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Steven P Cohen - One of the best experts on this subject based on the ideXlab platform.
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a systematic evaluation of prevalence and diagnostic accuracy of Sacroiliac Joint interventions
Pain Physician, 2012Co-Authors: Thomas T Simopoulos, Laxmaiah Manchikanti, Vijay Singh, Sanjeeva Gupta, Haroon Hameed, Sudhir Diwan, Steven P CohenAbstract:Background The contributions of the Sacroiliac Joint to low back and lower extremity pain have been a subject of considerable debate and research. It is generally accepted that 10% to 25% of patients with persistent mechanical low back pain below L5 have pain secondary to Sacroiliac Joint pathology. However, no single historical, physical exam, or radiological feature can definitively establish a diagnosis of Sacroiliac Joint pain. Based on present knowledge, a proper diagnosis can only be made using controlled diagnostic blocks. The diagnosis and treatment of Sacroiliac Joint pain continue to be characterized by wide variability and a paucity of the literature. Objective To evaluate the accuracy of diagnostic Sacroiliac Joint interventions. Study design A systematic review of diagnostic Sacroiliac Joint interventions. Methods Methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. Outcome measures In this evaluation we utilized controlled local anesthetic blocks using at least 50% pain relief as the reference standard. Results The evidence is good for the diagnosis of Sacroiliac Joint pain utilizing controlled comparative local anesthetic blocks. The prevalence of Sacroiliac Joint pain is estimated to range between 10% and 62% based on the setting; however, the majority of analyzed studies suggest a point prevalence of around 25%, with a false-positive rate for uncontrolled blocks of approximately 20%. The evidence for provocative testing to diagnose Sacroiliac Joint pain was fair. The evidence for the diagnostic accuracy of imaging is limited. Limitations The limitations of this systematic review include a paucity of literature, variations in technique, and variable criterion standards for the diagnosis of Sacroiliac Joint pain. Conclusions Based on this systematic review, the evidence for the diagnostic accuracy of Sacroiliac Joint injections is good, the evidence for provocation maneuvers is fair, and evidence for imaging is limited.
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a systematic evaluation of the therapeutic effectiveness of Sacroiliac Joint interventions
Pain Physician, 2012Co-Authors: Hans Hansen, Laxmaiah Manchikanti, Thomas T Simopoulos, Sanjeeva Gupta, Haroon Hameed, Paul J Christo, Howard S Smith, Steven P CohenAbstract:BACKGROUND: The contribution of the Sacroiliac Joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the Sacroiliac Joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing Sacroiliac Joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature. STUDY DESIGN: A systematic review of therapeutic Sacroiliac Joint interventions. OBJECTIVE: To evaluate the accuracy of therapeutic Sacroiliac Joint interventions. METHODS: The available literature on therapeutic Sacroiliac Joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. RESULTS: For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled radiofrequency neurotomy in managing Sacroiliac Joint pain is fair.The evidence for effectiveness of intraarticular steroid injections is poor.The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor. The evidence for effectiveness of conventional radiofrequency neurotomy is poor.The evidence for pulsed radiofrequency is poor. LIMITATIONS: The limitations of this systematic review include a paucity of literature on therapeutic interventions, variations in technique, and variable diagnostic standards for Sacroiliac Joint pain. CONCLUSIONS: The evidence was fair in favor of cooled radiofrequency neurotomy and poor for short-term and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.
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13 Sacroiliac Joint pain
Pain Practice, 2010Co-Authors: Pascal Vanelderen, Steven P Cohen, Karolina M Szadek, Jan De Witte, Arno Lataster, Jacob Patijn, Nagy Mekhail, Maarten Van Kleef, Jan Van ZundertAbstract:The Sacroiliac Joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the Sacroiliac Joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower limb(s). Because Sacroiliac Joint pain is difficult to distinguish from other forms of low back pain based on history, different provocative maneuvers have been advocated. Individually, they have weak predictive value, but combined batteries of tests can help ascertain a diagnosis. Radiological imaging is important to exclude “red flags” but contributes little in the diagnosis. Diagnostic blocks are the diagnostic gold standard but must be interpreted with caution, because false-positive as well as false-negative results occur frequently. Treatment of Sacroiliac Joint pain is best performed in the context of a multidisciplinary approach. Conservative treatments address the underlying causes (posture and gait disturbances) and consist of exercise therapy and manipulation. Intra-articular Sacroiliac Joint infiltrations with local anesthetic and corticosteroids hold the highest evidence rating (1 B+). If the latter fail or produce only short-term effects, cooled radiofrequency treatment of the lateral branches of S1 to S3 (S4) is recommended (2 B+) if available. When this procedure cannot be used, (pulsed) radiofrequency procedures targeted at L5 dorsal ramus and lateral branches of S1 to S3 may be considered (2 C+).
