- Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
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Comparative effectiveness of Sacroiliac Joint (SIJ) Fusion vs Nonoperative Care
- Describe why this topic is important.
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Enormous increase in utilization of SI joint fusion since ~2007 in the US, and especially since AMA published new CPT code for minimally invasive surgery. http://www.beckersspine.com/spine/item/22531-ama-publishes-new-cpt-code-for-mis-si-joint-fusion
Plus, CMS just increased payment to surgeons for these procedures in 2017, which will further incentivize surgery: https://spinalnewsinternational.com/us-cms-to-provide-increased-2017-reimbursement-for-minimally-invasive-sacroiliac-joint-fusion/
SIJ pain is purportedly related to low back pain in some proportion of patients (wide guesses in the literature say up to ~15-30% of low back pain patients may have SI issues). Patients typically have nonspecific chronic complaints and unclear surgical indications. No one specific clinical exam maneuver or diagnostic test is predictive of who will do best with surgery.
Seems like surgery is being recommended more frequently, and many surgeries (many more than other ortho surgeries) fail (implants loosen) and require revision. (Industry-funded) literature evidence seems focused on rather healthy patients-not at all like the majority who are considered for SIJ fusion, and certainly not like those who fail and need revision surgery.
It is unclear whether the procedure is beneficial in an "average" adult vs nonoperative care, who should even consider surgery, and which surgeons are sufficiently competent to suggest or perform such procedures. Seems like the procedures are not yet ready for prime time, yet are being increasingly recommended and utilized. Concerning that CMS increased payments - how many studies to date even include older or disabled adults??? Increasing payment often increases use.
Also, what does failed nonoperative care mean? I think there is limited evidence what is a good nonoperative program for SIJ dysfunction, and how that compares to SIJ fusion outcomes.
- How will an answer to your research question be used or help inform decisions for you or your group?
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Highlight evidence gaps to be used to inform patient care, and hopefully improve future research to involve "imperfect" patients (the average adult who might consider such a procedure. This is a major patient safety issue with permanent, potentially disabling consequences (failed surgery). I think complications are much higher than reported in the current literature.
- Other Information About You: (optional)
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- Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
- chiropractor
- If you are you making a suggestion on behalf of an organization, please state the name of the organization
- Please tell us how you heard about the Effective Health Care Program
- Read the reports when applicable
