Research Abstract Summaries
July 2013
Utilization and Growth Patterns of Sacroiliac
Joint Injections from 2000 to 2011 in the Medicare Population
Laxmaiah Manchikanti, MD, Hans Hansen, MD, Vidyasagar Pampati, MSc, and Frank J.E. Falco, MD
Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; Pain Relief Centers, Conover, NC;Mid Atlantic Spine & Pain Physicians, Newark, DE, and Temple University Hospital, Philadelphia, PA.
Summary
Among Medicare participants (less those with Medicare Advantage plans), the growth of sacroiliac joint injections being performed is even more than that of facet joint interventions. From 2000 to 2011 there was a 331% increase per 100,000 Medicare beneficiaries with an annual increase of 14.2%, compared to an increase in the Medicare population of 23% or annual increase of 1.9%. The number of procedures increased from 49,554 in 2000 to 252,654 in 2011, or a rate of 125 to 539 per 100,000 Medicare beneficiaries. Physicians specializing in neurology have shown an increase of 698%. Nonphysician providers including certified registered nurse anesthetists, nurse practitioners, and physician assistants performed 4,953 procedures in 2011.
June 2012
Precision and Accuracy Measurement of Radiostereometric Analysis Applied to Movement of the Sacroiliac Joint
Kibsgård TJ, Røise O, Stuge B, Röhrl SM.
Division of Surgery and Clinical Neuroscience, Department of Orthopaedics, Oslo University Hospital, Pb 4950 Nydalen, 0424, Oslo, Norway, kibsgard@gmail.com.
Summary
Different techniques have been used to quantify the movement of sacroiliac (SI) joints. These include radiostereometric analysis (RSA), but the accuracy and precision of this method have not been properly evaluated and it is unclear how many markers are required and where they should be placed to achieve proper accuracy and precision. The purpose of this study was to test accuracy and precision of RSA, applied to the SI joint, in a phantom model and in patients.
Free FullText PDF @ SpringerLink
May 2012
Role of computeric tomography and magnetic resonance imaging in diagnosis of inflammatory diseases of sacro-ileal joint
[Role of computeric tomography and magnetic resonance imaging in diagnosis of inflammatory diseases of sacro-ileal joint].
[Article in Ukrainian]
Baĭramov RB.
Summary
Sensitivity of computeric tomography (CT) and magnetic resonance imaging (MRI) for sacroileitis diagnosis was studied, optimal for MRI investigation was established.
Abstract @ PubMed
Feburary 2012
New Evidence Supports the Use of Radiofrequency Ablation of the Lateral Branches for Patients Suffering from Sacroiliac Joint Pain.
More information is available at www.painmed.org.
Summary
PALM SPRINGS, Calif., Feb. 24, 2012 /PRNewswire-USNewswire/ — Today at the American Academy of Pain Medicine’s 28th Annual Meeting, researchers from Cleveland Clinic report that there is no evidence that the degree of pain relief from intraarticular steroid injections of the sacroiliac joint predicts the outcome of radiofrequency ablation (RFA) of the lateral branches in patients suffering with low back pain. Read Full News Release
April 2011
Managing a Female Patient with Left Low Back Pain and Sacroiliac Joint Pain with Therapeutic Exercise: A Case Report
Kyndall L. Boyle PT, PhD, OCS, PRC
Associate Professor, Northern Arizona University, Flagstaff, Arizona
Program in Physical Therapy, College of Health and Human Services, Northern Arizona University, 208 E. Pine Knoll Drive, PO Box 15015, Flagstaff, AZ 86011-5015 USA; Tel.: 928-523-1606; E-mail: kyndall.boyle@nau.edu.
Summary
The purpose of this case study is to describe the management of a female patient with chronic left low back pain and sacroiliac joint pain (LBP/SIJP) using unique unilateral exercises developed by the Postural Restoration Institute (PRI) to address pelvic asymmetry and left hip capsule restriction, which is consistent with a Right Handed and Left Anterior Interior Chain pattern of postural asymmetry.
Free Fulltext / Free PDF
February 2011
What is the source of chronic low back pain and does age play a role?