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evaluation of Sacroiliac Joint interventions a systematic appraisal of the literature
Pain Physician, 2009Co-Authors: Matthew P Rupert, Laxmaiah Manchikanti, Sukdeb Datta, Steven P CohenAbstract:BACKGROUND: The Sacroiliac Joint has been implicated as a source of low back and lower extremity pain. There are no definite historical, physical, or radiological features that can definitively establish a diagnosis of Sacroiliac Joint pain. Based on the present knowledge, an accurate diagnosis is made only by controlled Sacroiliac Joint diagnostic blocks. The Sacroiliac Joint has been shown to be a source of pain in 10% to 27% of suspected patients with chronic low back pain utilizing controlled comparative local anesthetic blocks. STUDY DESIGN: A systematic review of diagnostic and therapeutic Sacroiliac Joint interventions. OBJECTIVE: To evaluate the accuracy of diagnostic Sacroiliac Joint interventions and the utility of therapeutic Sacroiliac Joint interventions. METHODS: The literature search was carried out by searching the databases of PubMed, EMBASE, and Cochrane reviews. Methodologic quality assessment of included studies was performed using the Agency for Healthcare Research and Quality (AHRQ) methodologic quality criteria for diagnostic accuracy and observational studies, whereas randomized trials were evaluated utilizing the Cochrane review criteria. Only studies with scores of 50 or higher were included for assessment. Level of evidence was based on the U.S. Preventive Services Task Force (USPSTF) criteria. OUTCOME MEASURES: For diagnostic interventions, the outcome criteria included at least 50% pain relief coupled with a patient's ability to perform previously painful maneuvers with sustained relief using placebo-controlled or comparative local anesthetic blocks. For therapeutic purposes, outcomes included significant pain relief and improvement in function and other parameters. Short-term relief for therapeutic interventions was defined as 6 months or less, whereas long-term effectiveness was defined as greater than 6 months. RESULTS: The indicated level of evidence is II-2 for the diagnosis of Sacroiliac Joint pain utilizing comparative, controlled local anesthetic blocks. The prevalence of Sacroiliac Joint pain is estimated to range between 10% and 38% using a double block paradigm in the study population. The false-positive rate of single, uncontrolled, Sacroiliac Joint injections is 20% to 54%. The evidence for provocative testing to diagnose Sacroiliac Joint pain is Level II-3 or limited. For radiofrequency neurotomy the indicated evidence is limited (Level II-3) for short- and long-term relief. LIMITATIONS: The limitations of this systematic review include the paucity of literature evaluating the role of both diagnostic and therapeutic interventions and widespread methodological flaws. CONCLUSIONS: The indicated evidence for the validity of diagnostic Sacroiliac Joint injections is Level II-2. The evidence for the accuracy of provocative maneuvers in the diagnosing of Sacroiliac Joint pain is limited (Level II-3). The evidence for radiofrequency neurotomy is also limited (Level II-3).
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randomized placebo controlled study evaluating lateral branch radiofrequency denervation for Sacroiliac Joint pain
Anesthesiology, 2008Co-Authors: Steven P Cohen, Robert W Hurley, Chester C Buckenmaier, Connie Kurihara, Benny Morlando, Anthony DragovichAbstract:Background Sacroiliac Joint pain is a challenging condition accounting for approximately 20% of cases of chronic low back pain. Currently, there are no effective long-term treatment options for Sacroiliac Joint pain.
Laxmaiah Manchikanti - One of the best experts on this subject based on the ideXlab platform.
