SI Joint Surgery Evidence (Whelan - Tech Orthop 2019)
The Evidence for Sacroiliac Joint Surgery
Sacroiliac joint (SIJ) dysfunction is a condition that has a significant impact on patient’s quality of life. In the past, accurate diagnosis of this condition has proven difficult and even when diagnosed, effective treatments with acceptable morbidity have been lacking. Recently, the use of composites of various physical examination tests in conjunction with joint injections has proven capable of diagnosing the condition with acceptable degrees of sensitivity and specificity. In addition, the advent of minimally invasive techniques for the fusion of the SIJ now offer patients an effective treatment option with morbidity far less than traditional open approaches. This paper is intended as a review of the evidence with regard to SIJ dysfunction and the various treatment options available for this condition. We first discuss the approach to diagnosing the condition and the evidence for the use of composites of physical examination tests and joint injections in reaching the diagnosis. This is followed by a detailed discussion of the various treatment options, broadly speaking these include conservative management, open surgical fusion, and minimally invasive fusion. We discuss the evidence examining the effectiveness of these treatment strategies including the various studies that directly compare the different modalities. On the basis of this evidence we recommend patients with SIJ dysfunction should first undergo a 6-month trial of conservative management before being considered for surgical intervention. If surgery is being considered, we recommend that due to the lower morbidity, minimally invasive techniques are the preferred approach.