Refer for SIJ PRP before or after fusion?

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Do you refer for SIJ PRP before or after SIJ fusion?

  • Strictly before.

    Votes: 9 69.2%

  • Strictly after.

    Votes: 2 15.4%

  • Why not both??

    Votes: 4 30.8%
  • Total voters
    13
SSdoc33 said:
false choice
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1619917964882.png
 
Posterior bone graft fusion? It works...
 
SSdoc33 said:
Ah.

Then i HOPE you are a better snake oil salesman than me, nelson....
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Randomized Controlled Trial

Pain Pract

. 2017 Jul;17(6):782-791.
doi: 10.1111/papr.12526. Epub 2016 Dec 1.

Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain​

Varun Singla 1, Yatindra K Batra 2, Neerja Bharti 3, Vijay G Goni 4, Neelam Marwaha 5
Affiliations expand

Abstract​

Background: Despite the widespread use of steroids to treat sacroiliac joint (SIJ) pain, their duration of pain reduction is short. Platelet-rich plasma (PRP) can potentially enhance tissue healing and may have a longer-lasting effect on pain.
Objectives: To assess the efficacy and safety of PRP compared with methylprednisolone in ultrasound-guided SIJ injection for low back pain.
Study design: Prospective randomized open blinded endpoint (PROBE) study.
Methods: Forty patients with chronic low back pain diagnosed with SIJ pathology were randomly allocated into 2 groups. Group S received 1.5 mL of methylprednisolone (40 mg/mL) and 1.5 mL of 2% lidocaine with 0.5 mL of saline, while Group P received 3 mL of leukocyte-free PRP with 0.5 mL of calcium chloride into ultrasound-guided SIJ injection. Visual analog scale (VAS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, Short Form (SF-12) Health Survey scores and complications (if any) were evaluated at 2 weeks, 4 weeks, 6 weeks, and 3 months.
Results: Intensity of pain was significantly lower in Group P at 6 weeks (median [interquartile range (IQR)] = 1 [1 to 1] vs. 3.5 [2 to 5]; P = 0.0004) and 3 months (Median [IQR] = 1 [1 to 3] vs. 5 [3 to 5]; P = 0.0002) as compared to Group S. The efficacy of steroid injection was reduced to only 25% at 3 months in Group S, while it was 90% in Group P. A strong association was observed in patients receiving PRP and showing a reduction of VAS ≥ 50% from baseline when other factors were controlled. The MODQ and SF-12 scores were improved initially for up to 4 weeks but deteriorated further at 3 months in Group S, while both the scores improved gradually for up to 3 months in Group P.
Conclusion: The intra-articular PRP injection is an effective treatment modality in low back pain involving SIJ.
Keywords: low back pain; methylprednisolone; platelet-rich plasma; prospective randomized open blinded endpoint study; sacroiliac joint injection; ultrasound-guided.
© 2016 World Institute of Pain.
 
PRP over Ablation. Never fusion. I don't like fusion. If someone is old, then I'd recommend Ablation. But age <40? PRP first if they prefer and can dish out the cash. I'm a believer in it.
 
A strong association was observed in patients receiving PRP and showing a reduction of VAS ≥ 50% from baseline when other factors were controlled.

These are not the words they wanted to type. Median interquartile pain relief? Will look up article but bet nrs with 50% relief wasn’t significant.
 
Steroid injection and Pt. Maybe sacral rf if covered. Never fusion.

what is the prp treating? Are u injecting posterior sacral ligaments? Intraarticular(insert slap head emoji)?

Almost all SI joint pain I see the joint is radiographically normal.
 
Wait, we could just stim it!

https://commonfund.nih.gov/sites/default/files/Stimwave.pdf Page 11-13of the PDF is the Stimwave brochure for the SI joint
1619988872042.png

Intractable sacroiliac joint pain treated with peripheral nerve field stimulation - PMC

As many as 62% low back pain patients can have sacroiliac joint (SIJ) pain. There is limited (to poor) evidence in regards to long-term pain relief with therapeutic intra-articular injections and/or conventional (heat or pulsed) radiofrequency ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
1619988983031.png
 
Orin said:
Wait, we could just stim it!

https://commonfund.nih.gov/sites/default/files/Stimwave.pdf Page 11-13of the PDF is the Stimwave brochure for the SI joint
View attachment 336112

Intractable sacroiliac joint pain treated with peripheral nerve field stimulation - PMC

As many as 62% low back pain patients can have sacroiliac joint (SIJ) pain. There is limited (to poor) evidence in regards to long-term pain relief with therapeutic intra-articular injections and/or conventional (heat or pulsed) radiofrequency ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
View attachment 336113
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This will be a Game changer! #gamechanger #FieldStimSOS_FTW @lobelsteve
 
nvrsumr said:
Steroid injection and Pt. Maybe sacral rf if covered. Never fusion.

what is the prp treating? Are u injecting posterior sacral ligaments? Intraarticular(insert slap head emoji)?

