Article Figures & Data
Figures
- Fig. 1
Physical examination tests for sacroiliac joint dysfunction: A: thigh thrust; B: flexion, abduction, and external rotation (FABER); C: pelvic gapping (distraction); D: compression; E: Gaenslen test.
- Fig. 2
Six- and 12-month absolute (top) and relative (i.e., percent, bottom) improvement in VAS SIJ pain by average pain reduction during SIJB. Each dot represents an individual SIJF in INSITE (light green) or SIFI (dark green). Values are jittered slightly for visualization. Shaded areas represent 95% smoothed confidence intervals from linear regression. Plots show Pearson correlation coefficient combined across studies and associated p-values.
- Fig. 3
Six- and 12-month absolute (top) and relative (i.e., percent, bottom) improvement in Oswestry Disability Index (ODI) by average pain reduction during SIJB. Each dot represents an individual SIJF in INSITE (light green) or SIFI (dark green). Values are jittered slightly for visualization. Shaded areas represent 95% smoothed confidence intervals from linear regression. Plots show Pearson correlation coefficient combined across studies and associated p-values.
Tables
Characteristic Non-Surgical Management (n=46) SI Joint Fusion (n=274)* P-value** Age, mean (SD, range)
=65 years old, n (%)53.8 (10.6, 29.5-71.1)
8 (17.4%)50.6 (11.3, 23.5-71.7)
32 (11.7%)0.7245
0.3325Women, n (% female) 28 (60.9%) 195 (71.2%) 0.1684 Race, n (%)
White
Black
American Indian
Hawaiian, Pacific Islander
Other43 (93.5%)
2 (4.3%)
0 (0.0%)
0 (0.0%)
1 (2.2%)263 (96.0%)
5 (1.8%)
1 (0.4%)
1 (0.4%)
4 (1.5%)0.4786 Ethnicity Hispanic or Latino, n (%) 4 (8.7%) 11 (4.0%) 0.2459 Body mass index, mean (SD, range) 30.6 (6.6, 19.4-48.9) 29.7 (6.5, 14.1-51.0) 0.1549 Smoking status, n (%) Current smoker Former smoker Never smoker 3 (6.5%) 13 (28.3%) 30 (65.2%) 70 (25.5%) 79 (28.8%) 125 (45.6%) 0.0050 Condition
DS
SD18 (39.1%)
28 (60.9%)79 (28.8%)
195 (71.2%)0.4132 Prior lumbar fusion (n, %) 17 (37.0%) 116 (42.3%) 0.5222 Years of pain, mean (range) 5.0 (0.5-38.9) 5.8 (0.4-41.1) 0.1059 VAS SI joint pain score, mean (±SD) 82.3 (10.0) 80.7 (12.6) 0.0589 ODI score, mean (±SD) 56.2 (14.3) 56.0 (11.9) 0.2422 - Table 2
Proportion of SIJF and NSM subjects in INSITE and SIFI achieving a threshold reduction in pain or ODI score at month 6 by average response during screening SIJB.
At least 20 point reduction in VAS SIJ pain At least 15 point reduction in ODI Score SIJ Fusion NSM SIJ Fusion NSM Average response during SIJ block 40-50% 25/32 (78.1%) 0/5 (0.0%) 19/32 (59.4%) 0/5 (0.0%) 50-60% 22/27 (81.5%) 1/4 (25.0%) 17/27 (63.0%) 0/4 (0.0%) 60-70% 28/33 (84.8%) 1/3 (33.3%) 20/33 (60.6%) 1/3 (33.3%) 70-80% 27/35 (77.1%) 2/9 (22.2%) 26/35 (74.3%) 0/9 (0.0%) 80-90% 36/44 (81.8%) 2/8 (25.0%) 33/44 (75.0%) 1/8 (12.5%) 90-100% 80/97 (82.5%) 6/16 (37.5%) 67/97 (69.1%) 4/16 (25.0%) All 219/271 (80.8%) 12/45 (26.7%) 183/271 (67.5%) 6/45 (13.3%) - Table 3
Proportion of SIJF and NSM subjects achieving 6 month pain or ODI scores less than indicated threshold by average response during screening SIJ block.
