Treatment Of Sacroiliac Joint Pain Research Articles

5. Sacroiliac joint pain.

Sacroiliac (SI) joint pain is defined as pain localized in the anatomical region of the SI joint. The reported prevalence of SI joint pain among patients with mechanical low back pain varies between 15% and 30%. In this narrative review, the literature on the diagnosis and treatment of SI joint pain was updated and summarized. Patient's history provides clues on the source of pain. The specificity and sensitivity of provocative maneuvers are relatively high when three or more tests are positive, though recent studies have questioned the predictive value of single or even batteries of provocative tests. Medical imaging is indicated only to rule out red flags for potentially serious conditions. The diagnostic value of SI joint infiltration with local anesthetic remains controversial due to the potential for false-positive and false-negative results. Treatment of SI joint pain ideally consists of a multidisciplinary approach that includes conservative measures as first-line therapies (eg, pharmacological treatment, cognitive-behavioral therapy, manual medicine, exercise therapy and rehabilitation treatment, and if necessary, psychological support). Intra- and extra-articular corticosteroid injections have been documented to produce pain relief for over 3 months in some people. Radiofrequency ablation (RFA) of the L5 dorsal ramus and S1-3 (or 4) lateral branches has been shown to be efficacious in numerous studies, with extensive lesioning strategies (eg, cooled RFA) demonstrating the strongest evidence. The reported rate of complications for SI joint treatments is low. SI joint pain should ideally be managed in a multidisciplinary and multimodal manner. When conservative treatment fails, corticosteroid injections and radiofrequency treatment can be considered.

Review of Opioid Sparing Interventional Pain Management Options and Techniques for Radiofrequency Ablations for Sacroiliac Joint Pain.

The goal of this clinical review was to provide an update about the existing treatment options and associated evidence for various radiofrequency ablation techniques for sacroiliac joint pain. An electronic literature search on radiofrequency for the treatment of sacroiliac joint pain was conducted using PubMed, NCBI and Google Scholar. The following search keywords were used: radiofrequency ablation (cooled, pulsed, conventional, bipolar, intra-articular), sacroiliac joint and sacroiliac pain. The search was limited to human subjects, English language and articles with available full text. The bibliographic sections of all manuscripts were further searched for additional relevant citations. The full text of the relevant articles was reviewed by all the authors. Our study showed that radiofrequency ablation is a safe and effective treatment option that can be utilized to manage sacroiliac joint pain. It offers accessibility to the primary care physician, reduces office visits with "pain" as the primary complaint and provides the added benefit of acting as a non-opioid sparing means of analgesia.

Far-Contralateral Oblique (FCO) Sacroiliac Joint Injection: Description of a Novel Technique

Sacroiliac (SI) joint arthropathy is the primary pain generator in approximately 15–25% of patients with axial low back pain and traditionally diagnosed with >50% pain reduction following an intra-articular injection localized to the inferior 1/3 of the SI joint. The conventional technique for accessing the SI joint encompasses a posterior approach with fluoroscopic guidance at 10–20⁰ contralateral oblique angulation, and minor adjustments to this approach have been implemented with varying degrees of success. The authors present a novel technique for SI joint injection, infiltrating the middle third of the joint through an alternative far-contralateral oblique (FCO) approach, angulation between 20–40⁰. This approach theoretically endows easier access to the SI joint and at the very least provides another option for interventionalists in the diagnosis and treatment of sacroiliac joint pain. It can also be utilized to determine if a patient is a candidate for posterior percutaneous SI joint fusion. The authors sought to document this approach to ensure that it was both reproducible and safe, while recognizing the need for future studies.

The Combined Effectiveness of Piriformis Stretch and Muscle Activation Exercises in Patients with Sacroiliac Joint Pain.