Almost all SI joint pain I see the joint is radiographically normal.
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Who cares if pt still has cash ⛵
 
it's a chicken and egg question. IT pump first to get the micro-dosing going, or stimulator?
if stimulator first, should we go dorsal column, peripheral stim, or DRG?

why not all 4?

PT before or after IT pump? DRG for knee arthropathy before or after recommending weight loss? should we just wait until the ASC opens? but how we afford the boat and alimony??
 
oreosandsake said:
it's a chicken and egg question. IT pump first to get the micro-dosing going, or stimulator?
if stimulator first, should we go dorsal column, peripheral stim, or DRG?

why not all 4?

PT before or after IT pump? DRG for knee arthropathy before or after recommending weight loss? should we just wait until the ASC opens? but how we afford the boat and alimony??
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I know that guy. 5 ex wives. Runs a chain of clinics.
 
One of the SIJ Fusion reps came by. I'll be honest, I might try it on a patient, if they really want to do it and they've been with true chronic SIJ pain for years, failed ablation, not interested in regenerative medicine. The likelihood of me finding this patient is low, but I would be curious to see how one does. Still not a believer in it, but I am open to trying it once. My biggest issue is, I don't want to be the guy to start a cascade chain reaction of misery for the patient due to biomechanical dysfunction they'll have afterward. Perhaps someone who is post lumbar fusion, chronic SIJ pain would be a candidate to try it on.
 
DrSpine said:
One of the SIJ Fusion reps came by. I'll be honest, I might try it on a patient, if they really want to do it and they've been with true chronic SIJ pain for years, failed ablation, not interested in regenerative medicine. The likelihood of me finding this patient is low, but I would be curious to see how one does. Still not a believer in it, but I am open to trying it once. My biggest issue is, I don't want to be the guy to start a cascade chain reaction of misery for the patient due to biomechanical dysfunction they'll have afterward. Perhaps someone who is post lumbar fusion, chronic SIJ pain would be a candidate to try it on.
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First make sure they had a good ablation. I’ve repeated SIJ RFA several times on such

All but one achieved more relief after a thorough ablation.

and take the time to find a PT truly skilled at SIJ manipulation in your area. 95% of PTs are terrible at this. They can mobilize but not manipulate the SIJ.

big difference
 
I have done a bunch of the bone graft SI fusions. Most of them are markedly better after the procedure.
 
How much is the cash price for SI PRP vs perc fusion?
 
drusso said:
The PRP is about 2-5% of the price of the fusion procedure especially if it's performed in an HOPD. Why not try something so much less expensive first?
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Hey look, someone using logic. "Yeah but do you think patient's have the money for PRP?" Well at the rate healthcare costs are going, especially with HOPD facility fees, useless labs/studies, intentional in house referrals by hospitals, and high deductibles...$500 PRP is absolutely nothing. I love the indoctrination people try to do with us and confusing us with nonsense. Also, some get easily swayed by a "Cool" rep, or want to do a procedure to show off on IG to look like a surgeon. There I said it.
 
it is easy to forget that what is "absolutely nothing" to you and I is a fortune to a patient.


paying out of pocket even $100 for a therapy that costs the system nothing vs paying nothing for treatment that costs the system tens of thousands of dollars is a no brainer for any patient not in a high deductible plan.
 
Ducttape said:
it is easy to forget that what is "absolutely nothing" to you and I is a fortune to a patient.


paying out of pocket even $100 for a therapy that costs the system nothing vs paying nothing for treatment that costs the system tens of thousands of dollars is a no brainer for any patient not in a high deductible plan.
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"One man's trash is another man's treasure."
 
Ducttape said:
it is easy to forget that what is "absolutely nothing" to you and I is a fortune to a patient.


paying out of pocket even $100 for a therapy that costs the system nothing vs paying nothing for treatment that costs the system tens of thousands of dollars is a no brainer for any patient not in a high deductible plan.
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That's true. But $400-500 PRP is still far lower than a bill patient's are often left with, especially with these crazy deductibles. Not to mention, surprise billing in hospitals, facility fees, etc. Private office, sure. I think that was my comparison.
 