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Utilization of Facet Joint and Sacroiliac Joint Interventions in Medicare Population from 2000 to 2014: Explosive Growth Continues!
Current Pain and Headache Reports, 2016Co-Authors: Laxmaiah Manchikanti, Joshua A Hirsch, Vidyasagar Pampati, Mark V. BoswellAbstract:Increasing utilization of interventional techniques in managing chronic spinal pain, specifically facet Joint interventions and Sacroiliac Joint injections, is a major concern of healthcare policy makers. We analyzed the patterns of utilization of facet and Sacroiliac Joint interventions in managing chronic spinal pain. The results showed significant increase of facet Joint interventions and Sacroiliac Joint injections from 2000 to 2014 in Medicare FFS service beneficiaries. Overall, the Medicare population increased 35 %, whereas facet Joint and Sacroiliac Joint interventions increased 313.3 % per 100,000 Medicare population with an annual increase of 10.7 %. While the increases were uniform from 2000 to 2014, there were some decreases noted for facet Joint interventions in 2007, 2010, and 2013, whereas for Sacroiliac Joint injections, the decreases were noted in 2007 and 2013. The increases were for cervical and thoracic facet neurolysis at 911.5 % compared to lumbosacral facet neurolysis of 567.8 %, 362.9 % of cervical and thoracic facet Joint blocks, 316.9 % of Sacroiliac Joints injections, and finally 227.3 % of lumbosacral facet Joint blocks.
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a systematic evaluation of prevalence and diagnostic accuracy of Sacroiliac Joint interventions
Pain Physician, 2012Co-Authors: Thomas T Simopoulos, Laxmaiah Manchikanti, Vijay Singh, Sanjeeva Gupta, Haroon Hameed, Sudhir Diwan, Steven P CohenAbstract:Background The contributions of the Sacroiliac Joint to low back and lower extremity pain have been a subject of considerable debate and research. It is generally accepted that 10% to 25% of patients with persistent mechanical low back pain below L5 have pain secondary to Sacroiliac Joint pathology. However, no single historical, physical exam, or radiological feature can definitively establish a diagnosis of Sacroiliac Joint pain. Based on present knowledge, a proper diagnosis can only be made using controlled diagnostic blocks. The diagnosis and treatment of Sacroiliac Joint pain continue to be characterized by wide variability and a paucity of the literature. Objective To evaluate the accuracy of diagnostic Sacroiliac Joint interventions. Study design A systematic review of diagnostic Sacroiliac Joint interventions. Methods Methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. Outcome measures In this evaluation we utilized controlled local anesthetic blocks using at least 50% pain relief as the reference standard. Results The evidence is good for the diagnosis of Sacroiliac Joint pain utilizing controlled comparative local anesthetic blocks. The prevalence of Sacroiliac Joint pain is estimated to range between 10% and 62% based on the setting; however, the majority of analyzed studies suggest a point prevalence of around 25%, with a false-positive rate for uncontrolled blocks of approximately 20%. The evidence for provocative testing to diagnose Sacroiliac Joint pain was fair. The evidence for the diagnostic accuracy of imaging is limited. Limitations The limitations of this systematic review include a paucity of literature, variations in technique, and variable criterion standards for the diagnosis of Sacroiliac Joint pain. Conclusions Based on this systematic review, the evidence for the diagnostic accuracy of Sacroiliac Joint injections is good, the evidence for provocation maneuvers is fair, and evidence for imaging is limited.
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a systematic evaluation of the therapeutic effectiveness of Sacroiliac Joint interventions
Pain Physician, 2012Co-Authors: Hans Hansen, Laxmaiah Manchikanti, Thomas T Simopoulos, Sanjeeva Gupta, Haroon Hameed, Paul J Christo, Howard S Smith, Steven P CohenAbstract:BACKGROUND: The contribution of the Sacroiliac Joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the Sacroiliac Joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing Sacroiliac Joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature. STUDY DESIGN: A systematic review of therapeutic Sacroiliac Joint interventions. OBJECTIVE: To evaluate the accuracy of therapeutic Sacroiliac Joint interventions. METHODS: The available literature on therapeutic Sacroiliac Joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. RESULTS: For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled radiofrequency neurotomy in managing Sacroiliac Joint pain is fair.The evidence for effectiveness of intraarticular steroid injections is poor.The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor. The evidence for effectiveness of conventional radiofrequency neurotomy is poor.The evidence for pulsed radiofrequency is poor. LIMITATIONS: The limitations of this systematic review include a paucity of literature on therapeutic interventions, variations in technique, and variable diagnostic standards for Sacroiliac Joint pain. CONCLUSIONS: The evidence was fair in favor of cooled radiofrequency neurotomy and poor for short-term and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.
