Open AccessA Systematic Evaluation of Prevalence and Diagnostic Accuracy of Sacroiliac Joint Interventions
Author(s) -
Thomas Simopoulos
Publication year - 2012
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.2012/15/e305
Subject(s) - sacroiliac joint , medicine , physical therapy , psychological intervention , systematic review , low back pain , medline , critical appraisal , diagnostic accuracy , physical medicine and rehabilitation , medical physics , alternative medicine , radiology , pathology , psychiatry , political science , law
Background: The contributions of the sacroiliac joint to low back and lower extremity pain havebeen a subject of considerable debate and research. It is generally accepted that 10% to 25% ofpatients with persistent mechanical low back pain below L5 have pain secondary to sacroiliac jointpathology. However, no single historical, physical exam, or radiological feature can definitivelyestablish a diagnosis of sacroiliac joint pain. Based on present knowledge, a proper diagnosis canonly be made using controlled diagnostic blocks. The diagnosis and treatment of sacroiliac jointpain continue to be characterized by wide variability and a paucity of the literature.Objective: To evaluate the accuracy of diagnostic sacroiliac joint interventions.Study Design: A systematic review of diagnostic sacroiliac joint interventions.Methods: Methodological quality assessment of included studies was performed using QualityAppraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50%of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% arepresented descriptively and analyzed critically.The level of evidence was classified as good, fair, or limited (or poor) based on the quality ofevidence developed by the United States Preventive Services Task Force (USPSTF).Data sources included relevant literature identified through searches of PubMed and EMBASEfrom 1966 to December 2011, and manual searches of the bibliographies of known primary andreview articles.Outcome Measures: In this evaluation we utilized controlled local anesthetic blocks using atleast 50% pain relief as the reference standard.Results: The evidence is good for the diagnosis of sacroiliac joint pain utilizing controlledcomparative local anesthetic blocks. The prevalence of sacroiliac joint pain is estimated torange between 10% and 62% based on the setting; however, the majority of analyzed studiessuggest a point prevalence of around 25%, with a false-positive rate for uncontrolled blocks ofapproximately 20%. The evidence for provocative testing to diagnose sacroiliac joint pain was fair.The evidence for the diagnostic accuracy of imaging is limited.Limitations: The limitations of this systematic review include a paucity of literature, variations intechnique, and variable criterion standards for the diagnosis of sacroiliac joint pain.Conclusions: Based on this systematic review, the evidence for the diagnostic accuracy ofsacroiliac joint injections is good, the evidence for provocation maneuvers is fair, and evidence forimaging is limited.Key words: Chronic low back pain, sacroiliac joint pain, sacroiliitis, sacroiliac joint injection,sacroiliac joint dysfunction, provocation manuevers, controlled diagnostic blocks, intraarticularinjection, extraarticular injection.