Focus of the Report: The use of minimally invasive sacroiliac joint (SIJ) fusion with cylindrical threaded implants (CTIs) for the treatment of adults with SIJ dysfunction who have not experienced adequate relief from nonsurgical management (NSM). Evaluation of minimally invasive SIJ fusion using triangular titanium implants (i.e., iFuse Implant System [SI-Bone Inc.]) is outside the scope of this report.

Technology Description: Minimally invasive arthrodesis of the SIJ involves the percutaneous placement of screws or cages with or without bone graft material to fuse the unstable joint. Of the numerous available devices, studies evaluating 4 brands of CTIs for SIJ fusion met inclusion criteria for this health technology assessment, including hollow modular anchorage (HMA) screws (Aescalup Ltd.), the SImmetry SIJ Fusion System (Zyga Technology Inc.), the Rialto SI Fusion System (Medtronic), and the SI-LOK (Globus Medical Inc.).

Controversy: Patients with low back pain due to SIJ dysfunction typically follow a course of treatment, including NSM. For those who do not respond satisfactorily to NSM and have no alleviation of pain, surgery is an option. SIJ fusion via open surgery may relieve pain but has many disadvantages, including: a large incision; bone harvesting and grafting; long operative times; blood loss; extended hospital stay; high complication rates; and prolonged postoperative rehabilitation. The lack of a widely accepted reference standard by which SIJ dysfunction can be diagnosed further complicates issues.

Key Questions:

  • Is minimally invasive SIJ fusion with CTIs effective in treating low back pain related to SIJ dysfunction?

  • How does minimally invasive SIJ fusion with CTIs compare with other treatments for SIJ dysfunction?

  • Is minimally invasive SIJ fusion with CTIs safe?

  • Have definitive patient selection criteria been identified for minimally invasive SIJ fusion with CTIs for treatment of low back pain related to SIJ dysfunction?

If you have a Hayes login, click here to view the full report on the Knowledge Center.