VAS SIJ Pain at 6 Mo =30 ODI at 6 Mo =20 SIJ Fusion NSM SIJ Fusion NSM Average response during SIJ block 40-50% 18/32 (56.2%) 0/5 (0.0%) 12/32 (37.5%) 0/5 (0.0%) 50-60% 16/27 (59.3%) 0/4 (0.0%) 10/27 (37.0%) 0/4 (0.0%) 60-70% 20/33 (60.6%) 1/3 (33.3%) 9/33 (27.3%) 1/3 (33.3%) 70-80% 20/35 (57.1%) 0/9 (0.0%) 18/35 (51.4%) 0/9 (0.0%) 80-90% 23/44 (52.3%) 0/8 (0.0%) 19/44 (43.2%) 0/8 (0.0%) 90-100% 60/97 (61.9%) 3/16 (18.8%) 32/97 (33.0%) 2/16 (12.5%) All 157/271 (57.9%) 4/45 (8.9%) 100/271 (36.9%) 3/45 (6.7%) - Table 4
Response to treatment in those with high or low responses to diagnosis of the underlying condition. Chart courtesy of Steven Cohen.*
Author N Procedure Comparison Results Cohen et al. 20071 92 Cervical facet RF >50% vs. >80% 56% success rate in > 50% group vs. 58% in > 80% group Erdek et al. 20102 50 Celiac plexus neurolysis >50% vs. >80% 56% success rate in > 50% group vs. 54% in > 80% group Cohen et al. 20073 262 Lumbar facet RF >50% vs. >80% 52% success rate in > 50% group vs. 56% in > 80% group Stojanovic et al. 20104 77 Lumbar facet RF >50% vs. >80% 47% success rates in both groups Williams et al. 20115 244 Spinal cord Stimulation <50% vs. >50% vs. >75% 18% in < 50% vs. 90% in > 50% vs. 71% in > 75% groups Cohen et al. 20096 77 SI joint RF >50% vs. >80% 51% success rate in > 50% group vs. 49% in > 80% group Huang et al. 20127 101 Pulsed RF of occipital nerves <50% vs. >50% vs. >80% 50% in < 50% vs. 48% in > 50% vs. 58% in > 75% groups McGreevy 20138 32 Superior hypogastric neurolysis % pain relief Mean pain relief of 75% for positive outcomes vs. 82% for negative outcomes ↵* Personal communication, Steven Cohen, MD (Johns Hopkins University), September 2, 2015.
↵1 Cohen SP, Bajwa ZH, Kraemer JJ, et al. Factors predicting success and failure for cervical facet radiofrequency denervation: a multi-center analysis. Reg Anesth Pain Med. 2007;32(6):495-503. doi:10.1016/j.rapm.2007.05.009.
↵2 Erdek MA, Halpert DE, González Fernández M, Cohen SP. Assessment of celiac plexus block and neurolysis outcomes and technique in the management of refractory visceral cancer pain. Pain Med Malden Mass. 2010;11(1):92-100. doi:10.1111/j.1526-4637.2009.00756.x.
↵3 Cohen SP, Hurley RW, Christo PJ, Winkley J, Mohiuddin MM, Stojanovic MP. Clinical predictors of success and failure for lumbar facet radiofrequency denervation. Clin J Pain. 2007;23(1):45-52. doi:10.1097/01.ajp.0000210941.04182.ea.
↵4 Stojanovic MP, Sethee J, Mohiuddin M, et al. MRI analysis of the lumbar spine: can it predict response to diagnostic and therapeutic facet procedures? Clin J Pain. 2010;26(2):110-115. doi:10.1097/AJP.0b013e3181b8cd4d.
↵5 Williams KA, Gonzalez-Fernandez M, Hamzehzadeh S, et al. A multi-center analysis evaluating factors associated with spinal cord stimulation outcome in chronic pain patients. Pain Med Malden Mass. 2011;12(8):1142-1153. doi:10.1111/j.1526-4637.2011.01184.x.
↵6 Cohen SP, Strassels SA, Kurihara C, et al. Outcome Predictors for Sacroiliac Joint (Lateral Branch) Radiofrequency Denervation. Reg Anesth Pain Med. 2009;34(3):206-214. doi:10.1097/AAP.0b013e3181958f4b.
↵7 Huang JHY, Galvagno SM, Hameed M, et al. Occipital nerve pulsed radiofrequency treatment: a multi-center study evaluating predictors of outcome. Pain Med Malden Mass. 2012;13(4):489-497. doi:10.1111/j.1526-4637.2012.01348.x.
↵8 McGreevy K, Hurley RW, Erdek MA, Aner MM, Li S, Cohen SP. The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study. Pain Pract Off J World Inst Pain. 2013;13(2):89-95. doi:10.1111/j.1533-2500.2012.00557.x.
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