Sacroiliac Joint Fusion Versus Sham Operation for Treatment of Sacroiliac Joint Pain

Not Applicable

Active, not recruiting

• Conditions: Sacroiliac Joint Somatic Dysfunction
• Interventions: Procedure: iFuse; Radiation: fMRI study; Procedure: sham group

• Registration Number: NCT03507049
• Lead Sponsor: Oslo University Hospital

Brief Summary

Sacroiliac joint fusion versus sham operasjon for treatment of sacroiliac pain. A prospective double blinded randomized controlled multicentre study.

Detailed Description

Sacroiliac(SI) joint pain can lead to long-lasting severe pain and reduce physical function. It is shown to be the source of pain in 13-30% of patients with low back pain. Former surgical techniques had a high level of complications and low success rates. Newer mini-invasive surgical approaches have shown promising results in scientific studies. It is difficult to find an adequate control group for surgery as most patients already have tried conservative and alternative treatments without effect. A sham-designed study is the best alternative. This study is designed as a prospective randomized double blinded controlled mulitcenter trial. The investigators want to examine whether there is a difference in SI joint pain in patients operated with miniinvasive arthrodesis of the SI joint compared to a sham operated control group. Patients with SI joint pain are included. They will be randomized to either surgery with arthrodesis or sham surgery. Neither patient nor health personell who work with the patient after the surgery will know what has been done. The primary end point for the study is group difference in sacroiliac joint pain on the operated side after 6 months.

Study Timeline

• Study First Submitted: 2018-04-06
• Study First Submitted QC: 2018-04-14
• Study First Posted: 2018-04-24
• Study Start: 2018-06-08
• Primary Completion: 2022-05-25
• Status Verified: 2022-07
• Last Update Submitted: 2022-07-06
• Last Update Posted: 2022-07-11
• Study Completion: 2030-05-25

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 63

Inclusion Criteria

1. Age 21-70 at time of screening
2. Patient with suspected SIJ pain for >6 months or >18 months for pregnancy induced pelvic girdle pain.
3. Diagnosis of the SI joint as the primary pain generator based on ALL of the following:

A. Patient has pain at or close to the posterior superior iliac spine (PSIS) with possible radiation into buttocks, posterior thigh or groin and can point with a single finger to the location of pain (Fortin Finger Test)

B. Patient has at least 3 of 6 physical examination maneuvers specific for SI joint pain:

1. Compression
2. Posterior Pelvic Pain Provocation test - P4 (Thigh Thrust)
3. Palpation of the long dorsal ligament
4. Patrick's test (Faber)
5. Leg Raise (ASLR )
6. Geanslens test

C. Patient has improvement in lower back pain NRS of at least 50% of the pre injection NRS score after fluoroscopic controlled injection of local anesthetic into affected SI joint (including previous documented test <6 months ago)

4. Baseline Oswestry Disability Index (ODI) score of at least 30%

5. Baseline lower back pain score of at least 5 on 0-10 point NRS

6. Patient should have tried adequate forms of conservative treatment with little or no response.

7. Patient has signed study-specific informed consent

8. Patient has the necessary mental capacity to participate and is physically able to comply with study protocol requirements.

9. Patients with unilateral or bilateral pain can be included in the study if they clearly can differentiate between the two sides. It is the most painful side that will be included and randomized to SIJ fusion or sham surgery in the study.

Exclusion Criteria

1. Severe low back pain due to other causes, such as lumbar disc degeneration, lumbar disc herniation, lumbar spondylolisthesis, lumbar spinal stenosis, lumbar facet degeneration, and lumbar vertebral body fracture.
2. Sacroiliac pathology caused by auto-immune disease (e.g. ankylosing spondylitis) and/or neoplasia (e.g. benign or malignant tumor) and/or crystal arthropathy
3. History of recent (<1 year) fracture of the pelvis with documented malunion, non-union of sacrum or ilium or any type of internal fixation of the pelvic ring.
4. Spine surgery during the past 12 months.
5. Previously diagnosed or suspected osteoporosis (defined as prior T-score <-2.5 or history of osteoporotic fracture)
6. Documented osteomalacia or other metabolic bone disease
7. Any condition or anatomy that makes treatment with the iFuse Implant System infeasible
8. Patients with prior successful fusion to the contra lateral side are exluded from the study.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention group	iFuse	The intervention Group receives operation with SI-joint arthrodesis with the iFuse implant. The patient undergoes full anesthesia. The procedure starts with an approximately 5cm long skin incision over the posterolateral aspect of the pelvis. A guide-pin is inserted over the sacroiliac joint at the desired entry-point, verified by fluoroscopy. The surgeons drills and boraches over the pin and the ifuse implant is inserted. This is repeated for a total of three implants. The wound is closed with non-resorbable suture. An injection of the SIJ with local anesthetic is performed under guidance of fluoroscopy at the time of the procedure.
Functional MRI study	fMRI study	The Swedish patients will also undergo quantitative sensory testing at inclusion and at 6 month follow-up. At the same time they will undergo a cerebral MRI and a Functional MRI looking at activation of the CNS from pain in the sacroiliac joints induced by one leg lift. The purpose of this study is to look at contributing factors in treatment response. One hopes to map which CNS mechanisms are involved in causing the chronic pain these patients experience as well as how they respond to treatment.
Sham group	sham group	The sham operation will consist of the surgeon making the same skin incision as for an iFuse procedure, although nothing more, and then closing the wound. The patients undergoing a sham operation will be under general anesthesia for a random time of 20-40minutes in order to keep the two procedures as similar as possible. An injection of the SIJ with local anesthetic is performed under guidance of fluoroscopy at the time of the procedure.

Primary Outcome Measures

Name	Time	Method
Primary outcome measure - Numeric Rating Scale operated side	6 months	the primary endpoint is group difference in Numeric Rating Scale(NRS) pain-score on the operated side at six months postoperatively. Numeric rating scale is a pain-score scale from 0-10, where 0 is no pain and 10 is worst possible pain.

Secondary Outcome Measures

Name	Time	Method
Baseline NRS	baseline, 3, 6, 12 and 24 months	Change from baseline Numeric Rating Scale (NRS) pain-score on the operated side at 3,6,12 and 24 months
Device breakage, loosening or migration on CT of the sacroiliac joint	12 months	Device breakage loosening or migration at 12 months judged by clinical symptoms and CT of the sacroiliac joint.
Oswestry disability index (ODI)	baseline, 3, 6,12, 24 months	Change in disability due to pelvic pain measured by Oswestry Disability Index(ODI) at 3,6,12,24 months
Quality of life (EQ-5D)	baseline, 3, 6, 12, 24 months	Change in quality of life measured by EQ-5D at 3,6,12,24 months
NRS on non-operated side	baseline, 3, 6, 12, 24 months	Change from baseline in non-operated side NRS at 3,6,12 and 24 months
Pelvic girdle questionnaire	baseline, 3, 6, 12, 24 months	Change in disability due to pelvic pain measured by Pelvic Girdle Questionnaire(PGQ) at 3,6,12,24 months
Global NRS	baseline,3 ,6 ,12 ,24 months	Change from baseline global NRS at 3,6,12 and 24 months
NRS leg pain	baseline, 3,6,12,24 months	Change from baseline leg pain NRS at 3,6,12,24 months

Trial Locations

Locations (2)

Karolinska University Hospital; 🇸🇪 Stockholm, Sweden

Rikshospitalet, Oslo University Hospital; 🇳🇴 Oslo, Norway