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evaluation of Sacroiliac Joint interventions a systematic appraisal of the literature
Pain Physician, 2009Co-Authors: Matthew P Rupert, Laxmaiah Manchikanti, Sukdeb Datta, Steven P CohenAbstract:BACKGROUND: The Sacroiliac Joint has been implicated as a source of low back and lower extremity pain. There are no definite historical, physical, or radiological features that can definitively establish a diagnosis of Sacroiliac Joint pain. Based on the present knowledge, an accurate diagnosis is made only by controlled Sacroiliac Joint diagnostic blocks. The Sacroiliac Joint has been shown to be a source of pain in 10% to 27% of suspected patients with chronic low back pain utilizing controlled comparative local anesthetic blocks. STUDY DESIGN: A systematic review of diagnostic and therapeutic Sacroiliac Joint interventions. OBJECTIVE: To evaluate the accuracy of diagnostic Sacroiliac Joint interventions and the utility of therapeutic Sacroiliac Joint interventions. METHODS: The literature search was carried out by searching the databases of PubMed, EMBASE, and Cochrane reviews. Methodologic quality assessment of included studies was performed using the Agency for Healthcare Research and Quality (AHRQ) methodologic quality criteria for diagnostic accuracy and observational studies, whereas randomized trials were evaluated utilizing the Cochrane review criteria. Only studies with scores of 50 or higher were included for assessment. Level of evidence was based on the U.S. Preventive Services Task Force (USPSTF) criteria. OUTCOME MEASURES: For diagnostic interventions, the outcome criteria included at least 50% pain relief coupled with a patient's ability to perform previously painful maneuvers with sustained relief using placebo-controlled or comparative local anesthetic blocks. For therapeutic purposes, outcomes included significant pain relief and improvement in function and other parameters. Short-term relief for therapeutic interventions was defined as 6 months or less, whereas long-term effectiveness was defined as greater than 6 months. RESULTS: The indicated level of evidence is II-2 for the diagnosis of Sacroiliac Joint pain utilizing comparative, controlled local anesthetic blocks. The prevalence of Sacroiliac Joint pain is estimated to range between 10% and 38% using a double block paradigm in the study population. The false-positive rate of single, uncontrolled, Sacroiliac Joint injections is 20% to 54%. The evidence for provocative testing to diagnose Sacroiliac Joint pain is Level II-3 or limited. For radiofrequency neurotomy the indicated evidence is limited (Level II-3) for short- and long-term relief. LIMITATIONS: The limitations of this systematic review include the paucity of literature evaluating the role of both diagnostic and therapeutic interventions and widespread methodological flaws. CONCLUSIONS: The indicated evidence for the validity of diagnostic Sacroiliac Joint injections is Level II-2. The evidence for the accuracy of provocative maneuvers in the diagnosing of Sacroiliac Joint pain is limited (Level II-3). The evidence for radiofrequency neurotomy is also limited (Level II-3).
