What is the role of surgery in the treatment of acute sacroiliac joint (SIJ) injuries?

Updated: Jan 16, 2019
  • Author: Andrew L Sherman, MD, MS; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

Surgical intervention is rarely used for nontraumatic SIJ pain. [4, 18, 19] Surgery is considered only in patients with chronic pain that has lasted for years, has not been effectively treated by other means, and has led to an extremely poor quality of life; the procedure is a fusion across the joint. A randomized, controlled trial by Polly et al found that patients who underwent minimally invasive SIJ fusion with triangular titanium implants achieved greater pain and disability relief at 24-month follow-up than did those who underwent nonsurgical management. The rates of pain and disability improvement for the fusion patients (102 subjects) at 24 months were 82.0% and 65.9%, respectively, compared with less than 10% for both pain and disability in the nonsurgical patients (46 subjects). [20]

Similarly, a randomized, controlled study by Sturesson et al also found better alleviation of pain and disability with SIJ joint fusion with triangular titanium implants than with conservative management. In the fusion patients (52 subjects), the mean lower back pain score had improved by 43.3 points at 6 months, compared with 5.7 points in the conservative treatment group, while the mean disability score had improved by 26 points in the fusion patients, compared with 6 points in the conservative management group. [21]

A study reported that ilio-sacral screws can be safely used to treat sacral fractures and sacroiliac joint injuries in children. [22]


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