Surgical and clinical efficacy of sacroiliac joint fusion: a systematic review of the literature

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>The sacroiliac joint (SIJ) and surgical intervention for treating SIJ pain or dysfunction has been a topic of much debate in recent years. There has been a resurgence in the implication of this joint as the pain generator for many patients experiencing low-back pain, and new surgical methods are gaining popularity within both the orthopedic and neurosurgical fields. There is no universally accepted gold standard for diagnosing or surgically treating SIJ pain. The authors systematically reviewed studies on SIJ fusion in the neurosurgical and orthopedic literature to investigate whether sufficient evidence exists to support its use.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A literature search was performed using MEDLINE, Google Scholar, and OvidSP–Wolters Kluwer Health for all articles regarding SIJ fusion published from 2000 to 2014. Original, peer-reviewed, prospective or retrospective scientific papers with at least 2 patients were included in the study. Exclusion criteria included follow-up shorter than 1-year, nonsurgical treatment, inadequate clinical data as determined by 2 independent reviewers, non-English manuscripts, and nonhuman subjects.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 16 peer-reviewed journal articles met the inclusion criteria: 5 consecutive case series, 8 retrospective studies, and 3 prospective cohort studies. A total of 430 patients were included, of whom 131 underwent open surgery and 299 underwent minimally invasive surgery (MIS) for SIJ fusion. The mean duration of follow-up was 60 months for open surgery and 21 months for MIS. SIJ degeneration/arthrosis was the most common pathology among patients undergoing surgical intervention (present in 257 patients [59.8%]), followed by SIJ dysfunction (79 [18.4%]), postpartum instability (31 [7.2%]), posttraumatic (28 [6.5%]), idiopathic (25 [5.8%]), pathological fractures (6 [1.4%]), and HLA-B27+/rheumatoid arthritis (4 [0.9%]). Radiographically confirmed fusion rates were 20%–90% for open surgery and 13%–100% for MIS. Rates of excellent satisfaction, determined by pain reduction, function, and quality of life, ranged from 18% to 100% with a mean of 54% in open surgical cases. For MIS patients, excellent outcome, judged by patients’ stated satisfaction with the surgery, ranged from 56% to 100% (mean 84%). The reoperation rate after open surgery ranged from 0% to 65% (mean 15%). Reoperation rate after MIS ranged from 0% to 17% (mean 6%). Major complication rates ranged from 5% to 20%, with 1 study that addressed safety reporting a 56% adverse event rate.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Surgical intervention for SIJ pain is beneficial in a subset of patients. However, with the difficulty in accurate diagnosis and evidence for the efficacy of SIJ fusion itself lacking, serious consideration of the cause of pain and alternative treatments should be given before performing the operation.</jats:p></jats:sec>

Microsurgery or open cervical foraminotomy for cervical radiculopathy? A systematic review

“…However, almost all scholars agree that indications for microsurgery should be aimed at a small range of soft lesions, such as single-or double-segments intervertebral disc pathological changes; large or complex pathological changes, such as cervical ossification of the posterior longitudinal ligament are not suitable for microsurgery [6][7][8].…”

Rheumatology in Poland

“…Joint replacement (endoprosthesis) is the most often performed procedure, arthrodesis or foot and hand corrections being less frequent. Of other rheumo-orthopedic procedures, the operative treatment of instability of sacroiliac joints (sacroplasty) is one of the most important [19,20]. Operative synovectomy is performed less frequently than in the past currently with more patients being referred for a radiosynovectomy [21].…”

Editorial Commentary: Consider the Sacroiliac Joint: Imaging a Source of Pain Can Feel Compelling. Orthopaedists Would Do Well to Remain Skeptical

“…Both conditions can cause severe buttock and groin pain; both have leapt to the forefront of their respective subspecialties in part because of new options for surgical management; and both have proven to be frustratingly variable in their treatment outcomes. 1,2 Perhaps then it is only natural to question if there is more linking these 2 diagnoses than the few inches of ilium between them.…”