Management of Chronic Sacroiliac Joint Pain; Conservative versus Minimally Invasive Intervention versus Sacroiliac Joint Fusion; A Systematic Review

Abstract

Abstract Background Chronic sacroiliac joint (SIJ) pain poses a significant clinical challenge, and the choice between conservative management and minimally invasive interventions or SIJ fusion is an ongoing debate. This systematic review and meta- analysis aimed to compare the effectiveness and safety of SIJ fusion versus conservative treatment versus minimally invasive interventions in patients with SIJ pain of degenerative origin or following lumbar fusion. Methods A comprehensive search of PubMed, Web of Science, and Scopus databases was conducted using a predefined search strategy. The search process adhered to the PRISMA guidelines and utilized Cochrane's systematic review methods. Eligible studies were identified through a two-step screening process, and data were extracted for analysis, including visual analog scale (VAS) scores, Oswestry Disability Index (ODI), Short Form-36 (SF-36) scores, and recurrence rates of low back pain. Risk of bias was assessed using Cochrane's risk of bias tool for randomized clinical trials and the ROBINS-1 tool for non-randomized clinical trials. Results Sixteen studies met the inclusion criteria, and a detailed analysis of subgroups and overall outcomes was conducted. The results showed that VAS scores at baseline favored the conservative treatment, while VAS score improvements at 3 months were more prominent in the fusion procedure. At 9 months or more, both minimal intervention and fusion procedures demonstrated significant improvements. Regarding ODI, fusion procedures were associated with higher baseline scores, but significant improvements were observed at various time points. In contrast, the conservative treatment showed significant ODI improvements at 3 months. The SF-36 scores varied, with minimal intervention appearing more favorable for SF-36 PCS and MCS after 12 months. Conclusion The choice between SIJ fusion and conservative treatment should be tailored to the specific outcome of interest. Fusion procedures, especially for VAS scores and ODI at various time points, offer benefits, while conservative treatment is effective for early ODI improvements. For long-term functional and pain outcomes, both minimal intervention and fusion procedures demonstrate efficacy, with a slight advantage for the fusion procedure. Ultimately, treatment decisions should consider individual patient needs and desired outcomes. Further research is needed to refine treatment recommendations and enhance patient outcomes.