Percutaneous Sacroiliac Joint Fusion: Indications and Technique

Sacroiliac joint (SIJ) pain is a common, although underdiagnosed cause of lower back pain. In the past, the surgical treatment for SIJ pain had been somewhat controversial and the indications for intervention rather unclear. The surgical treatment for SIJ dysfunction traditionally has been performed in an open fusion with a significant dissection and disruption of normal tissues to expose the joint and allow for arthrodesis. More recently, minimally invasive percutaneous techniques have been developed for SIJ fusion. A substantial body of evidence now supports the benefits of percutaneous SIJ fusion compared to nonoperative management for decreasing pain and improving quality of life. SIJ pain has been demonstrated to be responsible for 22% of low back pain and is found in 43% of patients who have previously undergone lumbar fusion. As of increased awareness of this pain generator, we can expect an increased recognition of its diagnosis. Thus, methods for SIJ fusion including percutaneous SIJ fusion, may become more utilized in the future. This overview will help to define the indications for SIJ fusion surgery and describe current techniques commonly used.