Predictors of Outcome in Conservative and Minimally Invasive Surgical Management of Pain Originating From the Sacroiliac Joint: A Pooled Analysis

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2017-11, Vol.42 (21), p.1664-1673
• Main Authors: Dengler, Julius, Duhon, Bradley, Whang, Peter, Frank, Clay, Glaser, John, Sturesson, Bengt, Garfin, Steven, Cher, Daniel, Rendahl, Aaron, Polly, David
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthralgia - therapy; Back Pain - diagnosis; Back Pain - surgery; Conservative Treatment - methods; Conservative Treatment - trends; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - trends; Pain Management - methods; Pain Management - trends; Predictive Value of Tests; Prospective Studies; Randomized Controlled Trials as Topic - methods; Sacroiliac Joint - pathology; Sacroiliac Joint - surgery; Spinal Fusion - methods; Spinal Fusion - trends; Surgery; Time Factors; Treatment Outcome
• ISSN: 0362-2436; 1528-1159; 1528-1159
• DOI: 10.1097/BRS.0000000000002169

STUDY DESIGN.A pooled patient-level analysis of two multicenter randomized controlled trials and one multicenter single-arm prospective trial. OBJECTIVE.The aim of this study was to identify predictors of outcome of conservative and minimally invasive surgical management of pain originating from the sacroiliac joint (SIJ). SUMMARY OF BACKGROUND DATA.Three recently published prospective trials have shown that minimally invasive SIJ fusion (SIJF) using triangular titanium implants produces better outcomes than conservative management for patients with pain originating from the SIJ. Due to limitations in individual trial sample size, analyses of predictors of treatment outcome were not conducted. METHODS.We pooled individual patient data from the three trials and used random effects models with multivariate regression analysis to identify predictors for treatment outcome separately for conservative and minimally invasive surgical treatment. Outcome was measured using visual analogue scale (VAS), Oswestry Disability Index (ODI), and EuroQOL-5D (EQ-5D). RESULTS.We included 423 patients assigned to either nonsurgical management (NSM, n = 97) or SIJF (n = 326) between 2013 and 2015. The reduction in SIJ pain was 37.9 points larger [95% confidence interval (95% CI) 32.5–43.4, P