Sacroiliac joint pain is one of the common misdiagnosed orthopedic causes of low back pain, which affects between 15 to 30 percent of individuals with mechanical low back pain below L5. The sacroiliac joint is found out to be a source of dysfunction and pain in 10% to 27% of suspected cases of patients with chronic low back pain. Clinicians use different electrotherapy modalities, biomechanical correction techniques, and exercises for addressing SI joint pain. Many studies have been undertaken to find out the efficacy of different treatment tools in combination or isolation. Likewise, there are studies done to understand the effect of piriformis stretch and muscles activation exercises on sacroiliac joint pain but, there exists very little evidence studying the combined effect of both the treatment tools. So our study aims to determine the combined effect of piriformis stretch and muscles activation exercises in patients with sacroiliac joint pain. About 30 subjects, both male and female with a primary diagnosis of sacroiliac joint pain by the physician were recruited into two groups. Group A having 15 patients received piriformis stretch and muscles activation exercises, and Group B having 15 patients received only muscles activation exercises. All the subjects received therapy sessions thrice weekly for four weeks. Outcome measures used were the visual analog scale (VAS) and oswestry disability index(ODI). Pre- intervention assessment and post-intervention assessment was carried out for both groups and the received data was analyzed using paired and independent t-test. According to the results of the analysis, the average improvement of VAS for Group A and Group B were 2.33 and 3.53 respectively. The paired t-test was 23.129 and 14.270, which is statistically highly significant (p-value = 0.000). The average improvement in oswestry disability index for group A and group B were 16.13 and 26.13 respectively using mean and standard deviation. The paired t-test was 11.014 and 6.934 respectively, which is statistically highly significant (p-value = 0.000). There is a significant improvement in both Group A and Group B. However, Group A (piriformis stretch and muscle activation exercises) showed significant improvement in the treatment of sacroiliac joint pain. The results indicated that both Group A and Group B had significant improvement in the scores of VAS and ODI scores at the 4th week when compared to baseline values, but when comparing the end results of group A and group B, it has been found out that group A intervention is more effective than Group B in treating patients with sacroiliac joint pain. From the data analysis reports, it can be concluded that when these treatment tools i.e piriformis stretch and muscles activation exercises are applied in combination, it gives better results in the management of sacroiliac joint pain

ID:16556 Interventional Treatment of Sacroiliac Joint Pain After Failed Back Surgery Using Percutaneous Lateral-Oblique Screw Technique

Sacroiliac joint (SIJ) pain has increased in incidence of lumbar fusion being performed. The pathophysiology is due to decrease motion in the lumbar spine with the increased mechanical load. The use of minimally invasive surgical (MIS) treatment options allow for treatment of pathology. The study aims to evaluate interventional surgical treatment of sacroiliac joint pain using a fluoroscopic guided percutaneous lateral-oblique screw technique.

Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature.

Sacroiliac joint (SIJ) pain is responsible for approximately 15-25% of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.

Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature.

Sacroiliac joint (SIJ) pain is responsible for approximately a third of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.

Preliminary Results of Endoscopic Radiofrequency Treatment of the Sacroiliac Joint Syndrome.

The sacroiliac joint (SIJ) may be the primary source of pain in 15 to 25% of patients with axial low back pain. Furthermore, 75% of patients who have had fusion surgery develop SIJ pain within 10 years. Treatment options include SIJ blocks, radiofrequency (RF) denervation, and fusion. The RF techniques range from ablation of the nerves supplying the joint, creating lesions to the joint itself, or a combination of both techniques. However, different clinical studies could only identify a limited or, in some cases, no effect in decreasing of pain intensity and duration of the effect. In this retrospective study, we selected 23 patients with SIJ pain, with a duration of more than 12 months and a 50% pain reduction on the Numeric Rating Scale (NRS) after diagnostic block. All patients received endoscopic ablation of the medial branch L5/S1 and the lateral branches, exiting the sacral foramina on S1/S2 and S2/S3 on both sides while using only one incision on each side. Telephone interviews were conducted with all patients. The outcome was determined with Odom's criteria, percent reduction NRS, subjective assessment of the patient, and duration of the effect. According to Odom's criteria, 79% of the patients showed acceptable to excellent results and confirmed that denervation helped them to manage their daily lives better. The average pain reduction in the responder group was 57% with an average duration of 13.4 months. In this retrospective study, we could demonstrate the practicability and effectiveness of endoscopic SIJ denervation in the treatment of SIJ pain using only one incision for three levels on each side. Further studies should investigate if this procedure is more effective than percutaneous RF.

