title: Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management.
abstract: To compare the safety and effectiveness of minimally invasive sacroiliac joint fusion (SIJF) using triangular titanium implants vs conservative management (CM) in patients with chronic sacroiliac joint (SIJ) pain.
  
  
  
  103 adults with chronic SIJ pain at nine sites in four European countries were randomly assigned to and underwent either minimally invasive SIJF using triangular titanium implants (N = 52) or CM (N = 51). CM was performed according to the European guidelines for the diagnosis and management of pelvic girdle pain and consisted of optimization of medical therapy, individualized physical therapy (PT) and adequate information and reassurance as part of a multifactorial treatment. The primary outcome was the difference in change in self-rated low back pain (LBP) at 6 months. Additional endpoints included quality of life using EQ-5D-3L, disability using Oswestry Disability Index (ODI), SIJ function using active straight leg raise (ASLR) test and adverse events. NCT01741025.
  
  
  
  At 6 months, mean LBP improved by 43.3 points in the SIJF group and 5.7 points in the CM group (difference of 38.1 points, p < 0.0001). Mean ODI improved by 26 points in the SIJF group and 6 points in the CM group (p < 0.0001). ASLR, EQ-5D-3L, walking distance and satisfaction were statistically superior in the SIJF group. The frequency of adverse events did not differ between groups. One case of postoperative nerve impingement occurred in the surgical group.
  
  
  
  In patients with chronic SIJ pain, minimally invasive SIJF using triangular titanium implants was safe and more effective than CM in relieving pain, reducing disability, improving patient function and quality of life.
authors.affiliation: Department of Orthopedics, Aleris, Ängelholm Hospital, Ängelholm, Sweden. sturesson.bengt@gmail.com.
authors.forename: Bengt
authors.initials: B
authors.lastname: Sturesson
authors.affiliation: Department of Neurosurgery, Onze-Lieve-Vrouw Hospital Aalst, Aalst, Belgium.
authors.forename: Djaya
authors.initials: D
authors.lastname: Kools
authors.affiliation: Department of Orthopedics and Traumatology, University Hospital Bonn, Bonn, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Pflugmacher
authors.affiliation: Instituto Ortopedico Rizzoli di Bologna, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gasbarrini
authors.affiliation: Department of Orthopedics and Traumatology, ASST Ovest Milanese, Ospedale di Legnano, Legnano, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Prestamburgo
authors.affiliation: Department of Neurosurgery, Charité, Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Dengler
mesh_terms: D000328:Adult; D000368:Aged; D000072700:Conservative Treatment; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D019736:Prostheses and Implants; D011788:Quality of Life; D012446:Sacroiliac Joint / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation; D014025:Titanium; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D014025:Titanium
keywords: Conservative management; Pelvic girdle pain; Randomized controlled trial; Sacroiliac joint dysfunction; Sacroiliac joint fusion; Titanium sacroiliac implant; iFuse Implant System