Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature

Abstract

Sacroiliac joint (SIJ) pain is responsible for approximately a third of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient’s that fail first line treatment.

Injective Treatments for Sacroiliac Joint Pain: A Systematic Review and Meta-analysis

“…The corticosteroids' anti-inflammatory action is used to reduce pain in many clinical conditions, such as osteoarthritis, synovitis, tendinitis, tenosynovitis, and others [10]. Analogously, corticosteroids are the most commonly applied injective treatment for SIJ, aiming to provide pain relief by relying on the pleiotropic effects on the inflammatory pathways: downregulating pro-inflammatory cytokines and chemokines, and upregulating the production of antiinflammatory genes [28]. Among the different available corticosteroids, triamcinolone acetate, methylprednisolone, betamethasone, and dexamethasone have all been used, since no agreement has been reached on the most effective product.…”

“…Overall, no major complications were reported in this systematic review, even though the literature largely documented the potential drawbacks of intraarticular steroid and anesthetic injections, with the risk of inducing local chondrolysis and osteoporosis, and, in case of surgery, of increased post-operative pain scores [36][37][38][39]. Local corticosteroids injections can lead also to systemic consequences by causing immunosuppression: infection diseases, Cushing's syndrome, weight gain, fluid retention, mood disturbances, and gastrointestinal upset [28]. The importance of considering the potential complications of corticosteroid is underlined by the fact that most patients need 2 or 3 steroid injections to see benefits, and more injections can be performed through years exposing patients to the potential corticosteroids side effects [28].…”

“…Local corticosteroids injections can lead also to systemic consequences by causing immunosuppression: infection diseases, Cushing's syndrome, weight gain, fluid retention, mood disturbances, and gastrointestinal upset [28]. The importance of considering the potential complications of corticosteroid is underlined by the fact that most patients need 2 or 3 steroid injections to see benefits, and more injections can be performed through years exposing patients to the potential corticosteroids side effects [28]. In this review, the larger group of patients was 40-60 years old, a relatively young age distribution predisposing to the need for repeated procedures over the years, ultimately leading to increased risks of side effects.…”

“…This procedure involves an injection of an irritating substances in a damaged zone such as osmotic agents, or chemotactic agents. The irritation induces an influx of inflammatory cells, which can ultimately lead to a healing response and a tissue repair [28]. Notably, one article reporting the worsening of outcomes was a dextrose retrospective study [40], while one of the articles reporting the best improvement was a botulinum case series [13].…”

“…Platelets release also fibronectin, vitronectin, and sphingosine 1-phosphate. All these molecules can accelerate tissue healing [28]. Different preparations of PRP have been tested, but no sufficient data have been published to clearly demonstrate which product is most suitable for this treatment indication [27,44].…”