Landmark-guided Injections for Treatment of Sacroiliac Joint Pain

<h3>Research Objectives</h3> To investigate patients' degree and duration of pain relief from landmark-guided injections without fluoroscopy or image-guidance for the treatment of sacroiliac joint (SIJ) pain. <h3>Design</h3> A retrospective cohort study was conducted to examine patients' degree and duration of SIJ pain relief from landmark-guided injections. Patients' self-reported measures to the provider's common follow-up questions were assessed in the electronic medical record from their follow-up visits. <h3>Setting</h3> An out-patient orthopedic spine surgery clinic. <h3>Participants</h3> 311 patients identified as having SIJ pain that received at least one landmark-guided injection were reviewed. Four patients with a history of image-guided or fluoroscopy-guided SIJ injections were excluded. <h3>Interventions</h3> The SIJ was palpated and a landmark-guided, periarticular injection consisting of an anesthetic agent and corticosteroid was administered with a 22-gauge needle without image or fluoroscopy guidance. The patient was prepped using an aseptic technique and ethyl chloride. <h3>Main Outcome Measures</h3> The primary outcomes included the duration of relief recorded in weeks and the degree of relief recorded as a percentage. Secondary outcomes included reported adverse side effects. Covariates of interest including age, smoking status, BMI, reason for pain onset, and sex were collected for further comparative analysis. <h3>Results</h3> Of these 311 patients included in this review, 191 patients returned for follow-ups with reports of duration and degree of pain relief. The average length of relief reported was 8.88 weeks. The average percent relief reported was 53.55%. Reported adverse side effects included: increased low back pain, an irregular menstrual cycle, and vaginal bleeding unrelated to menstruation. No other adverse side effects were reported. No comparisons between outcomes and covariates were statistically significant. <h3>Conclusions</h3> Landmark-guided SIJ injections are a reasonable and safe treatment option for SIJ pain, as our patient population had on average greater than 50% sustained relief for over 2 months. This treatment option is a more affordable and accessible option that can be done quickly in the clinic as compared to the gold-standard approach of fluoroscopically-guided SIJ Injections. A prospective, controlled study of the efficacy of these injections is underway at our institution. Other future research should investigate patients' degree and length of relief from subsequent landmark-guided injections. <h3>Author(s) Disclosures</h3> No conflicts to report.

Novel Interventional Techniques for Chronic Pain with Minimally Invasive Arthrodesis of the Sacroiliac Joint: (INSITE, iFuse, Tricor, Rialto, and others)

Acute and chronic pain are public health issues that clinicians have been battling for years. Opioid medications have been a treatment option for both chronic and acute pain; however, they can cause unwanted complications and are a major contributor to our present opioid epidemic. The sacroiliac (SI) joint is a common cause of both acute and chronic low back pain. It affects about 15–25% of patients with axial low back pain, and up to 40% of patients with ongoing pain following lumbar fusion. Recent advances in the treatment of SI joint pain have led to the development of a wide variety of SI joint fusion devices. These fusion devices seek to stabilize the joints themselves in order that they become immobile and, in theory, can no longer be a source for pain. This is a minimally invasive procedure aimed to address chronic pain without subjecting patients to lengthy surgery or medications, including opioids with the potential for addiction and abuse. Minimally invasive SI fusion can be performed by a lateral approach (i.e., iFuse, Tricor) or posterior approach (i.e., CornerLoc, LinQ, Rialto). The posterior approach requires the patient to be in the prone position but allows for less disruption of muscles with entry. More data are necessary to determine which fusion system may be best for a particular patient. SI fusion devices are a promising way of treating chronic lower back pain related to the SI joint. This narrative review will discuss various types of SI fusion devices, and their potential use in terms of their safety and efficacy.

