Systematic Review on Minimally Invasive Posterior Sacroiliac Joint Fusion

Sacroiliac joint dysfunction contributes to a significant proportion of lower back and leg pain and associated functional deficiencies. Following failure of conservative methods, lateral fusion approaches have previously provided the mainstay for surgical stabilization of the joint. In recent years there are multiple devices available for sacroiliac fusion via posterior or posterolateral oblique approaches, thereby reducing neurovascular complications of the lateral approach.

To provide a comprehensive review of the evidence for pain and functional outcomes in patients treated with posterior or posterolateral oblique sacroiliac joint fusion devices.

The primary outcome was improvement in pain following posterior or posterolateral oblique sacroiliac joint fusion in publications between 2020 and 2024, with the authors' previous review conducted up to 2020. Three authors assessed studies identified from multiple databases (PubMed, SCOPUS, Embase, MEDLINE, Cochrane, and Google Scholar).

Out of 740 initial publications, 12 studies fulfilled inclusion criteria. These peer-reviewed articles included two prospective and 10 retrospective observational studies, with two studies providing direct comparisons to lateral fusion approaches. Overall average improvement of VAS/NRS pain scores at final follow-up for intra-articular fusion via posterior approach and posterolateral oblique fusion ranged 35%-75% and 28%-89%, respectively. Cohort outcomes were nearly all statistically significant. Complications were minimal and typically resolved with revision fusion. The heterogeneity of studies prohibited proper meta-analysis.

There is increasing evidence for the effectiveness and safety of posterior and posterolateral oblique sacroiliac joint fusion. Future randomized, controlled trials are needed to guide specific device and approach selection, and elucidation of patient long-term outcomes.