DePalma MJ, Ketchum JM, Saullo T.
Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia Hospitals, Richmond, Virginia, USA. depalmamj8@yahoo.com
Summary
The objective of this study was to estimate the prevalence, mean age, and association of prevalence and age of lumbar internal disc disruption (IDD), facet joint pain (FJP), sacroiliac joint pain (SIJP), spinal and pelvic insufficiency fractures, interspinous ligament injury/Baastrup’s Disease, and soft tissue irritation by fusion hardware. The prevalence of internal disc disruption, facet joint pain and sacroiliac joint pain was 42%, 31%, and 18%, respectively.
Abstract @ PubMed
Fulltext $
December 2010
Anatomy of L4 to S3 nerve roots.
Waikakul S, Chandraphak S, Sangthongsil P.
Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Summary
The purpose of the article is to study the course of L4 to S3 nerve roots and their distance with the ala of the sacrum and the sacroiliac joint. It is concluded that sacral nerve roots may fuse at different levels. Most L4 to S3 nerve roots lie close to the anterior surface of the sacroiliac joint and the ala of the sacrum.
Abstract @ PubMed
Free FullText PDF @ J Orthop Surg (Hong Kong)
July 2010
Sacroiliac joint dysfunction.
Turk Neurosurg. 2010 Jul;20(3):398-401.
Ilaslan H, Arslan A, Koç ON, Dalkiliç T, Naderi S.
Istanbul Medipol Hospital Department of Neurosurgery Istanbul, Turkey.
Summary
AIM: Sacroiliac joint dysfunction is a disorder presenting with low back and groin pain. It should be taken into consideration during the preoperative differential diagnosis of lumbar disc herniation, lumbar spinal stenosis and facet syndrome.
MATERIAL and METHODS: Four cases with sacroiliac dysfunction are presented. The clinical and radiological signs supported the evidence of sacroiliac dysfunction, and exact diagnosis was made after positive response to sacroiliac joint block.
RESULTS: A percutaneous sacroiliac fixation provided pain relief in all cases. The mean VAS scores reduced from 8.2 to 2.2.
CONCLUSION: It is concluded that sacroiliac joint dysfunction diagnosis requires a carefull physical examination of the sacroiliac joints in all cases with low back and groin pain. The diagnosis is made based on positive response to the sacroiliac block. Sacroiliac fixation was found to be effective in carefully selected cases. Free Article
July 2010
Sacroiliac joint dysfunction presented with acute low back pain: three case reports.
No Shinkei Geka. 2010 Jul;38(7):655-61.
Hamauchi S, Morimoto D, Isu T, Sugawara A, Kim K, Shimoda Y, Motegi H, Matsumoto R, Isobe M.
Department of Neurosurgery, Kushiro Rosai Hospital.
Summary
Sacroiliac joint (SIJ) can cause low back pain when its joint capsule and ligamentous tissue are damaged. We report our experience in treating three SIJ dysfunction patients presenting with acute low back pain (a 38 year-old male, a 24 year-old male, and a 32 year-old female). SIJ dysfunction was diagnosed using the one-finger test, the modified Newton test, and SIJ injection. In all three patients, lumbar MRI demonstrated slightly degenerated lumbar lesions (lumbar canal stenosis, lumbar disc hernia). Two patients had paresthesia or pain in the leg and all three patients showed iliac muscle tenderness in the groin, which was thought to be a referred symptom because of improvement after SIJ injection. The two male patients returned to work and the problems have not recurred. Although our female patient resumed daily life as a housewife, her condition recurred at intervals of 2-3 months and she required regular SIJ injections. The prevalence of SIJ dysfunction of low back pain is about 10%, so it should be considered as a differential diagnosis when treating low back pain and designing treatment for lumbar spinal disorders. PubMed
June 2010
The occurrence of strain symptoms in the lumbosacral region and pelvis during pregnancy and after childbirth.
J Manipulative Physiol Ther. 2010 Jun;33(5):370-7.
Sipko T, Grygier D, Barczyk K, Eliasz G.
