Envision enduring chronic low back pain, a widespread affliction that impacts a significant number of adults worldwide. Often, the sacroiliac joint is implicated as a key source of this pain, sparking a critical need for effective treatments. Conventional therapies frequently fail to provide adequate relief, prompting researchers to investigate advanced surgical options like minimally invasive sacroiliac joint fusion. This technique is touted to significantly alleviate pain, but does it truly outperform a placebo?

Fresh insights from a recent study published in the journal eClinicalMedicine in February 2024 offer a detailed examination of the effectiveness of minimally invasive sacroiliac joint fusion versus a sham, or fake, operation. Directed by Dr. Engelke Marie Randers, Dr. Britt Stuge, Professor Lars Nordsletten, Professor Stephan M. Röhrl, and Dr. Thomas Kibsgård from the University of Oslo, along with Dr. Elias Diarbakerli from Karolinska Institutet and Professor Paul Gerdhem from Karolinska Institutet and Uppsala University, the research put the surgical method to the test against a placebo procedure in a rigorously controlled, double-blind study.

Dr. Randers shared insights on the importance of their findings, highlighting, “Our trial unveils new insights regarding the impact of minimally invasive sacroiliac joint fusion in managing severe sacroiliac joint pain.” This underscores the pioneering nature of their research and its contribution to medical understanding on a hotly debated issue. The results showed that although there was a reduction in pain scores in both the actual surgery and the sham groups, the difference was slight, indicating that the real benefit of the surgical procedure over the placebo might be minimal.

Dr. Randers further discussed the implications of their research, emphasizing, “With these results, we must consider whether a permanent surgical procedure, with its associated risks and complications, is justified when its actual effectiveness is so modest and a placebo effect may significantly influence outcomes.” This study is crucial as it adds to the accumulating evidence questioning the real benefits of certain surgical interventions compared to placebo effects, particularly given the high expectations and complex nature associated with surgical treatments. The team stressed the need for ongoing dialogue within the medical community about whether the risks and complications tied to irreversible surgical procedures are warranted when their effectiveness could be similar to a placebo.

Journal Reference

Engelke Marie Randers, Paul Gerdhem, and colleagues, “The effect of minimally invasive sacroiliac joint fusion compared to sham operation: a double-blind randomized placebo-controlled trial,” eClinicalMedicine, 2024. DOI: https://doi.org/10.1016/j.eclinm.2024.102438

About the Authors

Engelke Marie Randers graduated MD from the University of Oslo in 2009 and is completing her PhD thesis on the surgical treatment of the sacroiliac joint. She is a consultant in spine deformities at the Division of Orthopaedic Surgery at Oslo University Hospital, Norway.

Paul Gerdhem graduated from Karolinska Institutet, Sweden, 1993 as MD, received his PhD in 2004 at Lund university, Sweden, and became associate professor there 2005. From 2019 to 2022 his was adjunct professor at Karolinska Institutet. Since 2023 he is a full professor in Orthopaedics at Uppsala University, Sweden.

Britt Stuge has been a physical therapist since 1982, completed her PhD at University of Oslo in 2005, and is a pioneer and renowned researcher in the field of pelvic girdle pain. She currently holds a position as senior researcher at Oslo University Hospital.

Elias Diarbakerli, PhD, is a clinical and researching physical therapist specializing mainly in spinal disorders. He is currently a senior researcher at Karolinska Institutet and spine consultant at Karolinska University Hospital, Sweden.

Lars Nordsletten has his degree in experimental studies from 1994. His main topics now are total joint replacement and osteoarthritis and is professor at University of Oslo. He is Head of R&D in the Clinic and a consultant Hip surgeon at Oslo University Hospital.

Stephan Maximillian Herbert Röhrl has a PhD in biomechanical research from the Ludwig Maximillian University, Munich, Germany, 1996, followed with clinical research at the University of Umeå, Sweden, with a PhD on hip arthroplasty completed in 2004. Since 2006 he has been a consultant hip and knee surgeon doing orthopaedic research at Oslo University Hospital, and holds a position as professor at the University of Oslo since 2023.

Thomas Johan Kibsgård completed his PhD thesis on sacroiliac joint fusion and biomechanical sacroiliac Joint motion in 2014 at the University of Oslo, where he since 2016 holds a position as associate professor researching sacroiliac joint fusions and spinal deformities. He is also consultant in spine deformities at the Division of Orthopaedic surgery at the University Hospital in Oslo.