Cusi M; Saunders J; Hungerford B; Wisbey-Roth T; Lucas P; Wilson S. The use of prolotherapy in the sacroiliac joint. Br J Sports Med 2010;44: 100-104.
DEXTROSE: CUSI ET AL 2008: DEXTROSE INJECTION MARKEDLY IMPROVES LAXITY TESTING OF THE SI JOINT.
DR. REEVES’ NOTES:
Twenty-five consecutive patients with chronic low back pain localized to the SI joint region (posterior superior iliac spine) and positive on examination test for sacroiliac laxity/pain source were treated with 3 injections at 6 week intervals using 17% dextrose with CT guidance in the ligament and specifically not inside the joint itself. 12 month followup data revealed that the SI laxity maneuver score improved from a mean of 7.2 to 2.2 at 1 years (p < .001), the Quebec Pain Disability Scale improved from 57.7 to 39.5 (p = .002), the Roland Morris Back Pain Questionnaire improved from 13.3 to 7.2 (p = .001) and the Roland Morris Multi Form Questionnaire improved from 146.5 to 108.6 to 12 months. (P = .016)
The clinical history requirements to determine SI source of pain and mechanical dysfunction were the following:1. Localized and/or radiating low back or buttock pain in the vicinity of the posterior superior iliac spine, 2. Worse pain on loading positions such as standing, sitting, walking or negotiating stairs, and 3. 6 months of pain.
9 physical exam factors were looked at and scored to determine candidacy with maximum score of 9 and minimum score not mentioned. The diagnosis had to be made independently by a SEM physician (MC, JS) and a physiotherapist (BH, TWR) involved in the study. The minimum number was not mentioned. The tests were the sacroiliac joint (SIJ) glide test (antero-posterior and vertical arm, with and without self bracing) , posterior pelvic pain provocation test (PPPP) , active straight leg raise (ASLR) [13-15] with and without self bracing and external manual compression and stork support (Gillett) test . A score of one was given for each positive finding. Clinical tests were therefore not graded. Maximum score was nine.
Exercise program apparently continued that patient had performed with no sustainable benefit.
The amount injected was unclear with 0.8 ml was injected under CT guidance, but several injections along the ligament noted and a volume of 4 ml of approximately 17% dextrose in bupivicaine.
It is not clear if the study was truly consecutive. There were no controls. 25 patients were mentioned but only 19 had 3 month followup data gathered and the body of the paper was not clear why the 3 month followup point was not reached in all cases.
The authors make the point that previous studies on treatment of back pain with proliferant injection did not consider a specific clinical diagnosis. In contrast, if injury to specific structures, such as ligaments or fascia, can be related to a specific clinical presentation and subsequent loss of function associated with pain, the potential for measuring outcome with repeatable physical exam measures may be present. Standardization of those examination measures may be important.
The abstract of the study on Sacroiliac Pain is available here, with a copy of the content below.
To determine whether prolotherapy is effective in the treatment of deficient load transfer of the SIJ.
A prospective descriptive study.
Authors’ private practice.
25 patients who consented to treatment and attended for at least one follow up visit and assessment.
From April 2004 to July 2007.
Three injections of hypertonic dextrose solution into the dorsal interosseous ligament of the affected SIJ, under CT control, six weeks apart.
MAIN OUTCOME MEASURES:
Quebec Back Pain Disability Scale, Roland Morris 24, Roland Morris 24 Multiform questionnaires and clinical examination by two authors independently. Clinical tests include active straight leg raise, sacroiliac joint glide, Stork (Gillet), stance phase and posterior pelvic pain provocation tests.
All patients included in this study attended for at least one follow up visit at 3, 12 or 24 months. The number of patients at follow up decreased at 12 and 24 months. Functional questionnaires demonstrated significant improvements for those followed up at 3, 12 and 24 months (p < 0.05). Clinical scores showed significant improvement from commencement to three, 12 and 24 months (p < 0.001).
This descriptive study of prolotherapy in private practice has shown positive clinical outcomes for the 76% of patients who attended the 3 months and 12 months’ follow up visits and for the 32% of patients who attended follow up visits at 24 months. Similar results were found in the Questionnaires (Q, RM and RMM) at 3, 12 and 24 months. The findings of this study warrant further research. Trial registration Written informed consent was obtained from all participants in the trial. This was conducted as a practice quality assurance project, and as such did not require ethics approval or trial registration.