Ducttape said:
it is easy to forget that what is "absolutely nothing" to you and I is a fortune to a patient.


paying out of pocket even $100 for a therapy that costs the system nothing vs paying nothing for treatment that costs the system tens of thousands of dollars is a no brainer for any patient not in a high deductible plan.
Click to expand...

$100!? that's at least a week's worth of cigarettes!
 
bedrock said:
did an SIJ RFA recently which partially salvaged the results of an inappropriate SIJ fusion.

Just the saw the patient back yesterday as it was one month since the ablation. Now 70% better which is more than she ever got from the SIJ fusion.
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Are you talking about lateral screws or a posterior bone allograft? The latter typically has outstanding results and minimal recovery if a patient has good diagnostic response to SIJ injections...
 
bedrock said:
Posterior bone allograft. Didn’t help, but made her worse.
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I’m sure I only see a biased sample of the failures...... but I’ve seen at least 5 similar cases coming for 2nd opinion after the local worlds greatest pain doc (per linkedin at least) did a variety of these sij fusions. I know the ones who did well aren’t walking into my office, but still not something I’d be referring my family for
 
Taus said:
I’m sure I only see a biased sample of the failures...... but I’ve seen at least 5 similar cases coming for 2nd opinion after the local worlds greatest pain doc (per linkedin at least) did a variety of these sij fusions. I know the ones who did well aren’t walking into my office, but still not something I’d be referring my family for
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Can you elaborate?
 
Taus said:
I’m sure I only see a biased sample of the failures...... but I’ve seen at least 5 similar cases coming for 2nd opinion after the local worlds greatest pain doc (per linkedin at least) did a variety of these sij fusions. I know the ones who did well aren’t walking into my office, but still not something I’d be referring my family for
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After many cases, my experience is that it works better than most other procedures we do
 
drusso said:

Review of Current Evidence for Minimally Invasive Posterior Sacroiliac Joint Fusion

The sacroiliac joint (SIJ) is a large, irregularly shaped, serpentine joint structure bordered anteriorly and posteriorly by the sacroiliac ligaments. With increased recognition of the SIJ as a pain source, treatments have been historically nonsurgical in nature. Common treatments include...
www.ijssurgery.com www.ijssurgery.com
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GIGO...

oh and...

Disclosures and COI: Dr David Lee reports being a speaker for Abbott Neuromodulation. Dr Denis G. Patterson reports being a consultant for Abbott, CornerLoc, Flowonix, Saluda, Vertos; being a participant of speakers bureau for Abbott, Allergan, Amgen, Cornerloc, Flowonix, Lundbeck, and Vertos; an administrative board member for AIS, CornerLoc, Saluda, Spark Biomedical; and researcher for Abbott, Flowonix, Nevro. Dr. Dawood Sayed reports being a consultant and speaker for Abbott, Boston Scientific, Flowonix, Medtronic, Nevro, PainTEQ, SPR Therapeutics, Vertos, and Vertiflex


worse yet for this "study":
The authors were not able to conduct a metaanalysis of the data sets due to the following limitations: (1) the raw data from each include case series were not always included nor were they available upon request, (2) different outcomes measures were utilized, and (3) there was a lack of consistent follow-up timing.
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in fact, a total of 10 studies. essentially only 2 were prospective. the rest all retrospective.
 
Ducttape said:
GIGO...

oh and...

Disclosures and COI: Dr David Lee reports being a speaker for Abbott Neuromodulation. Dr Denis G. Patterson reports being a consultant for Abbott, CornerLoc, Flowonix, Saluda, Vertos; being a participant of speakers bureau for Abbott, Allergan, Amgen, Cornerloc, Flowonix, Lundbeck, and Vertos; an administrative board member for AIS, CornerLoc, Saluda, Spark Biomedical; and researcher for Abbott, Flowonix, Nevro. Dr. Dawood Sayed reports being a consultant and speaker for Abbott, Boston Scientific, Flowonix, Medtronic, Nevro, PainTEQ, SPR Therapeutics, Vertos, and Vertiflex


worse yet for this "study":


in fact, a total of 10 studies. essentially only 2 were prospective. the rest all retrospective.
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All fair and excellent points.

my question to the group is....has anyone done at least 5-10 posterior SI joint bone grafts themselves after working the patient up etc and feel that this procedure is NOT effective?
 
Espn123 said:
All fair and excellent points.

my question to the group is....has anyone done at least 5-10 posterior SI joint bone grafts themselves after working the patient up etc and feel that this procedure is NOT effective?
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You're hinting at epistemic arrogance or the illusion of knowledge.

