Minimally Invasive SI Joint Fusion Procedures for Chronic SI Joint Pain: Systematic Review and Meta-Analysis of Safety and Efficacy.

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2023-12-26 DOI:10.14444/8543

Peter G Whang, Vikas Patel, Bradley Duhon, Bengt Sturesson, Daniel Cher, W Carlton Reckling, Robyn Capobianco, David Polly

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Abstract

Background: Sacroiliac (SI) joint fusion is increasingly used to treat chronic SI joint pain. Multiple surgical approaches are now available.

Methods: Data abstraction and random effects meta-analysis of safety and efficacy outcomes from published patient cohorts. Patient-reported outcomes (PROs) and safety measures were stratified by surgical technique: transiliac, including lateral transiliac (LTI) and posterolateral transiliac (PLTI), and posterior interpositional (PI) procedures.

Results: Fifty-seven cohorts of 2851 patients were identified, including 43 cohorts (2126 patients) for LTI, 6 cohorts (228 patients) for PLTI, and 8 cohorts (497 patients) for PI procedures. Randomized trials were only available for LTI. PROs were available for pain (numeric rating scale) in 57 cohorts (2851 patients) and disability (Oswestry Disability Index [ODI]) in 37 cohorts (1978 patients).All studies with PROs showed improvement from baseline after surgery. Meta-analytic improvements in pain scores were highest for LTI (4.8 points [0-10 scale]), slightly lower for PLTI (4.2 points), and lowest for PI procedures (3.8 points, P = 0.1533). Mean improvements in ODI scores were highest for LTI (25.9 points), lowest for PLTI procedures (6.8 points), and intermediate for PI (16.3 points, P = 0.0095).For safety outcomes, acute symptomatic implant malposition was 0.43% for LTI, 0% for PLTI, and 0.2% for PI procedures. Wound infection was reported in 0.15% of LTI, 0% of PLTI, and 0% of PI procedures. Bleeding requiring surgical intervention was reported in 0.04% of LTI procedures and not reported for PLTI or PI. Breakage and migration were not reported for any device. Radiographic imaging evaluation reporting implant placement accuracy and fusion was only available for LTI.

Discussion: Literature support for SI joint fusion is growing. The LTI procedure contains the largest body of available evidence and shows the largest improvements in pain and ODI. Only LTI procedures have independent radiographic evidence of fusion and implant placement. The adverse event rate for all procedures was low.

Level of evidence: 1:

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微创SI关节融合术治疗慢性SI关节疼痛：安全性和有效性的系统评价和荟萃分析。

背景：骶髂关节融合术越来越多地用于治疗慢性骶髂关节疼痛。现在有多种手术方法可供选择。方法：对已发表的患者队列的安全性和有效性结果进行数据提取和随机效应荟萃分析。根据手术技术对患者报告的结果（PROs）和安全措施进行分层：经颅，包括经颅外侧（LTI）和经颅后外侧（PLTI），以及后介入（PI）手术。结果：确定了57个队列，共2851名患者，包括43个LTI队列（2126名患者）、6个PLTI队列（228名患者）和8个PI程序队列（497名患者）。随机试验仅适用于LTI。在57个队列（2851名患者）和37个队列（1978名患者）中，PROs可用于疼痛（数字评分量表）和残疾（Oswestry残疾指数[ODI]）。所有使用PROs的研究都显示，手术后与基线相比有所改善。LTI疼痛评分的荟萃分析改善最高（4.8分[0-10分制]），PLTI疼痛评分略低（4.2分），PI手术疼痛评分最低（3.8分，P=0.1533），急性症状性植入物错位LTI为0.43%，PLTI为0%，PI为0.2%。据报道，0.15%的LTI、0%的PLTI和0%的PI手术中存在伤口感染。在0.04%的LTI手术中报告了需要手术干预的出血，而PLTI或PI没有报告。未报告任何设备的损坏和迁移。报告植入物放置准确性和融合的放射学成像评估仅适用于LTI。讨论：对SI关节融合的文献支持正在增加。LTI程序包含了最大的可用证据，并显示了疼痛和ODI的最大改善。只有LTI程序具有融合和植入物放置的独立放射学证据。所有手术的不良事件发生率均较低。证据级别：1：

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.