PMID- 35017057 OWN - NLM STAT- MEDLINE DCOM- 20220719 LR - 20220902 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 22 IP - 8 DP - 2022 Aug TI - Minimally invasive sacroiliac joint fusion for chronic sacroiliac joint pain: a systematic review. PG - 1240-1253 LID - S1529-9430(22)00005-5 [pii] LID - 10.1016/j.spinee.2022.01.005 [doi] AB - BACKGROUND CONTEXT: Sacroiliac (SI) joint pain causes significant disability and impairment to quality of life (QOL). Minimally invasive SI joint fusion is increasingly used to relieve chronic SI joint pain among patients who do not respond to nonsurgical treatment. PURPOSE: To systematically review the existing literature to assess the effectiveness and safety of minimally invasive SI joint fusion. STUDY DESIGN/SETTING: Systematic review. DATA SOURCES: PubMed, Embase, Cochrane, and a clinical trial registry from database inception to June 30, 2021. STUDY SELECTION: Eligible studies were primary research studies published in the English language, enrolled adults with SI joint pain, and compared SI joint fusion to nonsurgical interventions or alternative minimally invasive procedures. We included randomized controlled trials (RCTs) or controlled cohort studies (CCSs) that reported effectiveness (pain, physical function, QOL, opioid use) or safety outcomes (adverse events [AEs], revision surgeries) and uncontrolled studies that reported safety outcomes. DATA ABSTRACTION AND SYNTHESIS: Data were abstracted into structured forms; two independent reviewers assessed risk of bias using standard instruments; certainty of evidence was rated using GRADE. RESULTS: Forty studies (2 RCTs, 3 CCSs, and 35 uncontrolled studies) were included. Minimally invasive SI joint fusion with the iFuse Implant System appeared to result in larger improvements in pain (two RCTs: mean difference in visual analog scale -40.5 mm, 95% CI, -50.1 to -30.9; -38.1 mm, p<.0001) and larger improvements in physical function (mean difference in Oswestry Disability Index -25.4 points, 95% CI, -32.5 to -18.3; -19.8 points, p<.0001) compared to conservative management at 6 months. Improvements in pain and physical function for the RCTs appeared durable at 1- and 2-year follow-up. Findings were similar in one CCS. The two RCTs also found significant improvements in QOL at 6 months and 1 year. Opioid use may be improved at 6 months and 1 to 2 years. AEs appeared higher in the fusion group at 6 months. The incidence of revision surgery varied by study; the highest was 3.8% at 2 years. Two CCSs compared the effectiveness of alternative minimally invasive fusion procedures. One CCS compared iFuse to the Rialto SI Fusion System and reported no differences in pain, function, QOL, and revision surgeries from 6 months to 1 year. One CCS compared iFuse to percutaneous screw fixation and reported significantly fewer revisions among iFuse participants (mean difference -61.0%, 95% CI, -78.4% to -43.5%). The 35 uncontrolled studies had serious limitations and reported heterogeneous safety outcomes. Two of the larger studies reported a 13.2% incidence of complications from minimally invasive SI joint fusion at 90 days using an insurance claims database and a 3.1% incidence of revision surgery over 2.5 years using a postmarket surveillance database. CONCLUSIONS: Among patients meeting diagnostic criteria for SI joint pain and who have not responded to conservative care, minimally invasive SI joint fusion is probably more effective than conservative management for reducing pain and opioid use and improving physical function and QOL. Fusion with iFuse and Rialto appear to have similar effectiveness. AEs appear to be higher for minimally invasive SI joint fusion than conservative management through 6 months. Based on evidence from uncontrolled studies, serious AEs from minimally invasive SI joint fusion may be higher in usual practice compared to what is reported in trials. The incidence of revision surgery is likely no higher than 3.8% at 2 years. Limited evidence is available that compares different minimally invasive devices. CI - Copyright (c) 2022. Published by Elsevier Inc. FAU - Chang, Eva AU - Chang E AD - Advocate Aurora Research Institute, 3075 Highland Parkway, Downers Grove, IL 60515. Electronic address: eva.chang@aah.org. FAU - Rains, Caroline AU - Rains C AD - Advocate Aurora Research Institute, 3075 Highland Parkway, Downers Grove, IL 60515. FAU - Ali, Rania AU - Ali R AD - RTI-University of North Carolina Evidence-Based Practice Center, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA. FAU - Wines, Roberta C AU - Wines RC AD - RTI-University of North Carolina Evidence-Based Practice Center, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA. FAU - Kahwati, Leila C AU - Kahwati LC AD - RTI-University of North Carolina Evidence-Based Practice Center, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PT - Systematic Review DEP - 20220110 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 RN - 0 (Analgesics, Opioid) SB - IM MH - Adult MH - Analgesics, Opioid MH - Arthralgia MH - *Chronic Pain/surgery MH - Humans MH - Minimally Invasive Surgical Procedures/adverse effects/methods MH - Sacroiliac Joint/surgery MH - *Spinal Diseases MH - *Spinal Fusion/methods OTO - NOTNLM OT - Chronic low back pain OT - Minimally invasive surgery OT - Sacroiliac arthrodesis OT - Sacroiliac joint OT - Sacroiliac joint fusion OT - Systematic review EDAT- 2022/01/13 06:00 MHDA- 2022/07/20 06:00 CRDT- 2022/01/12 05:53 PHST- 2021/08/18 00:00 [received] PHST- 2021/12/13 00:00 [revised] PHST- 2022/01/03 00:00 [accepted] PHST- 2022/01/13 06:00 [pubmed] PHST- 2022/07/20 06:00 [medline] PHST- 2022/01/12 05:53 [entrez] AID - S1529-9430(22)00005-5 [pii] AID - 10.1016/j.spinee.2022.01.005 [doi] PST - ppublish SO - Spine J. 2022 Aug;22(8):1240-1253. doi: 10.1016/j.spinee.2022.01.005. Epub 2022 Jan 10.