Many of us here have been doing this for a long time. If you KNOW that PRP doesn't work, or SIJ fusion doesn't work, or PNS doesn't work, or Kypho doesn't work, or Minuteman doesn't work, or opioids don't work, etc then the last thing that will change hearts and minds are KOL's with COI's.
 
drusso said:
You're hinting at epistemic arrogance or the illusion of knowledge.

Many of us here have been doing this for a long time. If you KNOW that PRP doesn't work, or SIJ fusion doesn't work, or PNS doesn't work, or Kypho doesn't work, or Minuteman doesn't work, or opioids don't work, etc then the last thing that will change hearts and minds are KOL's with COI's.
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I don’t understand the second part of your post. It doesn’t really address my question.

and I DEFINITeLy do not understand the first part. I will never have that type of vocabulary 🙂

I just want to know: does anyone who has done some cases think (not know) this doesn’t give the patient significant pain relief...?

i stated above that I have done some cases and I think it gives the patient pretty damn good relief
 
Espn123 said:
I don’t understand the second part of your post. It doesn’t really address my question.

and I DEFINITeLy do not understand the first part. I will never have that type of vocabulary 🙂

I just want to know: does anyone who has done some cases think (not know) this doesn’t give the patient significant pain relief...?

i stated above that I have done some cases and I think it gives the patient pretty damn good relief
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You are describing bias. Maybe the patient sees you afterwards x1 and tells you it is great. Then they see one of us and say the sij fusion made them worse. This is more in line with my clinical experience.
Think how hard it is to study this. No blinding. No placebo. Relying on case series from paid KOL to tell us how great it is. Meh.
 
Espn123 said:
I don’t understand the second part of your post. It doesn’t really address my question.

and I DEFINITeLy do not understand the first part. I will never have that type of vocabulary 🙂

I just want to know: does anyone who has done some cases think (not know) this doesn’t give the patient significant pain relief...?

i stated above that I have done some cases and I think it gives the patient pretty damn good relief
Click to expand...

Okay, this is what I'm getting at: What's the difference between "innovation" and what people around here characterize as "quackery," "fraud," or "human experimentation" in the field of pain medicine?

7-8 years ago I took ALOT of heat for injecting PRP into appendicular joints and tendons. Now, I don't think anyone thinks that is such an aberration. Some people still think it's quackery.

Despite multiple studies saying it doesn't work and Evicore guidelines saying it's no different from placebo, many people here do vertebral augmentation for VCF. Why? Because they believe in their experience and not the meta-analytic GIGO science.

Perc posterior SIJ fusion could be a gamechanger for our field.

Do we owe it to our patients to set aside our epistemic arrogance (our illusion of knowledge) and actually gain practical experience and find out?
 
drusso said:
Okay, this is what I'm getting at: What's the difference between "innovation" and what people around here characterize as "quackery," "fraud," or "human experimentation" in the field of pain medicine?

7-8 years ago I took ALOT of heat for injecting PRP into appendicular joints and tendons. Now, I don't think anyone thinks that is such an aberration. Some people still think it's quackery.

Despite multiple studies saying it doesn't work and Evicore guidelines saying it's no different from placebo, many people here do vertebral augmentation for VCF. Why? Because they believe in their experience and not the meta-analytic GIGO science.

Perc posterior SIJ fusion could be a gamechanger for our field.

Do we owe it to our patients to set aside our epistemic arrogance (our illusion of knowledge) and actually gain practical experience and find out?
Click to expand...
Which is exactly my question. I have a small sample size of practical experience. I think it helps patients greatly. Wondering if anyone else has had similar or different experiences after doing some cases.

I don’t feel this article does much for me one way or another...
 
drusso said:
Okay, this is what I'm getting at: What's the difference between "innovation" and what people around here characterize as "quackery," "fraud," or "human experimentation" in the field of pain medicine?

7-8 years ago I took ALOT of heat for injecting PRP into appendicular joints and tendons. Now, I don't think anyone thinks that is such an aberration. Some people still think it's quackery.

Despite multiple studies saying it doesn't work and Evicore guidelines saying it's no different from placebo, many people here do vertebral augmentation for VCF. Why? Because they believe in their experience and not the meta-analytic GIGO science.

Perc posterior SIJ fusion could be a gamechanger for our field.

Do we owe it to our patients to set aside our epistemic arrogance (our illusion of knowledge) and actually gain practical experience and find out?
Click to expand...

You are using big words to insert experience over science and research. Stop saying gamechanger. Nothing in Pain is a gamechanger. Your bashing of kypho is based on politics and nothing to do with the science. The articles written in NEJM 2009 were heartily debunked. The articles showing NNT to save a life of 1:15 are stout. Review from SIS should be out by end of year.
 
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