Clinical Data
Systematic Review, SI Joint Fusion vs. Conservative Care (Hermans - Int J Spine Surg 2022)
Minimally Invasive Sacroiliac Joint Fusion vs Conservative Management in Patients With Sacroiliac Joint Dysfunction: A Systematic Review and Meta-Analysis
Hermans SMM, Droeghaag R, Schotanus MGM, Santbrink HV, van Hemert WLW, Curfs I.
Int J Spine Surg. 2022 Jun;16(3):472-480.
DOI: 10.14444/8241. PMID: 35772982; PMCID: PMC9650193.
ABSTRACT
Background: The sacroiliac joint (SIJ) is affected in 14% to 22% in individuals presenting with chronic low back or buttock pain. This percentage is even higher in patients who underwent lumbar fusion surgery: 32% to 42%. Currently, there is no standard treatment or surgical indication for SIJ dysfunction. When patients do not respond well to nonsurgical treatment, minimally invasive sacroiliac joint fusion (MISJF) seems to be a reasonable option. This systematic review and meta-analysis evaluates the current literature on the effectiveness of MISJF compared to conservative management in patients with SIJ dysfunction.
Methods: A systematic search of health-care databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were randomized controlled trials (RCTs) or prospective and retrospective comparative cohort studies that compared MISJF with conservative management. Primary outcome measures were pain, disability, and patient satisfaction measured by patient-reported outcome measures. Secondary outcomes were adverse events (AEs), serious AEs, financial benefits, and costs.
Results: Two RCTs and one retrospective cohort study were included comparing MISJF and conservative management with regard to pain and disability outcome, encompassing 388 patients (207 conservative and 181 surgical). In a pooled mean difference analysis, MISJF demonstrated greater reduction in visual analog scale-pain score compared to conservative management: -37.03 points (95%CI [-43.91, -30.15], P < 0.001). Moreover, MISJF was associated with a greater reduction in Oswestry Disability Index outcome: -21.14 points (95% CI [-24.93, -17.35], P < 0.001). AEs were low among the study groups and comparable across the included studies. One cost-effectiveness analysis was also included and reported that MISJF is more cost-effective than conservative management.001). AEs were low among the study groups and comparable across the included studies. One cost-effectiveness analysis was also included and reported that MISJF is more cost-effective than conservative management.
Conclusions: This systematic review and meta-analysis suggest that MISJF, using cannulated triangular, titanium implants, is more effective and cost-effective than conservative management in reducing pain and disability in patients with SIJ dysfunction. Further well-powered, independent research is needed to improve the overall evidence.
Keywords: conservative management; minimally invasive sacroiliac joint fusion; sacroiliac joint; sacroiliac joint dysfunction; systematic review and meta-analysis.
Author Information
- Hermans SMM - Department of Orthopaedic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands; Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, the Netherlands.
- Droeghaag R - Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, the Netherlands; Department of Orthopaedic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands.
- Schotanus MGM - Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, the Netherlands; Department of Orthopaedic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands.
- Santbrink HV - Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery, Zuyderland Medical Center, Heerlen, the Netherlands.
- van Hemert WLW - Department of Orthopaedic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands.
- Curfs I - Department of Orthopaedic Surgery, Zuyderland Medical Center, Heerlen, the Netherlands.