Sacroiliac joint interventions: a systematic review

Area of Science:

• Pain Medicine
• Interventional Pain Management
• Diagnostic Accuracy

Background:

• The sacroiliac joint is a common source of chronic low back pain, often presenting with referred pain.
• Diagnosing sacroiliac joint pain is challenging due to a lack of definitive clinical and radiological signs.
• Controlled diagnostic blocks are considered the gold standard for identifying sacroiliac joint pain generators.

Purpose of the Study:

• To systematically review and update evidence on diagnostic and therapeutic interventions for sacroiliac joint pain.
• To assess the accuracy of diagnostic techniques, including provocative maneuvers and diagnostic blocks.
• To evaluate the clinical effectiveness of therapeutic interventions such as intraarticular injections and radiofrequency neurotomy.

Main Methods:

• Systematic review adhering to AHRQ and Cochrane criteria.
• Searched EMBASE, MEDLINE, and Cochrane Reviews (1966-2006) for relevant studies.
• Included systematic reviews, narrative reviews, and prospective/retrospective studies on sacroiliac joint pain interventions.

Main Results:

• Moderate evidence supports the accuracy of comparative, controlled sacroiliac joint diagnostic blocks.
• Prevalence of sacroiliac joint pain ranges from 10% to 27% based on diagnostic blocks.
• Limited evidence exists for the diagnostic accuracy of provocative maneuvers and the therapeutic efficacy of intraarticular injections and radiofrequency neurotomy for pain relief.

Conclusions:

• Diagnostic sacroiliac joint injections demonstrate moderate evidence for specificity and validity.
• Provocative maneuvers have limited evidence for accurately diagnosing sacroiliac joint pain.
• Evidence for therapeutic intraarticular sacroiliac joint injections and radiofrequency neurotomy in managing chronic pain is limited.