A Systematic Evaluation of the Therapeutic Effectiveness of Sacroiliac Joint Interventions

Background: The contribution of the sacroiliac joint to low back and lower extremity pain has beena subject of debate with extensive research. It is generally accepted that approximately 10% to 25%of patients with persistent low back pain may have pain arising from the sacroiliac joints. In spite ofthis, there are currently no definite conservative, interventional, or surgical management options formanaging sacroiliac joint pain. In addition, there continue to be significant variations in the applicationof various techniques as well as a paucity of literature.Study Design: A systematic review of therapeutic sacroiliac joint interventions.Objective: To evaluate the accuracy of therapeutic sacroiliac joint interventions.Methods: The available literature on therapeutic sacroiliac joint interventions in managing chroniclow back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteriautilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventionaltechniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies.The level of evidence was classified as good, fair, or limited (or poor) based on the quality of evidencedeveloped by the U.S. Preventive Services Task Force (USPSTF).Data sources included relevant literature published from 1966 through December 2011 that wasidentified through searches of PubMed and EMBASE, and manual searches of the bibliographies ofknown primary and review articles.Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6months and long-term > 6 months). Secondary outcome measures were improvement in functionalstatus, psychological status, return to work, and reduction in opioid intake.Results: For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies wereexcluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6randomized trials and 5 non-randomized studies.The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is fair.The evidence for effectiveness of intraarticular steroid injections is limited (or poor).The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is limited (orpoor).The evidence for effectiveness of conventional radiofrequency neurotomy is limited (or poor).The evidence for pulsed radiofrequency is limited (or poor).Limitations: The limitations of this systematic review include a paucity of literature on therapeuticinterventions, variations in technique, and variable diagnostic standards for sacroiliac joint pain.Conclusions: The evidence was fair in favor of cooled radiofrequency neurotomy and limited (orpoor) for short-term and long-term relief from intraarticular steroid injections, periarticular injectionswith steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.Key words: Chronic low back pain, sacroiliac joint pain, sacroiliitis, sacroiliac joint injection, sacroiliacjoint dysfunction, thermal radiofrequency, pulsed radiofrequency