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Sacroiliac Joint interventions a systematic review
Pain Physician, 2007Co-Authors: Hans Hansen, Anne Marie Mckenziebrown, Steven P Cohen, John R Swicegood, James D Colson, Laxmaiah ManchikantiAbstract:BACKGROUND: The Sacroiliac Joint is a diarthrodial synovial Joint with abundant innervation and capability of being a source of low back pain and referred pain in the lower extremity. There are no definite historical, physical, or radiological features to provide definite diagnosis of Sacroiliac Joint pain, although many authors have advocated provocational maneuvers to suggest Sacroiliac Joint as a pain generator. An accurate diagnosis is made by controlled Sacroiliac Joint diagnostic blocks. The Sacroiliac Joint has been shown to be a source of pain in 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks. Intraarticular injections, and radiofrequency neurotomy have been described as therapeutic measures. This systematic review was performed to assess diagnostic testing (non-invasive versus interventional diagnostic techniques) and to evaluate the clinical usefulness of interventional techniques in the management of chronic Sacroiliac Joint pain. OBJECTIVE: To evaluate and update the available evidence regarding diagnostic and therapeutic Sacroiliac Joint interventions in the management of Sacroiliac Joint pain. STUDY DESIGN: A systematic review using the criteria as outlined by the Agency for Healthcare Research and Quality (AHRQ), Cochrane Review Group Criteria for therapeutic interventions and AHRQ, and Quality Assessment for Diagnostic Accuracy Studies (QUADAS) for diagnostic studies. METHODS: The databases of EMBASE and MEDLINE (1966 to December 2006), and Cochrane Reviews were searched. The searches included systematic reviews, narrative reviews, prospective and retrospective studies, and cross-references from articles reviewed. The search strategy included Sacroiliac Joint pain and dysfunction, Sacroiliac Joint injections, interventions, and radiofrequency. RESULTS: The results of this systematic evaluation revealed that for diagnostic purposes, there is moderate evidence showing the accuracy of comparative, controlled local anesthetic blocks. Prevalence of Sacroiliac Joint pain is estimated to range between 10% and 27% using a double block paradigm. The false-positive rate of single, uncontrolled, Sacroiliac Joint injections is around 20%. The evidence for provocative testing to diagnose Sacroiliac Joint pain is limited. For therapeutic purposes, intraarticular Sacroiliac Joint injections with steroid and radiofrequency neurotomy were evaluated. Based on this review, there is limited evidence for short-term and long-term relief with intraarticular Sacroiliac Joint injections and radiofrequency thermoneurolysis. CONCLUSIONS: The evidence for the specificity and validity of diagnostic Sacroiliac Joint injections is moderate. The evidence for accuracy of provocative maneuvers in diagnosis of Sacroiliac Joint pain is limited. The evidence for therapeutic intraarticular Sacroiliac Joint injections is limited. The evidence for radiofrequency neurotomy in managing chronic Sacroiliac Joint pain is limited.
Hans Hansen - One of the best experts on this subject based on the ideXlab platform.
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a systematic evaluation of the therapeutic effectiveness of Sacroiliac Joint interventions
Pain Physician, 2012Co-Authors: Hans Hansen, Laxmaiah Manchikanti, Thomas T Simopoulos, Sanjeeva Gupta, Haroon Hameed, Paul J Christo, Howard S Smith, Steven P CohenAbstract:BACKGROUND: The contribution of the Sacroiliac Joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the Sacroiliac Joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing Sacroiliac Joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature. STUDY DESIGN: A systematic review of therapeutic Sacroiliac Joint interventions. OBJECTIVE: To evaluate the accuracy of therapeutic Sacroiliac Joint interventions. METHODS: The available literature on therapeutic Sacroiliac Joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles. OUTCOME MEASURES: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. RESULTS: For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled radiofrequency neurotomy in managing Sacroiliac Joint pain is fair.The evidence for effectiveness of intraarticular steroid injections is poor.The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor. The evidence for effectiveness of conventional radiofrequency neurotomy is poor.The evidence for pulsed radiofrequency is poor. LIMITATIONS: The limitations of this systematic review include a paucity of literature on therapeutic interventions, variations in technique, and variable diagnostic standards for Sacroiliac Joint pain. CONCLUSIONS: The evidence was fair in favor of cooled radiofrequency neurotomy and poor for short-term and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.
