Sacroiliac joint fusion for low back pain: a systematic review and meta-analysis

Abstract

Background context: Although pain is generally regarded as originating in the lumbar spine, it has been estimated that in 15-30 % of patients, LBP originates from the sacroiliac joint (SIJ).

Purpose: To determine whether sacroiliac joint fusion (SIJF) for LBP is effective in reducing pain when the SIJ is known to be the pain generator.

Study design/setting: Systematic review and meta-analysis.

Methods: A systematic literature review and meta-analysis was performed of observational studies describing outcome of SIJF in patients with LBP. Outcome measures were VAS pain, ODI, SF-36 PCS/MCS and Majeed score. The following databases were searched: PubMed, Web of Science, Embase, Medline and Google scholar. The methodological quality of selected studies was assessed using the National Heart Lung and Blood Institute case series quality assessment tool. Meta-analysis was used to combine the studies for each outcome and forest plots were prepared. Outcomes were expressed as mean difference (MD).

Results: Six studies were included in the meta-analysis with a mean follow-up of 17.6 months. All outcomes showed statistical and clinical improvement (VAS pain MD: 54.8; 95 % CI 48.6, 61.0; n = 380; p < 0.001, ODI MD: 14.5; 95 % CI 8.4, 20.6; n = 102; p < 0.001, SF-36 PCS MD: -19.5; 95 % CI -24.7, -14.2; n = 140; p < 0.001, SF-36 MCS MD: -8.5; 95 % CI -12.9, -4.1; n = 198; p < 0.001 and Majeed score MD: -35.4; 95 % CI -48.5, -22.2; n = 140; p < 0.001).

Conclusions: SIJF appears to be a satisfactory procedure for alleviating pelvic girdle pain.

Keywords: Fusion; Low back pain; Meta-analysis; Outcome; Pelvic girdle pain; Sacroiliac joint.