1. 2005;8;115-125A Systematic Review of Sacroiliac Joint Interventions
   A Systematic Review
   Ann Marie McKenzie-Brown, MD, Rinoo V. Shah, MD, Nalini Sehgal, MD, and Clifford R. Everett, MD.

Background: The sacroiliac joint is an accepted source of low back pain with or without associated lower extremity symptoms.  The diagnosis and management of sacroiliac joint pain and the role of interventional techniques have been controversial.

Objective: To evaluate the clinical usefulness of sacroiliac joint interventions in the diagnosis and management of sacroiliac joint pain.

Study Design: A systematic review using the criteria as outlined by the Agency for Healthcare Research and Quality (AHRQ), Cochrane Review Group Criteria, and QUADAS criteria for diagnostic studies.

Methods: The databases of EMBASE and MEDLINE  (1966 to November 2004), and Cochrane Review were searched.  The searches included systematic reviews, narrative reviews, prospective and retrospective studies, and cross-references from articles reviewed.  The search strategy included sacroiliac joint pain and dysfunction, sacroiliac joint injections, interventions, and radiofrequency.

Results: The results of this systematic evaluation showed that for diagnostic purposes, there is moderate evidence showing the accuracy of comparative, controlled local anesthetic blocks.  Prevalence of sacroiliac joint pain was demonstrated to be 10% to 19% by a double block paradigm.  The false-positive rate of single, uncontrolled, sacroiliac joint injections was reported as 20%.

For therapeutic purposes intraarticular sacroiliac joint injections with steroid and radiofrequency neurotomy were evaluated.  Based on this review, there was moderate evidence for short-term and limited evidence for long-term relief with intraarticular sacroiliac joint injections.  Evidence for radiofrequency neurotomy in managing sacroiliac joint pain was limited or inconclusive.

Conclusions: The evidence for the specificity and validity of diagnostic sacroiliac joint injections was moderate. 

The evidence for therapeutic intraarticular sacroiliac joint injections was limited to moderate.

The evidence for radiofrequency neurotomy in managing chronic sacroiliac joint pain was limited.

Keywords:  Low back pain, sacroiliac joint pain, axial pain, spinal pain, diagnostic block, and sacroiliac joint injection