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Sacroiliac Joint interventions a systematic review
Pain Physician, 2007Co-Authors: Hans Hansen, Anne Marie Mckenziebrown, Steven P Cohen, John R Swicegood, James D Colson, Laxmaiah ManchikantiAbstract:BACKGROUND: The Sacroiliac Joint is a diarthrodial synovial Joint with abundant innervation and capability of being a source of low back pain and referred pain in the lower extremity. There are no definite historical, physical, or radiological features to provide definite diagnosis of Sacroiliac Joint pain, although many authors have advocated provocational maneuvers to suggest Sacroiliac Joint as a pain generator. An accurate diagnosis is made by controlled Sacroiliac Joint diagnostic blocks. The Sacroiliac Joint has been shown to be a source of pain in 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks. Intraarticular injections, and radiofrequency neurotomy have been described as therapeutic measures. This systematic review was performed to assess diagnostic testing (non-invasive versus interventional diagnostic techniques) and to evaluate the clinical usefulness of interventional techniques in the management of chronic Sacroiliac Joint pain. OBJECTIVE: To evaluate and update the available evidence regarding diagnostic and therapeutic Sacroiliac Joint interventions in the management of Sacroiliac Joint pain. STUDY DESIGN: A systematic review using the criteria as outlined by the Agency for Healthcare Research and Quality (AHRQ), Cochrane Review Group Criteria for therapeutic interventions and AHRQ, and Quality Assessment for Diagnostic Accuracy Studies (QUADAS) for diagnostic studies. METHODS: The databases of EMBASE and MEDLINE (1966 to December 2006), and Cochrane Reviews were searched. The searches included systematic reviews, narrative reviews, prospective and retrospective studies, and cross-references from articles reviewed. The search strategy included Sacroiliac Joint pain and dysfunction, Sacroiliac Joint injections, interventions, and radiofrequency. RESULTS: The results of this systematic evaluation revealed that for diagnostic purposes, there is moderate evidence showing the accuracy of comparative, controlled local anesthetic blocks. Prevalence of Sacroiliac Joint pain is estimated to range between 10% and 27% using a double block paradigm. The false-positive rate of single, uncontrolled, Sacroiliac Joint injections is around 20%. The evidence for provocative testing to diagnose Sacroiliac Joint pain is limited. For therapeutic purposes, intraarticular Sacroiliac Joint injections with steroid and radiofrequency neurotomy were evaluated. Based on this review, there is limited evidence for short-term and long-term relief with intraarticular Sacroiliac Joint injections and radiofrequency thermoneurolysis. CONCLUSIONS: The evidence for the specificity and validity of diagnostic Sacroiliac Joint injections is moderate. The evidence for accuracy of provocative maneuvers in diagnosis of Sacroiliac Joint pain is limited. The evidence for therapeutic intraarticular Sacroiliac Joint injections is limited. The evidence for radiofrequency neurotomy in managing chronic Sacroiliac Joint pain is limited.
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Is fluoroscopy necessary for Sacroiliac Joint injections
Pain Physician, 2003Co-Authors: Hans HansenAbstract:: The use of Sacroiliac Joint injection has been a steadily increasing for therapeutic and diagnostic purposes in the United States. Because of the conceivably easy accessibility of Sacroiliac Joint and reported low incidence of morbidity, the Sacroiliac Joint injection is felt to be a procedure that maybe performed easily in the office based setting. While this procedure may be common, the Sacroiliac Joint injection is not performed accurately without the aide of imaging. Further complicating the issue of Sacroiliac Joint injections is the lack of specific and reliable diagnostic testing. Clinical evaluation and imaging studies are often unreliable and practitioners often mistakenly assume that pain over the posterior superior iliac spine is pathognomonic for sacral Joint pain. In addition, referral patterns are unreliable and bedside testing is often non-diagnostic. Sixty patients undergoing Sacroiliac Joint injections were studied. Sacroiliac Joint injections were placed blindly then examined under fluoroscopy for accurate needle placement. The needle was placed by a single this experienced spinal injectionist. Results of blind needle placement revealed that only 5 of 60 patients were felt to have needle placement approximating a therapeutic point of contact with the Sacroiliac Joint. Furthermore, the posterior superior iliac spine, was found to be a poor indicator of Sacroiliac Joint anatomic access. The results of this study show that accurate placement of Sacroiliac Joint injections is successful without fluoroscopy in only 12% of the patients, even in experienced hands.
David W. Polly - One of the best experts on this subject based on the ideXlab platform.
