 point) ODI improvement at 6 months occurred in 75% of surgery subjects vs. 27.3% of NSM subjects. At six months, quality of life improved more in the surgery group and satisfaction rates were high. The mean number of adverse events in the first six months was slightly higher in the surgical group compared to the non-surgical group (1.3 vs. 1.0 events per subject, p=0.1857). Conclusions Six-month follow-up from this level 1 study showed that minimally invasive SI joint fusion using triangular titanium implants was more effective than non-surgical management in relieving pain, improving function and improving quality of life in patients with SI joint dysfunction due to degenerative sacroiliitis or SI joint disruptions. Clinical relevance Minimally invasive SI joint fusion is an acceptable option for patients with chronic SI joint dysfunction due to degenerative sacroiliitis and sacroiliac joint disruptions unresponsive to non-surgical treatments.
KW - Minimally invasive spine surgery
KW - Minimally invasive surgery
KW - Randomized controlled trial
KW - Sacroiliac joint
KW - Sacroiliac joint arthrodesis
KW - Sacroiliac joint dysfunction
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U2 - 10.14444/2006
DO - 10.14444/2006
M3 - Article
AN - SCOPUS:84951280276
SN - 2211-4599
VL - 9
JO - International Journal of Spine Surgery
JF - International Journal of Spine Surgery
M1 - 6
ER -