Abstract
Purpose
Fusion of the sacroiliac joints (SIJ) has been a treatment option for patients with severe pelvic girdle pain (PGP). The primary aims were to evaluate the long-term outcomes in patients who underwent SIJ fusion and to compare 1-year outcomes with long-term outcomes. The secondary aim was to compare patients who underwent SIJ fusion with a comparable group who did not.
Methods
This study includes fifty patients that underwent SIJ fusion between 1977 and 1998. Function (the Oswestry disability index; ODI), pain intensity (visual analogue scale; VAS) and health-related quality of life (SF-36) were determined according to a patient-reported questionnaire. The questionnaire scores were compared with previously recorded 1-year outcomes and with questionnaire scores from a group of 28 patients who did not undergo SIJ fusion.
Results
The patients who underwent SIJ fusion reported a mean ODI of 33 (95 % CI 24–42) and a mean VAS score of 54 (95 % CI 46–63) 23 years (range 19–34) after surgery. Regarding quality of life, the patients reported reduced physical function, but mental health was not affected in the same manner. The patients with successful 1-year outcomes (48 %) retained significantly improved function and reduced pain levels compared with the subgroup of patients with unsuccessful 1-year outcomes (28 %). The patients who underwent surgery did not differ from the non-surgery group in any outcome at the long-term follow-up.
Conclusions
Patients treated with SIJ fusion had moderate disability and pain 23 years after surgery, and the 1-year outcomes were sustained 23 years after surgery. Although many fused patients reported good outcome, this group did not differ from the comparable non-surgical group.
Similar content being viewed by others
References
Al-Khayer A, Hegarty J, Hahn D, Grevitt MP (2008) Percutaneous sacroiliac joint arthrodesis: a novel technique. J Spinal Disord Tech 21:359–363
Bellamy N, Park W, Rooney PJ (1983) What do we know about the sacroiliac joint? Semin Arthritis Rheum 12:282–313
Buchowski JM, Kebaish KM, Sinkov V, Cohen DB, Sieber AN, Kostuik JP (2005) Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint. Spine J 5:520–528
Damen L, Buyruk HM, Guler-Uysal F, Lotgering FK, Snijders CJ, Stam HJ (2001) Pelvic pain during pregnancy is associated with asymmetric laxity of the sacroiliac joints. Acta Obstet Gynecol Scand 80:1019–1024
Dreyfuss P, Michaelsen M, Pauza K, McLarty J, Bogduk N (1996) The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine (Phila Pa 1976) 21:2594–2602
Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine (Phila Pa 1976) 25:2940–2952
Hagen R (1974) Pelvic girdle relaxation from an orthopaedic point of view. Acta Orthop Scand 45:550–563
Hagg O, Fritzell P, Nordwall A (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20
Loge JH, Kaasa S (1998) Short form 36 (SF-36) health survey: normative data from the general Norwegian population. Scand J Soc Med 26:250–258
Schutz U, Grob D (2006) Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Acta Orthop Belg 72:296–308
Sitzia J (1999) How valid and reliable are patient satisfaction data? An analysis of 195 studies. Int J Qual Health Care 11:319–328
Smith-Peterson MN (1921) Arthrodesis of the sacroiliac joint. A new method of approch. J Bone Joint Surg 3:400–405
Stuge B, Laerum E, Kirkesola G, Vollestad N (2004) The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine (Phila Pa 1976) 29:351–359
Sturesson B, Selvik G, Uden A (1989) Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis. Spine 14:162–165
Sturesson B, Uden A, Vleeming A (2000) A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine (Phila Pa 1976) 25:214–217
van Zwienen CMA, van den Bosch EW, Snijders CJ, van Vugt AB (2004) Triple Pelvic Ring Fixation in Patients With Severe Pregnancy-Related Low Back and Pain. Spine 29:478–484
Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B (2008) European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J 17:794–819
Waisbrod H, Krainick JU, Gerbershagen HU (1987) Sacroiliac joint arthrodesis for chronic lower back pain. Arch Orthop Trauma Surg 106:238–240
Walheim GG (1984) Stabilization of the pelvis with the Hoffmann frame. An aid in diagnosing pelvic instability. Acta Orthop Scand 55:319–324
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483
Acknowledgments
We gratefully acknowledge the assistance of Ingar Holme for his help with statistics, Kaja Sætre (study coordinator) and Terje Sande with the DOS patient database. This study was supported by grants from the Norwegian Foundation for Health and Rehabilitation and Sophies Minde Ortopedi AS.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kibsgård, T.J., Røise, O., Sudmann, E. et al. Pelvic joint fusions in patients with chronic pelvic girdle pain: a 23-year follow-up. Eur Spine J 22, 871–877 (2013). https://doi.org/10.1007/s00586-012-2512-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-012-2512-8