Open AccessEvaluation of Sacroiliac Joint Interventions: A Systematic Appraisal of the Literature
Author(s) -
Matthew P Rupert,
Marion Lee,
Laxmaiah Manchikanti,
Sukdeb Datta,
Steven P. Cohen
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/399
Subject(s) - medicine , sacroiliac joint , psychological intervention , observational study , physical therapy , systematic review , randomized controlled trial , critical appraisal , manual therapy , medline , placebo , low back pain , minimal clinically important difference , physical medicine and rehabilitation , surgery , alternative medicine , pathology , psychiatry , political science , law
Background: The sacroiliac joint has been implicated as a source of low back and lower extremity pain. There are no definite historical, physical, or radiological features that can definitively establish a diagnosis of sacroiliac joint pain. Based on the present knowledge, an accurate diagnosis is made only by controlled sacroiliac joint diagnostic blocks. The sacroiliac jointhas been shown to be a source of pain in 10% to 27% of suspected patients with chronic lowback pain utilizing controlled comparative local anesthetic blocks.Study Design: A systematic review of diagnostic and therapeutic sacroiliac jointinterventions.Objective: To evaluate the accuracy of diagnostic sacroiliac joint interventions and the utilityof therapeutic sacroiliac joint interventions.Methods: The literature search was carried out by searching the databases of PubMed, EMBASE, and Cochrane reviews.Methodologic quality assessment of included studies was performed using the Agency forHealthcare Research and Quality (AHRQ) methodologic quality criteria for diagnostic accuracyand observational studies, whereas randomized trials were evaluated utilizing the Cochrane review criteria. Only studies with scores of 50 or higher were included for assessment.Level of evidence was based on the U.S. Preventive Services Task Force (USPSTF) criteria.Outcome Measures: For diagnostic interventions, the outcome criteria included at least50% pain relief coupled with a patient’s ability to perform previously painful maneuvers withsustained relief using placebo-controlled or comparative local anesthetic blocks.For therapeutic purposes, outcomes included significant pain relief and improvement in function and other parameters. Short-term relief for therapeutic interventions was defined as 6months or less, whereas long-term effectiveness was defined as greater than 6 months.Results: The indicated level of evidence is II-2 for the diagnosis of sacroiliac joint pain utilizing comparative, controlled local anesthetic blocks. The prevalence of sacroiliac joint pain is estimated to range between 10% and 38% using a double block paradigm in the study population. The false-positive rate of single, uncontrolled, sacroiliac joint injections is 20% to 54%.The evidence for provocative testing to diagnose sacroiliac joint pain is Level II-3 or limited.For radiofrequency neurotomy the indicated evidence is limited (Level II-3) for short- and longterm relief.Limitations: The limitations of this systematic review include the paucity of literature evaluating the role of both diagnostic and therapeutic interventions and widespread methodological flaws.Conclusions: The indicated evidence for the validity of diagnostic sacroiliac joint injections is Level II-2. The evidence for the accuracy of provocative maneuvers in the diagnosing of sacroiliac jointpain is limited (Level II-3). The evidence for radiofrequency neurotomy is also limited (Level II-3).Key words: Chronic low back pain, sacroiliac joint pain, sacroiliitis, sacroiliac joint injection,sacroiliac joint dysfunction, thermal radiofrequency, pulsed radiofrequency