Minimally Invasive SI Joint Fusion Procedures for Chronic SI Joint Pain: Systematic Review and Meta-Analysis of Safety and Efficacy

Peter G Whang; Vikas Patel; Bradley Duhon; Bengt Sturesson; Daniel Cher; W Carlton Reckling; Robyn Capobianco; David Polly

doi:10.14444/8543

Minimally Invasive SI Joint Fusion Procedures for Chronic SI Joint Pain: Systematic Review and Meta-Analysis of Safety and Efficacy

Int J Spine Surg. 2023 Dec 26;17(6):794-808. doi: 10.14444/8543.

Authors

Peter G Whang¹, Vikas Patel², Bradley Duhon³, Bengt Sturesson⁴, Daniel Cher⁵, W Carlton Reckling⁵, Robyn Capobianco⁶, David Polly⁷

Affiliations

¹ Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA.
² Department of Orthopedics and Spine Surgery, University of Colorado, Aurora, CO, USA.
³ Front Range Spine and Neurosurgery, Lone Tree, CO, USA.
⁴ Department of Orthopedics, Ängelholm Hospital, Ängelholm, Sweden.
⁵ SI-BONE, Inc., Santa Clara, CA, USA.
⁶ SI-BONE, Inc., Santa Clara, CA, USA robyn.capobianco@si-bone.com.
⁷ Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA.

PMID: 37798076
PMCID: PMC10753354
DOI: 10.14444/8543

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.

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