Clinical Data
Meta-analysis of MIS SI Joint Fusion Procedures (Whang - Int J Spine Surg 2023)
Minimally Invasive SI Joint Fusion Procedures for Chronic SI Joint Pain: Systematic Review and Meta-Analysis of Safety and Efficacy
Whang PG, Patel V, Duhon B, Sturesson B, Cher D, Reckling WC, Capobianco R, Polly D.
Int J Spine Surg. Dec 26;17(6):794-808.
DOI: 10.14444/8543. PMID: 37798076. PMCID: PMC10753354.
ABSTRACT
Background: Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available.
Methods: Data abstraction and random effects meta-analysis of safety and efficacy outcomes from published patient cohorts. Patient-reported outcomes (PROs) and safety measures were stratified by surgical technique: transiliac, including lateral transiliac (LTI) and posterolateral transiliac (PLTI), and posterior interpositional (PI) procedures.
Results: Fifty-seven cohorts of 2851 patients were identified, including 43 cohorts (2126 patients) for LTI, 6 cohorts (228 patients) for PLTI, and 8 cohorts (497 patients) for PI procedures. Randomized trials were only available for LTI. PROs were available for pain (numeric rating scale) in 57 cohorts (2851 patients) and disability (Oswestry Disability Index [ODI]) in 37 cohorts (1978 patients).All studies with PROs showed improvement from baseline after surgery. Meta-analytic improvements in pain scores were highest for LTI (4.8 points [0-10 scale]), slightly lower for PLTI (4.2 points), and lowest for PI procedures (3.8 points, P = 0.1533). Mean improvements in ODI scores were highest for LTI (25.9 points), lowest for PLTI procedures (6.8 points), and intermediate for PI (16.3 points, P = 0.0095).For safety outcomes, acute symptomatic implant malposition was 0.43% for LTI, 0% for PLTI, and 0.2% for PI procedures. Wound infection was reported in 0.15% of LTI, 0% of PLTI, and 0% of PI procedures. Bleeding requiring surgical intervention was reported in 0.04% of LTI procedures and not reported for PLTI or PI. Breakage and migration were not reported for any device. Radiographic imaging evaluation reporting implant placement accuracy and fusion was only available for LTI.
Discussion: Literature support for SI joint fusion is growing. The LTI procedure contains the largest body of available evidence and shows the largest improvements in pain and ODI. Only LTI procedures have independent radiographic evidence of fusion and implant placement. The adverse event rate for all procedures was low.
Keywords: lateral transiliac; meta-analysis; sacroiliac joint; sacroiliac joint fusion; systematic review.
Author Information
- Whang PG - Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA.
- Patel V - Department of Orthopedics and Spine Surgery, University of Colorado, Aurora, CO, USA.
- Duhon B - Front Range Spine and Neurosurgery, Lone Tree, CO, USA.
- Sturesson B - Department of Orthopedics, Ängelholm Hospital, Ängelholm, Sweden.
- Cher D, Reckling WC, Capobianco R - SI-BONE, Inc., Santa Clara, CA, USA.
- Polly D - Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA.