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

Abstract

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). To determine whether sacroiliac joint fusion (SIJF) for LBP is effective in reducing pain when the SIJ is known to be the pain generator. Systematic review and meta-analysis. 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). Six studies were included in the meta-analysis with a mean follow-up of 17.6months. 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). SIJF appears to be a satisfactory procedure for alleviating pelvic girdle pain.