Perioperative Outcomes of Minimally Invasive Sacroilliac Joint Fusion Using Hollow Screws Through a Lateral Approach: A Single Surgeon Retrospective Cohort Study

Sacroiliac joint (SIJ) pain is a common cause of lower back pain and a significant source of disability in the United States. There is no consensus on the best surgical treatment for SIJ pain that is not responsive to conservative therapy. Minimally invasive fusion of the SIJ using hollow fenestrated screws from a lateral trajectory is a newer technique for SIJ fusion. This study presents perioperative and patient-reported outcomes amongst 62 patients who underwent SIJ fixation with hollow fenestrated screws. We find that mean disability on the Oswestry disability index improved from 52.2% to 34.9% at one-year post-op. Mean operative time was 34±9 minutes and blood loss was 22±35ml. Only six patients required overnight hospitalization. There were two cases of complications requiring operative intervention. We conclude that SIJ fixation using hollow fenestrated screws is a safe and effective procedure for the fixation of the SIJ. Further investigation is warranted to determine the best surgical treatment for SIJ pain.

Effectiveness of kinesiotaping in pregnant women with sacroiliac joint pain: A randomised controlled study.

Sacroiliac joint (SIJ) dysfunction is an especially common cause of pain during pregnancy. Treatment options during pregnancy are very limited in order to reduce pain and increase the quality of life. We aimed to determine the efficacy of kinesiotaping (KT) in the treatment of SIJ pain in pregnant women. A total of 50 pregnant women with SIJ pain were included in the study. Patients were randomised into two groups as KT and sham KT groups. Women in the KT group underwent a total of 5weeks of KT once per week; the sham KT group also underwent 5weeks of KT applications, but without tension in the kinesiotape. Patients were assessed before and 5weeks after the treatment with a visual analogue scale (VAS) for pain and the Roland-Morris Disability Questionnaire (RMDQ) and Pelvic Girdle Questionnaire (PGQ) for disability and quality of life. The KT and sham KT groups were similar in terms of age, parity, gravidas, gestational week and body mass index. At the beginning of the study, there were no statistically significant differences between the two groups in their VAS, RMDQ or PGQ scores. Five weeks later, the KT group showed significant improvement in all parameters, but no significant differences were observed for the sham KT group in terms of VAS, RMDQ or PGQ. KT treatment improved the pain levels, functioning and quality of life among pregnant women with SIJ pain.

How I do it? Fully endoscopic rhizotomy assisted with three-dimensional robotic C-arm navigation for sacroiliac joint pain.

In some cases, the conventional C-arm fluoroscopy can barely identify anatomical landmarks such as the dorsal sacral foramen. A fully endoscopic rhizotomy under three-dimensional (3D) provides satisfactory results in the treatment of sacroiliac (SI) joint pain. The workflow of a fully endoscopic rhizotomy under 3D robotic C-arm navigation system is introduced. The presented technique is novel, effective, and safe for the treatment of SI joint pain. The 3D navigation system guides the operator to easily locate the target points for finding the medial branches of L5 and sacral lateral branches from S1, S2, and S3 dorsal foramina under endoscopic visualization.

A Review and Algorithm in the Diagnosis and Treatment of Sacroiliac Joint Pain.

IntroductionThe sacroiliac joint (SIJ) has been estimated to contribute to pain in as much as 38% of cases of lower back pain. There are no clear diagnostic or treatment pathways. This article seeks to establish a clearer pathway and algorithm for treating patients.MethodsThe literature was reviewed in order to review the biomechanics, as well as establish the various diagnostic and treatment options. Diagnostic factors addressed include etiology, history, physical exam, and imaging studies. Treatment options reviewed include conservative measures, as well as interventional and surgical options.ResultsProposed criteria for diagnosis of sacroiliac joint dysfunction can include pain in the area of the sacroiliac joint, reproducible pain with provocative maneuvers, and pain relief with a local anesthetic injection into the SIJ. Conventional non-surgical therapies such as medications, physical therapy, radiofrequency denervation, and direct SI joint injections may have some limited durability in therapeutic benefit. Surgical fixation can be by a lateral or posterior/posterior oblique approach with the literature supporting minimally invasive options for improving pain and function and maintaining a low adverse event profile.ConclusionSIJ pain is felt to be an underdiagnosed and undertreated element of LBP. There is an emerging disconnect between the growing incidence of diagnosed SI pathology and underwhelming treatment efficacy of medical treatment. This has led to an increase in SI joint fixation. We have created a clearer diagnostic and treatment pathway to establish an algorithm for patients that can include conservative measures and interventional techniques once the diagnosis is identified.

Dolor sacroilíaco: Epidemiología, fisiopatología, diagnóstico y tratamiento

El dolor sacroilíaco es una causa generalmente subdiagnosticada de dolor lumbar, que afecta del 15% a 30% de los pacientes con dolor lumbar bajo crónico no radicular. La articulación sacroilíaca (ASI) recibe continuo stress durante la bipedestación y marcha, siendo estabilizada por estructuras ligamentarias, capsulares y miofasciales fuertes, que reciben una abundante inervación. Destaca la dificultad en el diagnóstico del dolor sacroilíaco; debido a su naturaleza heterogénea. éste se debe sospechar en todo paciente con síndrome de dolor lumbar no radicular, unilateral y no central. El examen físico debería descartar patología de cadera y columna lumbar. La realización de maniobras de provocación del dolor sacroilíaco aporta en el diagnóstico, teniendo la combinación de 3 o más maniobras positivas una sensibilidad de 85% y especificidad de 79%. Se ha recurrido a inyecciones diagnósticas con anestésicos locales, tanto intraarticulares como de ligamentos circundantes. El tratamiento del dolor sacroilíaco es multimodal e individualizado para cada paciente. El tratamiento conservador –basado en terapia física y antiinflamatorios no esteroidales– es la terapia de primera línea. Las infiltraciones esteroidales tanto intra como extraarticulares pueden proveer alivio en un grupo de pa-cientes con inflamación activa. La denervación de los ramos dorsales laterales con radiofrecuencia ha mostrado ser un tratamiento exitoso en pacientes con dolor sacroilíaco, logrando 6 meses a 1 año de alivio del dolor. En pacientes con dolor refractario, la fusión de la articulación sacroilíaca es una opción, prefiriéndose la técnica mínimamente invasiva de fijación trans-sacroilíaca.

Cooled radiofrequency for the treatment of sacroiliac joint pain -impact on pain and psychometrics: a retrospective cohort study.

Objectives Cooled radiofrequency (cRF) is an effective treatment for sacroiliac pain. In contrast to conventional radiofrequency denervation, this technique allows enlarging the area of denervation by cooling the radiofrequency probe. However, there is sparse knowledge about the impact of interventional procedures like cRF treatment of sacroiliac joint pain on psychological comorbidities. The aim of this retrospective study was to evaluate the outcome of cRF in chronic pain patients regarding the psychological outcomes anxiety, depression, sleep quality and pain related disability. Methods In this retrospective observational study 29 interventions were performed over a period of two years in 28 patients. Pre- and post-interventional pain levels, depression and anxiety scores, pain-related disability, treatment satisfaction and sleep quality were assessed by standardized and validated questionnaires. Pain medication was recorded prior to the intervention and at follow-up. Results Hospital Anxiety and Depression Scale (HADS-D) scores for depression showed a statistically significant reduction after therapy which did not remain significant after Bonferroni-Holm correction. Anxiety as measured by the HADS-A score did not show a statistically significant change. No statistically significant improvement was observed in the pain disability index. Patients reported fewer sleep disorders after treatment. Mean pain (NRS) was statistically significantly reduced 1week post intervention and at time of follow-up. There was no clear reduction of analgesic medication. Conclusions Besides pain reduction, our data show a positive influence on sleep quality, possibly on depression, but not on anxiety and pain disability.

