Promising results associated with sacroiliac joint fusion for patients with lower back pain but more evidence needed

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Sacroiliac joint fusion (SIJF) shows potential as a surgical treatment option for those with lower back pain as a result of sacroiliac joint (SIJ) pathology, new research has indicated. A systematic review and meta-analysis—the results of which were presented by Jay Toor (University of Toronto, Toronto, Canada) at the Global Spine Congress 2022 (1–4 June; Las Vegas, USA)—found that SIJF provided improvements in postoperative patient reported Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) pain scores, thus highlighting potential improved efficacy compared to conservative management (CM).

Despite these findings however, the study authors note that “there is a paucity of independent trials with long term follow-up in this field” and therefore “definitive conclusions about the efficacy of SIJF are limited”. They add that this particular research “supports further exploration into the efficacy of SIJF through multicentre comparative studies with long-term follow-up”.

For the study, the Embase, Cochrane, PubMed, and Scopus databases were searched prior to 18 August 2020 for the treatment of SIJ pathology. The primary outcomes measure was VAS for lower back pain and the secondary outcome measure was ODI score.

For single cohort studies, treatment outcomes were analysed using the pooled mean VAS and ODI scores. For studies comparing SIJF to CM, treatment outcomes were analysed using the standardised mean difference (SMD) for VAS and ODI scores.

In total, 558 patients and six studies (two randomised controlled trials and four prospective cohort studies) were included. Five of the six studies were industry funded.

The mean pooled VAS scores at baseline were 76.3 (95% confidence interval [CI] 68.4, 84.1) and at six-month follow-up 31 (95% CI, 27.9, 34). The mean pooled ODI scores at baseline were 56.7 (95% CI, 53.1, 60.2) and at six-month follow-up was 32.4 (95% CI, 30.4, 34.4). According to VAS scores, the SMD between SIJF and CM at six-months follow-up was -1.5 (95% CI, -1.8, -1.1). The SMD between SIJF and CM ODI scores at six months was -1.1 (95% CI, -1.6, -0.5).


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