Efficacy and Safety of Posterior Minimally Invasive Sacroiliac Joint Fusion: A Narrative Review of Recent Evidence

Chronic low back pain is one of the top three causes of diminished quality of life in well-developed countries. There are many etiologies of lower back pain, and sometimes, the pain is of true spinal pathology. However, this is not always the case, and sacroiliac joint (SIJ) pain has been described as an etiology in 15-30% or more of patients who are experiencing low back pain. Overlooking SIJ dysfunction as the cause of low back pain has considerable consequences on the patient's quality of life and healthcare-associated costs. SIJ dysfunction has been gaining recognition through well-described algorithms and reports on how to diagnose and differentiate types of low back pain.

When conservative management fails in patients with SIJ dysfunction, fusion of the SIJ is a possibility. SIJ fusion was introduced as an open procedure but was often seen as a "last resort" related to the high complication rates and intensity of the procedure consistent with long operative time, high blood loss, and extended hospital stays. Minimally invasive surgical techniques for SIJ fusion were developed and have produced quality relief for some patients. Most minimally invasive SIJ fusion procedures are performed through a lateral approach. However, newer studies have shown evidence of a posterior or posterior oblique approach that may be more desirable for patients. The posterior approach to SIJ fusion has demonstrated a shorter operative time, smaller incision, and quicker return to activities of daily living. This narrative review aims to highlight up to date evidence on the efficacy and safety posterior minimally invasive SIJ fusion.