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Minimally invasive Sacroiliac Joint fusion vs. conservative management for chronic Sacroiliac Joint pain.
The Journal of Spine Surgery, 2019Co-Authors: David W. PollyAbstract:Dengler et al . have reported the 12-month results of a randomized controlled trial comparing minimally invasive Sacroiliac Joint fusion to conservative measures (1). This study is the second RCT (randomized control trial) of MIS SI (minimally invasive Sacroiliac Joint) fusion versus CM (conservative management) and it has findings consistent in direction and magnitude of effect as the first RCT (2). Why is this study important?
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Sacroiliac Joint Fusion: Approaches and Recent Outcomes.
Pm&r, 2019Co-Authors: Sharon C. Yson, Jonathan N. Sembrano, David W. PollyAbstract:: The Sacroiliac Joint may be a primary source of pain in patients complaining of low back and/or buttock pain. Nonsurgical treatment of Sacroiliac Joint pain typically includes structured core and pelvic muscle flexibility and strengthening; pharmaceutical management through oral and injectable medication; and ablation procedures. For patients who do not improve with comprehensive, nonoperative treatment, surgical fusion of the Sacroiliac Joint is an option with overall good reported outcomes and high patient satisfaction. Minimally invasive surgery (MIS) approaches have been shown to have lower morbidity and earlier recovery than traditional open approaches. To date, the majority of published clinical studies on MIS Sacroiliac Joint fusion are industry-sponsored and predominantly using one system (ingrowth triangular titanium rods). These include two level 1 randomized controlled trials comparing MIS Sacroiliac Joint fusion to nonoperative management, with results favoring surgery.
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comparative effectiveness of open versus minimally invasive Sacroiliac Joint fusion
Medical Devices : Evidence and Research, 2014Co-Authors: Charles Gerald T Ledonio, David W. Polly, Marc F Swiontkowski, John CummingsAbstract:BACKGROUND: The mainstay of Sacroiliac Joint disruption/degenerative sacroiliitis therapy has been nonoperative management. This nonoperative management often includes a regimen of physical therapy, chiropractic treatment, therapeutic injections, and possibly radiofrequency ablation at the discretion of the treating physician. When these clinical treatments fail, Sacroiliac Joint fusion has been recommended as the standard treatment. Open and minimally invasive (MIS) surgical techniques are typical procedures. This study aims to compare the perioperative measures and Oswestry Disability Index (ODI) outcomes associated with each of these techniques. METHODS: A comparative retrospective chart review of patients with Sacroiliac Joint fusion and a minimum of 1 year of follow-up was performed. Perioperative measures and ODI scores were compared using the Fisher's exact test and two nonparametric tests, ie, the Mann-Whitney U test and the Wilcoxon signed-rank test. The results are presented as percent or median with range, as appropriate. RESULTS: Forty-nine patients from two institutions underwent Sacroiliac Joint fusion between 2006 and 2012. Ten patients were excluded because of incomplete data, leaving 39 evaluable patients, of whom 22 underwent open and 17 underwent MIS Sacroiliac Joint fusion. The MIS group was significantly older (median age 66 [39-82] years) than the open group (median age 51 [34-74] years). Surgical time and hospital stay were significantly shorter in the MIS group than in the open group. Preoperative ODI was significantly greater in the open group (median 64 [44-78]) than in the MIS group (median 53 [14-84]). Postoperative improvement in ODI was statistically significant within and between groups, with MIS resulting in greater improvement. CONCLUSION: The open and MIS Sacroiliac Joint fusion techniques resulted in statistically and clinically significant improvement for patients with degenerative sacroiliitis refractory to nonoperative management. However, the number of patients reaching the minimal clinically important difference and those showing overall improvement were greater in the MIS group.
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Sacroiliac Joint pain burden of disease
Medical Devices : Evidence and Research, 2014Co-Authors: Daniel J Cher, David W. Polly, Sigurd BervenAbstract:Objectives The Sacroiliac Joint (SIJ) is an important and significant cause of low back pain. We sought to quantify the burden of disease attributable to the SIJ.