Academy of Physical Education, Faculty of Physiotherapy in Wrocław, Al. Paderewskiego 35, Wrocław, Poland. tsipko@wp.pl
Summary
OBJECTIVE: The etiology and pathology of pain in the lumbosacral region and pelvis of pregnant women during and after pregnancy have not been fully determined. This study evaluated if lower back pain during pregnancy and after childbirth is connected with static alterations in the alignment of the pelvis, dysfunction of sacroiliac joints, and irritation of the pelvic ligaments and spine in the lumbosacral region. METHODS: This study was carried out on a group of 30 women in their eighth month of pregnancy and through 3 months after childbirth. Techniques of manual examination were used to determine the strain. Static alteration of the pelvis was evaluated in both the sitting and standing positions on the basis of alignment of the posterior superior iliac spines. Irritation of the iliolumbar ligaments, sacrotuberous, sacroiliac, and interspinous ligaments was evaluated by means of pressure palpation. Disorders of sacroiliac joint function were evaluated with the Patrick FABERE test, the standing Gillet test, and the standing and sitting flexion tests. RESULTS: The most frequently irritated ligaments in the lumbar region are interspinous (60%), iliolumbar (40%), and sacroiliac (36%). CONCLUSIONS: In women, in their eighth month of pregnancy and after childbirth, disorders of static alterations in pelvis alignment and sacroiliac joint dysfunction may occur. The state of pregnancy may result in strain symptoms in the lumbosacral region and pelvis with variable pain intensifying in various static positions. Copyright (c) 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved. PubMed Full-Text Article
June 2010
Evidence-based Review of Radiofrequency Ablation Techniques for Chronic Sacroiliac Joint Pain.
Pain Medicine News. June 2010
Anita Gupta, DO, PharmD
Assistant Professor Department of Anesthesiology and Critical Care Division of Pain Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Summary
An evidence-based review of SIJ radiofrequency ablation. Link to FREE article…
May 2010
Clinical effectiveness of botulinum toxin A compared to a mixture of steroid and local anesthetics as a treatment for sacroiliac joint pain.
Pain Med. 2010 May;11(5):692-700.
Lee JH, Lee SH, Song SH.
Department of Physical Medicine and Rehabilitation, Wooridul Spine Hospital, Seoul, Korea.
Summary
A study was conducted to determine the efficacy of injecting the SIJ with Botulinum toxin (BT) type A, perhaps more familiar to some by the name BOTOX®, compared to injecting the joint with a corticosteriod/anesthetic mixture. The results show that BT was able to reduce pain and with a longer duration which it was more effective than the control. This study was only followed for 3 months following the injection. Pubmed
April 2010
Inflammatory and Degenerative Sacroiliac Joint Disease in a Primary Back Pain Cohort.
Arthritis Care Res (Hoboken). 2010 Apr;62(4):447-54.
O’Shea FD, Boyle E, Salonen DC, Ammendolia C, Peterson C, Hsu W, Inman RD.
Toronto Western Hospital, Toronto, Ontario, Canada.
Summary
The study was conducted to determine the prevalence of SIJ disease among a group at patients with low back pain. 31.7% demonstrated SIJ abnormalities. The authors concluded that “degenerative SIJ disease may be an under-recognized clinical entity.” PubMed
April 2010
Paradigm for assessment and treatment of SIJ mechanical dysfunction.
J Bodyw Mov Ther. 2010 Apr;14(2):152-61. Epub 2010 Jan 25.
Cusi MF.
School of Medicine, Sydney University of Notre Dame, 160 Oxford Street, Darlinghurst, NSW, 2010, Australia. manuel.cusi@gmail.com
Summary
The sacroiliac joint (SIJ) is an integral part of both the lumbar spine and the pelvic girdle. It is frequently the source of low back pain and pelvic girdle pain. Recent research has permitted a deeper understanding of its function and assessment. The mechanical assessment of the SIJ as a transmitter of load between trunk and lower limbs, and as a means to absorb torsion stresses of the pelvis absorber of torsion is examined; history, clinical examination and imaging modalities are explored and the role of exercise and some interventional therapies are described in general terms. Copyright 2009 Elsevier Ltd. All rights reserved. PubMed
2009
Diagnostic validity of criteria for sacroiliac joint pain: a systematic review.