To Study the Effect of Mulligan Mobilization Versus Conventional Therapy in Sacroiliac Joint Pain

Background: Sacroiliac Joint Pain (SIJP) is a pain arising from SIJ structures such as anterior sacroiliac ligament, posterior sacroiliac ligament, interosseous ligaments or articular cartilage. The treatment of sacroiliac joint pain is quite challenging. The standard physical therapy (PT) interventions include repetitive exercises, manual joint mobilization, manipulation, bracing, massage, patient education, aerobic conditioning, general therapeutic exercise and electrotherapeutic modalities. Objectives: To compare the effect of mulligan mobilization versus conventional therapy on pain on VAS, Lumbar Range of motion and functional disability in patients with sacroiliac joint pain. Material and Method: A total 93 patients were screened as per the inclusion and exclusion criteria. Patients were randomly allocated in two groups. Group A received mulligan mobilization and Ultrasound therapy and group B received Conventional therapy i.e Ultrasound therapy. Outcome measures assessed were VAS for pain, Lumbar flexion by modified schober’s test and MODQ for functional Disability. Result: Mean difference of Pain on VAS 4.41±1.04 in group A and in group B 3.63±1.27. Mean difference in Lumbar flexion ROM in group A it was 1.30 ± 0.67 and in group B it was 0.98 ±0.55 Mean difference in MODI Score in group A was 34.67 ± 10.84 and in group B it was 13.50 ± 6.45. Conclusion: In the present study, we found that both the techniques Mulligan mobilization and Conventional therapy are effective in the subjects with Sacroiliac joint pain but Mulligan mobilization was found to be more effective than conventional therapy.

Clinical results of the treatment for sacroiliac joint pain by radiofrequency neurotomy

ObjectiveSacroiliac joint pain is one of several causes of lower limb and lower back pain not originating from the spine, spinal cord, or nerve roots. The authors examined outcomes of treating sacroiliac joint pain using radiofrequency neurotomy (RFN), as described in several previous studies by Murakami et al. between 2007 and 2018. The RFN treatment in the present study was performed on 67 patients (31 male, 36 female; median age 61.8 years) who experienced re-flares of pain despite ≥2 injections of local anesthetics into the sacroiliac joint. Patients and MethodsRFN treatment was considered to be effective when pain was reduced by ≤50% after treatment. Additional RFN treatment(s) was administered to patients who experienced pain re-flares. ResultsOf the 67 patients, 57 (85.1%) achieved sustained pain relief, 30 (44.8%) of whom experienced immediate pain relief after the first treatment and no longer required therapy. The other 27 patients who experienced subsequent re-flares underwent additional RFN treatment(s) and successfully achieved sustainable pain relief sufficient to end therapy. ConclusionRFN resulted in no complications and was safe and minimally invasive, and should be considered a conservative treatment option in advance of sacroiliac joint fusion surgery.

Nonoperative Treatment Options for Patients With Sacroiliac Joint Pain.

Sacroiliac joint (SIJ) pain is thought to be a component of low back pain in 20% of people who suffer with it chronically. There is no consistent objective diagnostic testing that includes SIJ pain as the diagnosis and thereby it can become a diagnosis of exclusion. Treatment of SIJ pain is variable, and no set method or protocol of treatment has been found to be efficacious or reliable. Thus, the healthcare provider is often left to create an individual treatment plan based on their own experiences and expertise. The purpose of this narrative review is to describe and discuss nonoperative treatment options for patients with SIJ pain. Further, coordination of treatment options and progression of treatment will be offered.

Sacroiliac Joint Fusion: Approaches and Recent Outcomes.

The sacroiliac joint may be a primary source of pain in patients complaining of low back and/or buttock pain. Nonsurgical treatment of sacroiliac joint pain typically includes structured core and pelvic muscle flexibility and strengthening; pharmaceutical management through oral and injectable medication; and ablation procedures. For patients who do not improve with comprehensive, nonoperative treatment, surgical fusion of the sacroiliac joint is an option with overall good reported outcomes and high patient satisfaction. Minimally invasive surgery (MIS) approaches have been shown to have lower morbidity and earlier recovery than traditional open approaches. To date, the majority of published clinical studies on MIS sacroiliac joint fusion are industry-sponsored and predominantly using one system (ingrowth triangular titanium rods). These include two level 1 randomized controlled trials comparing MIS sacroiliac joint fusion to nonoperative management, with results favoring surgery.