Movement of the Sacroiliac (SI) Joint, Comparing Conventional RSA With the Sectra Implant Movement Analysis.

Sacroiliac Instability Clinical Trial

— IMSRA  

Official title:

Accuracy of the CT-Implant Movement Analysis. A Feasibility Study.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04752007
• Other study ID #: IMSRA
• Status: Completed
• Phase: N/A
• Start date: September 1, 2020
• Est. completion date: September 1, 2021

Study information

• Verified date: June 2022
• Source: University of Bergen
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Movement of the Sacroiliac (SI) Joint, comparing conventional RSA with the Sectra Implant Movement analysis using a low dose CT for high accuracy measurement. A feasibility study for a future kohort study.

Description:

Abstract Background: Radiostereometric analysis (RSA) is a high precision in vivo measuring method and regarded as the gold standard for motion analysis. RSA has been around for over 40 years and its accuracy is properly evaluated. The CT technics have evolved and now low dose CT scans can reproduce 3-D models of bone and joints. The Sectra Implant Movement analysis (IMA) is a new method using a low dose CT for high accuracy measurement. There is no study evaluating the precision and accuracy of the new CT based method.The investigator want to compare the accuracy of the two methods. Method/design: The RSA method will be tested in patients that already have tantalum markers inserted around the SI joints from earlier studies conducted at Ullevål University Hospital. There are 2-6 patients in the age of 40-50 years available for RSA analysis with and without provocation of the SI joints. Some are fused in one SI joint after insertion of the tantalum markers, but the contralateral joint can then be used for the analysis. At the same time,the investigator will perform low dose CT with and without provocation of the SI joints. The results of the analysis will be compared. Discussion: The conventional RSA is an invasive method using tantalum markers inserted in to bone. If the CT method has the same accuracy, then the tantalum markers will become obsolete and future studies can easily be performed using non-invasive low dose CT scans. Keywords: RSA, CT method, low dose CT, IS joint, movement Introduction: Because of the high accuracy and precision, radiostereometric analysis (RSA), has become a well- established method for three-dimensional (3-D) measurements of micro motion in joints. The implantation of tantalum markers is invasive, but no reports of patient injuries are reported. The markers might be inserted through the approach used during a surgical intervention or in an extra stab incisions in the skin to get the markers to the necessary position in the bony structures. The placements of the markers are of outmost importance to achieve good quality measurements. At least three no collinear markers in each segment and a good distance and distribution in all three axes (X, Z, Y) is essential for a good 3-D configuration. The CT techniques have evolved and now low dose CT scans can reproduce 3-D models of bone and joints. The Sectra Implant movement analysis (IMA) is a non-invasive method using a low dose CT scan. No tantalum markers are needed and joint provocation can easily be conducted in the CT. The CT scan is then sent to the Sectra AB for analysis. Method: Patients and methods: The RSA method will be tested in patients that already have tantalum markers inserted around the SI joints from earlier studies , approximately five years ago, conducted at Ullevål University Hospital. These are patients with long lasting severe sacroiliac joint pain. There are six patients in the age of 40-50 years available for RSA analysis with and without provocation of the SI joints, at the same time the investigator will perform low dose CT with and without provocation of the SI joints. For the non-provocation, the patient will be in a supine-position. The provocation x-ray/low dose CT will be performed; 1: anterior straight leg raise 2: One side figure of four position, both with 1kg of load. Some are fused in one SI joint after insertion of the tantalum markers, but the contralateral joint can then be used for the analysis. The investigators will also measure eventual movement in the fused joint and the symphysis (if tantalum markers present). The Center for Implant and Radiostereometric Research Oslo has extensive experience with RSA and established state of the art measuring method of movement in the SI joint. They will perform the RSA measurements. The CT scan is send to the Sectra AB for analysis. Statistical analysis: Null hypothesis (H0): There is no difference in the accuracy Alternate Hypothesis (H1): There is a difference in the accuracy Continuous variables will be described with mean and standard deviation\, and the normality of the data will be checked using the histograms, QQ-plots and the Kolmogorov-Smirnov-Test of normality. The differences of motion will also be tested for normality. The paired sample T-test will be used to detect possible significance in the difference between the two groups. Non-parametric tests are used if the assumption of normality does not hold. All analysis will be conducted using commercially available software (SPSS version 24, IBM Inc.) and the level of significance is set to p<0.05 in a two-sided test. Participants Project leader and responsible institution Stephan M. Röhrl, PhD, MD, Ass. Professor, Head of Center for Implant and Radiostereometric Research Oslo, President of Knee and Hip Register, Oslo University Hospital, Oslo, Norway. PhD candidate Vinjar Myklevoll, MD, Haukeland University Hospital, Bergen. Collaborating partner Thomas Kibsgård, Ass. Professor, PhD, MD, President Pelvic Girdle Pain Society, Head of Department Rikshospitalet, Oslo, OUS.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 2
• Est. completion date: September 1, 2021
• Est. primary completion date: September 1, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• The RSA method will be tested in patients that already have tantalum markers inserted around the SI joints from earlier studies, approximately five years ago, conducted at Ullevål University Hospital.

