Sacroiliac joint fusion (SIJF) and triangular titanium implants are associated with higher pain relief and greater reductions in disability than conservative management in patients with sacroiliac joint-related chronic low back pain, according to results of a randomized placebo-controlled trial published in Pain Physician.

In this prospective multicenter trial, investigators randomly assigned patients with chronic low back pain to receive conservative management (n=51) or SIJF with triangular titanium implants (n=52). Patients in the conservative management group received individualized physiotherapy, optimized medical therapy, and cognitive behavioral therapy in some instances.

Self-rated low back pain improved by 41.6 points in the SIJF group compared with 14.0 points in the conservative management arm at 12 months (P <.0001).

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In addition, patients receiving SIJF vs conservative management experienced greater reductions in disability as assessed by the Oswestry Disability Index (P <.0001). At 6 months, a greater proportion of patients who received surgery reported they were “very satisfied” with treatment vs those receiving conservative management (53.8% vs 18.4%, respectively; P <.0001).

Patients receiving conservative management who did not see benefits at 6 months crossed over to the SIJF arm. Following crossover, patients who had previously received conservative management experienced improvements in pain, disability, and quality of life similar to those of patients originally assigned to surgery. A total of 2 patients receiving surgery had recurrent pain potentially related to treatment.

Considering that this study did not blind participants or operators, some of the reported effects in patients receiving surgery may be attributed to a placebo effect. In addition, the investigators suggest that some patients may have had underlying contributors to their low back pain that were not accounted for prior to treatment, potentially limiting patients’ response to surgical intervention.

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Despite the study’s inherent limitations, the researchers believe that the findings supporting beneficial effects of SIJF will “help to inform decisions regarding its use as a treatment option…for patients with sacroiliac joint pain not responsive to non-surgical care.”

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Cher D, Sturesson B, van Eeckhoven E, et al. 1-Year results of a randomized controlled trial of conservative management vs. minimally invasive surgical treatment for sacroiliac joint pain. Pain Physician. 2017;20(6):537-550.