The sacroiliac joint (SIJ) has been implicated as the primary source of pain in 15% to 30% of patients with chronic low back pain. Patients who experience pain for ≥ 6 months and do not respond adequately to nonsurgical, conservative management may be eligible for SIJ fusion.

Description of Technology: Open SIJ fusion typically involves opening the SIJ, denuding of cartilage, and bone grafting. To stabilize the SIJ, the iliac crest bone and the sacrum are typically held together by plates or screws or an interbody fusion cage until the 2 bones fuse.

Patient Population: This health technology assessment focuses on unspecified, confirmed SIJ dysfunction not relating to acute trauma, fracture, dislocation, tumor, pregnancy, infection, spinal deformity, degenerative spine disease, pelvic ring fracture, acetabular fractures, sacral agenesis, or spinopelvic dissociation.

Clinical Alternatives: Clinical alternatives to open fusion for low back pain due to SIJ dysfunction include:

  • Minimally invasive surgery approaches: These include the lateral transarticular and posterior approaches.
  • Nonsurgical management: Physical therapy, medications (including anti-inflammatory agents), pelvic/sacroiliac belts, chiropractic management, intra-articular or periarticular steroid or anesthesia injections, or radiofrequency ablation of the lateral branches of the sacral nerve roots (neurotomy).

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