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minimally invasive versus open Sacroiliac Joint fusion are they similarly safe and effective
Clinical Orthopaedics and Related Research, 2014Co-Authors: Charles Gerald T Ledonio, David W. Polly, Marc F SwiontkowskiAbstract:Background The Sacroiliac Joint has been implicated as a source of chronic low back pain in 15% to 30% of patients. When nonsurgical approaches fail, Sacroiliac Joint fusion may be recommended. Advances in intraoperative image guidance have assisted minimally invasive surgical (MIS) techniques using ingrowth-coated fusion rods; however, how these techniques perform relative to open anterior fusion of the Sacroiliac Joint using plates and screws is not known.
Israel Hershkovitz - One of the best experts on this subject based on the ideXlab platform.
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The association of Sacroiliac Joint bridging with other enthesopathies in the human body.
Spine, 2007Co-Authors: Smadar Peleg, Youssef Masharawi, Nili Steinberg, Bruce M. Rothschild, Israel HershkovitzAbstract:Study Design. A descriptive study of the association between Sacroiliac Joint (extra-articular) bridging and other enthesopathies. Objectives. To examine the relationship between Sacroiliac Joint bridging with other entheseal reaction sites in the skeleton, and its prognostic value in spinal diseases. Summary of Background Data. Sacroiliac Joint bridging is considered a hallmark of spinal diseases (e.g., ankylosing spondylitis). Nevertheless, its association with other enthesopathies has never been quantified and analyzed. Methods. A total of 289 human male skeletons with Sacroiliac Joint bridging and 127 without (of similar demographic structure) were evaluated for the presence of entheseal ossification, cartilaginous calcification, and other axial skeleton Joint fusion (a total of 18 anatomic sites). The presence of diffuse idiopathic skeletal hyperostosis and spondyloarthropathy was also recorded. Results. Sacroiliac Joint bridging was strongly associated with entheseal reactions in other parts of the body. Of the Sacroiliac Joint bridging group, 24.91% had diffuse idiopathic skeletal hyperostosis, and 8.05% had spondyloarthropathy. Conclusions. The presence of Sacroiliac Joint bridging indicates an intensive general entheseal process in the skeleton.
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Sacroiliac Joint Bridging: Demographical and Anatomical Aspects
Spine, 2005Co-Authors: Gali Dar, Youssef Masharawi, Smadar Peleg, Nili Steinberg, Nir Peled, Bruce M. Rothschild, Israel HershkovitzAbstract:STUDY DESIGN: A descriptive study of the association between Sacroiliac Joint bridging (SIB) and age, gender, laterality, and ethnic origin in a normal skeletal population. The effectiveness of radiographs in identifying SIB was also evaluated. OBJECTIVES: To characterize the phenomenon of SIB demographically and anatomically and to evaluate the validity of diagnosis based on roentgenograms. SUMMARY AND BACKGROUND DATA: Although SIB is an important diagnostic parameter in many spinal diseases, the type of association between them has never been established. Furthermore, the extent of SIB in humans and its relationship to demographic parameters await osteological research as radiograph studies hamper the results. METHODS: Two thousand eight hundred and forty-five skeleton pelves were examined for SIB. Extent and laterality were recorded. Ten pelves (5 with SIB and 5 without) were X-rayed and the roentgenograms given to radiologists for evaluation. RESULTS: Sacroiliac bridging was present in 12.27% of all males, contrasted with only 1.83% of females (P < 0.001). SIB was independent of ethnic origin (P = 0.0535) but was age-dependent (r = 0.985; P = 0.0001). Bridging was present bilaterally in 38.6% of the individuals and in the superior region in 72.4%. Diffuse bridging (areas 1-6) was present in only 2.3% of the individuals. Radiologic examination was insensitive to diagnosis of SIB. CONCLUSIONS: SIB is a common, but predominantly male phenomenon. Its occurrence is age-dependent and ethnicity independent. Bridging occurs mainly on the superior aspect of the Sacroiliac Joint. The irregular shape and orientation of Sacroiliac Joints preclude definitely distinguishing normal versus bridged Joints from roentgenograms. Our findings also negate the belief that bridging/fusion of the Sacroiliac Joint represents the most severe form of osteoarthritis and mandate that they be separately recorded and that their significance be determined.
