A Systematic Evaluation of Prevalence and Diagnostic Accuracy of Sacroiliac Joint Interventions

Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA.
Pain physician (Impact Factor: 3.54). 05/2012; 15(3):E305-44.
Source: PubMed


The contributions of the sacroiliac joint to low back and lower extremity pain have been a subject of considerable debate and research. It is generally accepted that 10% to 25% of patients with persistent mechanical low back pain below L5 have pain secondary to sacroiliac joint pathology. However, no single historical, physical exam, or radiological feature can definitively establish a diagnosis of sacroiliac joint pain. Based on present knowledge, a proper diagnosis can only be made using controlled diagnostic blocks. The diagnosis and treatment of sacroiliac joint pain continue to be characterized by wide variability and a paucity of the literature.
To evaluate the accuracy of diagnostic sacroiliac joint interventions.
A systematic review of diagnostic sacroiliac joint interventions.
Methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles.
In this evaluation we utilized controlled local anesthetic blocks using at least 50% pain relief as the reference standard.
The evidence is good for the diagnosis of sacroiliac joint pain utilizing controlled comparative local anesthetic blocks. The prevalence of sacroiliac joint pain is estimated to range between 10% and 62% based on the setting; however, the majority of analyzed studies suggest a point prevalence of around 25%, with a false-positive rate for uncontrolled blocks of approximately 20%. The evidence for provocative testing to diagnose sacroiliac joint pain was fair. The evidence for the diagnostic accuracy of imaging is limited.
The limitations of this systematic review include a paucity of literature, variations in technique, and variable criterion standards for the diagnosis of sacroiliac joint pain.
Based on this systematic review, the evidence for the diagnostic accuracy of sacroiliac joint injections is good, the evidence for provocation maneuvers is fair, and evidence for imaging is limited.

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Available from: Steven P Cohen, Dec 15, 2014
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    • "The SI joint is suspected to be the primary pain generator if at least three of five tests are positive.19 Finally, SI joint dysfunction is confirmed with two separate fluoroscopically guided, intra-articular diagnostic SI joint blocks that provide >75% immediate symptom relief.20 "
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    ABSTRACT: Chronic sacroiliac (SI) joint-related low back pain (LBP) is a common, yet under-diagnosed and undertreated condition due to difficulties in accurate diagnosis and highly variable treatment practices. In patients with debilitating SI-related LBP for at least 6 months duration who have failed conservative management, arthrodesis is a viable option. The SImmetry(®) SI Joint Fusion System is a novel therapy for SI joint fusion, not just fixation, which utilizes a minimally invasive surgical approach, instrumented fixation for immediate stability, and joint preparation with bone grafting for a secure construct in the long term. The purpose of this report is to describe the minimally invasive SI Joint Fusion System, including patient selection criteria, implant characteristics, surgical technique, postoperative recovery, and biomechanical testing results. Advantages and limitations of this system will be discussed.
    Full-text · Article · May 2014 · Medical Devices: Evidence and Research
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    • "The sacroiliac joint (SIJ) is a possible cause of pain in patients with low back and pelvic girdle pain (PGP), with a reported prevalence ranging from 10% to 60% depending on the patient population and choice of diagnostic criteria (Cohen et al., 2013; Simopoulos et al., 2012; Vleeming et al., 2008). A large amount of force is transferred from the spine to the legs through the pelvis and SIJ joints. "
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    ABSTRACT: Background Chamberlain’s projections (anterior-posterior x-ray of the pubic symphysis) have been used to diagnose sacroiliac joint mobility during the single-leg stance test. This study examined the movement in the sacroiliac joint during the single-leg stance test with precise radiostereometric analysis. Methods Under general anesthesia, tantalum markers were inserted into the dorsal sacrum and the ilium of 11 patients with long-lasting and severe pelvic girdle pain. After two to three weeks, a radiostereometric analysis was conducted while the subjects performed a single-leg-stance. Findings Small movements were detected in the sacroiliac joint during the single-leg stance. In both the standing- and hanging-leg sacroiliac join, a total of 0.5 degree rotation was observed; however, no translations were detected. There were no differences in total movement between the standing- and hanging-leg sacroiliac joint. Interpretation The movement in the sacroiliac joint during the single-leg stance is small and almost undetectable by the precise radiostereometric analysis. A complex movement pattern was seen during the test, with a combination of movements in the two joints. The interpretation of the results of this study is that, the Chamberlain examination likely is inadequate in the examination of sacroiliac joint movement in patients with pelvic girdle pain.
    Full-text · Article · Apr 2014 · Clinical biomechanics (Bristol, Avon)
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    • "A positive result on 3 or more pain provocation tests such as Gaenselen’s, flexion abduction external rotation (FABER), compression, distraction and thigh thrust, was used as criteria for further testing to confirm the SI joint as the pain generator [16-19]. Diagnostic imaging studies such as x-ray, CT and MRI, while not sensitive in diagnosing disorders of the SI joint, are helpful in ruling out pathology in the lumbar spine and hip [17]. When clinical, physical and imaging findings were congruent, patients were sent for image-guided diagnostic injections of the SI joint. "
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    ABSTRACT: Sacroiliac joint (SI) pain is an often-overlooked cause of low back pain due, in part, to lack of specific findings on radiographs and symptoms mimicking other back-related disorders. We report our experience with minimally invasive (MIS) SI joint arthrodesis using a series of triangular, titanium plasma spray (TPS) coated implants in patients refractory to conservative care. We report outcomes from 18 patients with 12 months of postoperative follow-up. Demographics, complications, and clinical outcomes using visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) for back function and SF-12 for quality of life were collected preoperatively and at 3, 6 and 12 months post-operatively. Mean age was 64 years and 67% of patients were female. There were no intraoperative complications and one explant at three months for malposition. All patient-reported outcomes showed both clinically and statistically significant improvement at 12 months (p < 0.001 for each of the following): VAS improved by 6.6 points, ODI scores improved by −37.5 points. One year SF-12 physical and mental component (PCS, MCS) scores approximated population normal scores for both physical and mental functioning. Patient satisfaction with outcomes was high at 95%; 89% said would have the same surgery again. MIS SI joint fusion using a series of triangular porous TPS coated titanium implants is a safe and effective procedure for patients with SI joint disorders who have failed conservative care.
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