Minimally Invasive Sacroiliac Joint Fusion: The Current Evidence

Abstract

Background: Fusion of the sacroiliac (SI) joint as a treatment for low back pain remains controversial. The purpose of this manuscript is to review the current literature and clinical outcomes of SI joint fusion surgery. Methods: We conducted a literature review and included studies with the term ''sacroiliac joint fusion'' that had at least 12 months of clinical follow-up, reported on minimally invasive techniques, and included patient-reported outcome measures. Results: Two approach types (dorsal and lateral) and numerous different implant manufacturers were identified. Most studies included level 4 data, with a small number of level 2 prospective cohort studies and 2 prospective level 1 studies. Every reviewed study reported clinical benefit in terms of improved pain scores or improvement in validated disability measures. Complication rates were low. Conclusions: Minimally invasive SI joint fusion provides clinically significant improvement in pain scores and disability in most patients, across multiple studies and implant manufacturers. Level of Evidence: 5 Clinical Relevance: Emerging evidence in support of SI joint fusion indicates that clinicians should examine the SI joint and include SI joint pain in their differential diagnosis for low back pain patients.

International Society for the Advancement of Spine Surgery Policy 2020 Update—Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity

“…159 Reviews Several reviews (narrative, systematic, and metaanalysis) have been published focusing on lateral transiliac MIS SIJF with transfixing devices. [186][187][188][189][190][191][192][193] These reviews support the previously stated conclusions, including that lateral MIS SIJF is beneficial (proven improvements in pain and function) in appropriately selected patients with SIJ pain.…”

“…The posterior (dorsal) MIS SIJF procedure is a recognized and well-described distinct surgical procedure. 192,193,215 In the dorsal approach, allograft bone products or devices are placed into the ligamentous portion of the joint via dissection of the multifidus muscle and removal of a portion of the ligaments covering the dorsal, posterior aspect of the joint. A portion of the interosseous SIJ ligament is also typically removed.…”

Pelvic Girdle Pain, Hypermobility Spectrum Disorder and Hypermobility-Type Ehlers-Danlos Syndrome: A Narrative Literature Review

“…Martin et al conducted a meta-analysis by assessing the impact of minimally invasive surgery for SIJ fusion on VAS and ODI, and found that both PROMs had significantly reduced ( p < 0.05 for VAS and ODI) implying a significant improvement in pain as well functional outcomes of patients undergoing these procedures. Statistical analysis was not conducted against open SIJ fusion, nor between the different options for minimally invasive surgery [ 106 ]. A randomised controlled trial conducted by Dengler et al compared the iFuse minimally invasive technique against conservative management for pain secondary to SIJ dysfunction, and found that those managed surgically had significantly improved VAS ( p < 0.001), ODI ( p < 0.001) and EuroQol 5-Dimension (EQ-5D) ( p < 0.001) 24 months post-procedure [ 107 ].…”

<p>A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain</p>

“…A Limitation of this review is that the majority of the data is retrospective and mainly where involving the iFuse Implant system. 78 …”