A new study published in Spine compares minimally invasive sacroiliac joint surgery to conservative care.
Study authors examined three prospective trials addressing minimally invasive SI joint fusion with triangular titanium implants. The recently published studies show surgical management was associated with better outcomes than conservative management, but due to the studies' small sample sizes, the original authors were unable to predict outcomes based on the data for each individual study.
In this most recent article, the study authors pooled data from all three trials and conducted a multivariate regression analysis for the 423 patients. Ninety-seven patients underwent nonsurgical management and 326 underwent fusion.
Study authors found:
1. Patients who underwent the minimally invasive surgical procedures experienced a larger pain reduction than the nonsurgical management group, measured at 37.9 points on the visual analog scale.
2. Oswestry Disability Index scores improved more in the surgical management group as well, with an 18.3 point gap between the average surgical and nonsurgical management scores.
3. Predictors of reduced improvement in the surgical management group include smoking, opioid use, younger patients and longer time spent with SI joint pain. There weren't any significant predictors of outcome among the conservative management group.
4. Study authors concluded, "Our results support the view that SIJF leads to better treatment outcome than conservative management of SIJ pain and that a higher margin of improvement can be predicted in nonsmokers, nonopioid users and patients of increased age and with longer pain duration."