J Pain. 2009 Apr;10(4):354-68. Epub 2008 Dec 19.
Szadek KM, van der Wurff P, van Tulder MW, Zuurmond WW, Perez RS.
Department of Anesthesiology, VU University Medical Center, and EMGO Institute for Research in Extramural Medicine, VU University Medical Center Amsterdam, Amsterdam, The Netherlands. km.szadek@vumc.nl
Summary
A systematic literature review was conducted to determine the diagnostic validity of the criteria for sacroiliac (SI) joint pain as proposed by the International Association for the Study of Pain (IASP). Databases were searched up to September 2007. Quality of the studies was assessed using a Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated together with 95% confidence intervals (CI). Statistical pooling was conducted for results of provocative tests. Eighteen studies were included. Five studies examined the pattern of SI joint pain, whereas another 5 examined stressing test specific for SI joint pain. None of the studies evaluated the diagnostic validity of the SI joint infiltration or the diagnostic validity of the IASP criteria set as a whole. In all studies, the SI joint selective infiltration was used as a gold standard; however, the technique, medications, and required pain relief after the infiltration varied considerably between the studies. Taking the double infiltration technique as reference test, the pooled data of the thigh thrust test (DOR, 18.461; CI, 5.82 to 58.53), compression test (DOR, 3.88; CI, 1.7 to 8.9), and 3 or more positive stressing tests (DOR, 17.16; CI, 7.6 to 39) showed discriminative power for diagnosing SI joint pain. PERSPECTIVE: This review of clinical studies focused on the diagnostic validity of the IASP criteria for diagnosing SI joint pain. A meta-analysis showed that the thigh thrust test, the compression test, and 3 or more positive stressing tests have discriminative power for diagnosing SI joint pain. Because a gold standard for SI joint pain diagnosis is lacking, the diagnostic validity of tests related to the IASP criteria for SI joint pain should be regarded with care. PubMed
December 2007
The role of sacroiliac joint dysfunction in the genesis of low back pain: the obvious is not always right.
Arch Orthop Trauma Surg. 2007 Dec;127(10):885-8. Epub 2007 Sep 8.
Weksler N, Velan GJ, Semionov M, Gurevitch B, Klein M, Rozentsveig V, Rudich T.
Pain Service, Division of Anesthesiology and Critical Care, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. weksler@bgumail.bgu.ac.il
Summary
BACKGROUND CONTEXT: It is a common practice to the link low back pain with protruding disc even when neurological signs are absent. Because pain caused by sacroiliac joint dysfunction can mimic discogenic or radicular low back pain, we assumed that the diagnosis of sacroiliac joint dysfunction is frequently overlooked. PURPOSE: To assess the incidence of sacroiliac joint dysfunction in patients with low back pain and positive disc findings on CT scan or MRI, but without claudication or objective neurological deficits. METHODS: Fifty patients with low back pain and disc herniation, without claudication or neurological abnormalities such as decreased motor strength, sensory alterations or sphincter incontinence and with positive pain provocation tests for sacroiliac joint dysfunction were submitted to fluoroscopic diagnostic sacroiliac joint infiltration. RESULTS: The mean baseline VAS pain score was 7.8 +/- 1.77 (range 5-10). Thirty minutes after infiltration, the mean VAS score was 1.3 +/- 1.76 (median 0.000E+00 with an average deviation from median = 1.30) (P = 0.0002). Forty-six patients had a VAS score ranging from 0 to 3, 8 weeks after the fluoroscopic guided infiltration. There were no serious complications after treatment. An unanticipated motor block that required hospitalization was seen in four patients, lasting from 12 to 36 h. CONCLUSIONS: Sacroiliac joint dysfunction should be considered strongly in the differential diagnosis of low back pain in this group of patients. PubMed
December 2006
Sacroiliac Joint Pain: Anatomy, Biomechanics, Diagnosis, and Treatment.
Foley BS, Buschbacher RM.
Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Summary
This review article describes the anatomy, biomechanics, diagnosis, and treatment of the SIJs. PubMed
November 2005
Sacroiliac Joint Pain: A Comprehensive Review of Anatomy, Diagnosis, and Treatment.
Anesth Analg 2005; 101:1440-1453.
Cohen, Steven P.
Johns Hopkins Hospital Pain Management Center 550 North Broadway, Suite 301 Baltimore, MD 21205, USA. scohen40@jhmi.edu.
Summary
This article is a comprehensive review of sacroiliac joint (SIJ) pain where the author discusses the anatomy, function, and mechanisms of injury of the SIJ, along with a systematic assessment of its diagnosis and treatment. Link to FREE article
2003
Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests.
Aust J Physiother. 2003;49(2):89-97.
Laslett M, Young SB, Aprill CN, McDonald B.
Linkopings Universitet, Sweden. mark.laslett@xtra.co.nz
Summary
Research suggests that clinical examination of the lumbar spine and pelvis is unable to predict the results of diagnostic injections used as reference standards. The purpose of this study was to assess the diagnostic accuracy of a clinical examination in identifying symptomatic and asymptomatic sacroiliac joints using double diagnostic injections as the reference standard. In a blinded concurrent criterion-related validity design study, 48 patients with chronic lumbopelvic pain referred for diagnostic spinal injection procedures were examined using a specific clinical examination and received diagnostic intraarticular sacroiliac joint injections. The centralisation and peripheralisation phenomena were used to identify possible discogenic pain and the results from provocation sacroiliac joint tests were used as part of the clinical reasoning process. Eleven patients had sacroiliac joint pain confirmed by double diagnostic injection. Ten of the 11 sacroiliac joint patients met clinical examination criteria for having sacroiliac joint pain. In the primary subset analysis of 34 patients, sensitivity, specificity and positive likelihood ratio (95% confidence intervals) of the clinical evaluation were 91% (62 to 98), 83% (68 to 96) and 6.97(2.70 to 20.27) respectively. The diagnostic accuracy of the clinical examination and clinical reasoning process was superior to the sacroiliac joint pain provocation tests alone. A specific clinical examination and reasoning process can differentiate between symptomatic and asymptomatic sacroiliac joints Link to FREE article
January 2001
Computed tomography findings in patients with sacroiliac pain.
Clin Orthop Relat Res. 2001 Jan;(382):112-8.
Elgafy H, Semaan HB, Ebraheim NA, Coombs RJ.
Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43614-5807, USA.
Summary
This retrospective study evaluated the diagnostic value of computed tomography in patients with sacroiliac pain. Computed tomography scans of the sacroiliac joints of 62 patients with sacroiliac joint pain were reviewed. The criteria to include the patient in the current study were pain relief after a local injection in the sacroiliac joint under computed tomography guidance, a physical examination consistent with a sacroiliac origin of the pain, and negative magnetic resonance imaging of the lumbar spine. A control group consisted of 50 patients of matched age who had computed tomography scans of the pelvis for a reason other than pelvic or back pain. Computed tomography scans showed one or more findings in 57.5% and 31% of the sacroiliac joints in the symptomatic and the control groups, respectively. The computed tomography scans were negative in 37 (42.5%) symptomatic sacroiliac joints with a positive sacroiliac joint injection test. The sensitivity of computed tomography was 57.5 % and its specificity was 69%. The finding of the current study suggests limited diagnostic value of computed tomography in sacroiliac joint disease because of its low sensitivity and specificity. With clinical suspicion of a sacroiliac origin of pain, intraarticular injection is currently the only means to confirm that diagnosis. PubMed
April 1987
Recognizing specific characteristics of nonspecific low back pain.
Bernard TN Jr, Kirkaldy-Willis WH.
Summary
A retrospective review of 1293 cases of low back pain treated over a 12-year period revealed that sacroiliac joint syndrome and posterior joint syndromes were the most common referred-pain syndromes, whereas herniated nucleus pulposus and lateral spinal stenosis were the most common nerve root compression lesions…In 30% of the cases of spondylolisthesis, the radiographic findings were incidental and the source of pain was the sacroiliac joint.
Abstract @ Pubmed