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Short-term sacroiliac joint fusion results for pelvic girdle pain predict long-term outcomes
Patients with successful sacroiliac joint fusions continued to see good outcomes 20 years after surgery, but the results were no different than those in non-surgical controls.
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AMSTERDAM — Among patients who underwent sacroiliac joint fusion for severe pelvic girdle pain, Norwegian researchers found their status at the 1-year follow-up was a good predictor of results 2 decades later.
“Twenty-three years after sacroiliac (SI) joint fusion, the patients were moderately disabled and had moderate pain,” Thomas J. Kibsgård, MD, said. “One-year outcomes seem to predict long-term outcomes, but the results did not differ from a non-matched control group,” he said.
Kibsgård, of Oslo University Hospital in Norway, and colleagues compared patients who underwent SI joint fusion between 1977 and 1998 with patients with severe girdle pain who did not undergo surgery. They analyzed function, health-related quality of life and pain intensity in both groups with the Oswestry Disability Index (ODI), SF-36 and Visual Analog Scale (VAS), according to the abstract.
Outcomes at each follow-up
Thomas J. Kibsgård
Of the original 81 patients with SI joint fusion, 50 patients were available for follow-up. Additionally, researchers sent a quality-of-life questionnaire to 48 patients who did not undergo surgical treatment for severe pelvic girdle pain and 28 of them answered the letter, Kibsgård said.
Study results showed SI joint fusions for this indication, all of which were transiliac fusions, were successful in 48% of patients at the 1-year follow-up. These patients had significantly higher ODI scores compared to those patients in the study who had unsuccessful SI joint fusions.
Sacroiliac joint fusion was performed for severe pelvic girdle pain.
Image: Kibsgård TJ
At 1 year postoperatively, mean ODI scores were 27 points for patients with successful outcomes, 37 points for the 12 patients with partially successful outcomes, and 43 points for the 14 patients with unsuccessful fusions. Success was defined as pain after treatment that was the same as or worse than it was preoperatively, according to investigators.
Similar long-term results
Patients with successful outcomes at 1 year maintained significantly better pain and function scores over time than those with unsuccessful fusions, according to the abstract.
There was no significant difference between ODI, joint pain and education for the two groups, but the controls were 6 years younger, Kibsgård said.
Overall, outcomes in patients who underwent fusion surgery did not differ from those in the control group at 23 years, he said.
At the long-term follow-up, patients with SI joint fusion, as a whole, had mean ODI scores of 33 points and mean VAS pain scores of 54 points, while the non-surgical group reported having a mean ODI of 37 points and mean VAS of 60 points, according to the results. – by Jeff Craven
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Disclosure: The authors received grants from the Norwegian Foundation for Health and Rehabilitation and Rehabilitation and Sophies Minde Ortopedie AS for this study.
Perspective
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Steven R. Garfin, MD
This paper demonstrates that SI joint fusion for SI pain can be helpful with good improvement in function and pain in long-term (30 year) follow-up. The procedures performed were open, as distinguished from current more minimally invasive stabilization/fusion techniques. Their work-up was similar to what is done today, though I did not find reference to SI joint injections for pain relief — to assist with the diagnosis (unless"normal radiculography" implies SI joint injection). The authors had about 70% good-fair long-term results, which is similar to most previous articles (mainly case series) of open procedures for SI joint pain with 70% success in much shorter follow-up. It is interesting to note how similar the 1 year and 30 year follow-ups were, which is encouraging. The article points out that many patients can benefit from SI joint fusions for chronic SI joint-related problems — a diagnosis and patient group many of us (particularly surgeons) have ignored. I agree with the authors' comment that "future research should address the question of who will benefit from the surgery" since we know from this article a significant number of patients do obtain relatively long-term functional and pain relief.
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