Exclusion Criteria:

• The patients that can not perfome the provocation images of the SI joints.
• Pregnancy
• Not able to or do not want to participate

Related Conditions & MeSH terms

• Sacroiliac Instability

Intervention

Radiation:
• ASLR; CT; SI joint movement: stright leg raise with 1 kg load
Measurement of the SI joint movement in mikrometer
• Fig.Four; CT; SI joint movement: One side figure of four position with 1 kg load
Measurement of the SI joint movement in mikrometer
• Supine; CT; SI joint movement: supine position
Baseline position
• ASLR; RSA; SI joint movement: stright leg raise with 1 kg load
Measurement of the SI joint movement in mikrometer
• Fig.Four; RSA; SI joint movement: One side figure of four position with 1 kg load
Measurement of the SI joint movement in mikrometer
• Supine; RSA; SI joint movement: supine position
Baseline position

Locations

Country	Name	City	State
Norway	Cirro at Ullevål Uiversity Hospital	Oslo

Sponsors (2)

Lead Sponsor	Collaborator
University of Bergen	Oslo University Hospital

Country where clinical trial is conducted

Norway, 

References & Publications (15)

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Eriksson T, Maguire GQ Jr, Noz ME, Zeleznik MP, Olivecrona H, Shalabi A, Hänni M. Are low-dose CT scans a satisfactory substitute for stereoradiographs for migration studies? A preclinical test of low-dose CT scanning protocols and their application in a pilot patient. Acta Radiol. 2019 Dec;60(12):1643-1652. doi: 10.1177/0284185119844166. Epub 2019 May 1. — View Citation

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Kibsgård TJ, Röhrl SM, Røise O, Sturesson B, Stuge B. Movement of the sacroiliac joint during the Active Straight Leg Raise test in patients with long-lasting severe sacroiliac joint pain. Clin Biomech (Bristol, Avon). 2017 Aug;47:40-45. doi: 10.1016/j.clinbiomech.2017.05.014. Epub 2017 May 29. — View Citation

Kibsgård TJ, Røise O, Stuge B, Röhrl SM. Precision and accuracy measurement of radiostereometric analysis applied to movement of the sacroiliac joint. Clin Orthop Relat Res. 2012 Nov;470(11):3187-94. doi: 10.1007/s11999-012-2413-5. Epub 2012 Jun 14. — View Citation

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Sturesson B, Uden A, Vleeming A. A radiostereometric analysis of movements of the sacroiliac joints during the standing hip flexion test. Spine (Phila Pa 1976). 2000 Feb 1;25(3):364-8. — View Citation

Sturesson B, Uden A, Vleeming A. A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine (Phila Pa 1976). 2000 Jan 15;25(2):214-7. — View Citation

Svedmark P, Berg S, Noz ME, Maguire GQ Jr, Zeleznik MP, Weidenhielm L, Nemeth G, Olivecrona H. A New CT Method for Assessing 3D Movements in Lumbar Facet Joints and Vertebrae in Patients before and after TDR. Biomed Res Int. 2015;2015:260703. doi: 10.1155/2015/260703. Epub 2015 Oct 26. — View Citation

Svedmark P, Tullberg T, Noz ME, Maguire GQ Jr, Zeleznik MP, Weidenhielm L, Nemeth G, Olivecrona H. Three-dimensional movements of the lumbar spine facet joints and segmental movements: in vivo examinations of normal subjects with a new non-invasive method. Eur Spine J. 2012 Apr;21(4):599-605. doi: 10.1007/s00586-011-1988-y. Epub 2011 Sep 1. — View Citation

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* Note: There are 15 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Movement of the SI joint in mikrometer	Movement analysis	4 weeks