Minimally invasive sacroiliac joint fusion for chronic sacroiliac joint pain: A systematic review

• Published in: The Spine Journal
• Main Authors: Chang, Eva, Rains, Caroline, Ali, Rania, Wines, Roberta C, Kahwati, Leila C
• Format: Text
• Language: unknown
• Published: Advocate Aurora Health Institutional Repository 2022
• Subjects: Chronic low back pain; Minimally invasive surgery; Sacroiliac arthrodesis; Sacroiliac joint; Sacroiliac joint fusion; Systematic review; Advocate Aurora Research Institute; Orthopedics; Aurora Research Institute
• Online Access: https://institutionalrepository.aah.org/allother/163; https://doi.org/10.1016/j.spinee.2022.01.005; https://libkey.io/libraries/1712/pmid/35017057

Background context: Sacroiliac (SI) joint pain causes significant disability and impairment to quality of life (QOL). Minimally invasive SI joint fusion is increasingly used to relieve chronic SI joint pain among patients who do not respond to nonsurgical treatment. Purpose: To systematically review the existing literature to assess the effectiveness and safety of minimally invasive SI joint fusion. Study design/setting: Systematic review. Data sources: PubMed, Embase, Cochrane, and a clinical trial registry from database inception to June 30, 2021. Study selection: Eligible studies were primary research studies published in the English language, enrolled adults with SI joint pain, and compared SI joint fusion to nonsurgical interventions or alternative minimally invasive procedures. We included randomized controlled trials (RCTs) or controlled cohort studies (CCSs) that reported effectiveness (pain, physical function, QOL, opioid use) or safety outcomes (adverse events [AEs], revision surgeries) and uncontrolled studies that reported safety outcomes. Data abstraction and synthesis: Data were abstracted into structured forms; two independent reviewers assessed risk of bias using standard instruments; certainty of evidence was rated using GRADE. Results: Forty studies (2 RCTs, 3 CCSs, and 35 uncontrolled studies) were included. Minimally invasive SI joint fusion with the iFuse Implant System appeared to result in larger improvements in pain (two RCTs: mean difference in visual analog scale -40.5 mm, 95% CI, -50.1 to -30.9; -38.1 mm, p<.0001) and larger improvements in physical function (mean difference in Oswestry Disability Index -25.4 points, 95% CI, -32.5 to -18.3; -19.8 points, p<.0001) compared to conservative management at 6 months. Improvements in pain and physical function for the RCTs appeared durable at 1- and 2-year follow-up. Findings were similar in one CCS. The two RCTs also found significant improvements in QOL at 6 months and 1 year. Opioid use may be improved at 6 months and 1 to 2 years. ...