Review of SI Joint Fusion for LBP (Lodin - Cesk Slov Neurol N 2019)

A systematic review of the clinical efficacy of sacroiliac joint stabilization in the treatment of lower back pain

Lodin J, Procházka J, Jelínek M, Waldauf P, Sameš M, Vachata P.
Cesk Slov Neurol N 2019;82(6):665-663.
DOI: 10.14735/amcsnn2019655

ABSTRACT

Aim: Sacroiliac joint (SIJ) dysfunction is a chronic disorder, representing a significant cause of lower back pain. This study aims to present an evidence-based systematic analysis of published literature concerning the surgical management of SIJ dysfunction within the last 10 years. Its main goal is to demonstrate the clinical efficacy of SIJ arthrodesis via preoperative and postoperative analysis of patient pain and disability scores, as well as presenting the incidence of surgery-related complications.

Methods
: The PRISMA algorithm was used to stratify online search results into 27 studies, which made up our dataset. The parameters collected included study design, number of follow-up patients, surgical complications and preoperative and postoperative Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores. A random effects meta-analysis model was used to analyze the selected data, statistical heterogeneity was assessed using the inconsistency I test, publication bias was analyzed using the funnel plot and Egger’s test.

Results
: The mean (95% CI) values of the preoperative VAS and ODI scores were 7.86 (7.65–8.07) and 55.1 (49.8–60.5), resp. These values improved postoperatively to a mean (95% CI) score of 3.23 (2.89–3.58) for VAS and 30.7 (25.9–35.5) for ODI. The total number of recorded surgical complications was 7.04%. The mean (95% CI) incidence of wound complications was 3.87% (2.44–6.09) and the mean (95% CI) proportion of screw dislocation or malposition was 4.32% (3.18–5.81). The proportion (95% CI) of patients requiring a second operation was 5.19% (3.93–6.83).

Conclusion
: This study demonstrated that patients indicated for sacroiliac stabilization showed significant improvement in VAS (by 4.6 points) and ODI (by 25 points) scores. These findings suggest that SIJ stabilization is a feasible and effective treatment option for this group of patients. Furthermore, overall morbidity of the procedure was lower than in previously reported studies and is expected to decrease with improvement in surgical technique and navigational imaging.

KEYWORDS: sacroiliac joint – fusion – arthrodesis – analysis

Author Information

Lodin J, Sameš M, Vachata P - Neurosurgical Department, University of J. E. Purkyne and Masaryk Hospital Krajská Zdravotní a. s., Ústí nad Labem, Czech Republic.
Procházka J - Chronic Pain Therapy Centre, Ústí nad Labem.
Jelínek M - University of J. E. Purkyne, Ústí nad Labem, Czech Republic.
Waldauf P - Anesthesiology and Intensive Care Department, Královské Vinohrady Faculty Hospital, Prague, Czech Republic.

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