. 2012 Nov;3(4):41–53. doi: 10.1055/s-0032-1328142

Table 1. Summary of patient and study characteristics for case series (CoE IV) on surgical or injection treatment for chronic sacroiliac joint pain.^*.

Author (Year)	Demographics^†/follow-up	Patient characteristics	Requirement(s) for confirmed diagnosis	Intervention(s)
Surgical studies
Khurana et al⁵ (2009)	N = 15 (19 joints) Age: 48.7 (37.3–62.6) y Male: 26.7%, unilateral (n = 11) Bilateral (n = 4) Duration of pain: NR (chronic nontraumatic condition) FU: mean 17 (range, 9–39) mo (% NR)	Principal symptom: low back pain or pain in buttock: OA, n = 7 SIJ dysfunction, n = 4 SIJ instability, n = 3 Inflammatory arthritis, n = 1 Previous spinal surgery, n = 6	All the following: Image intensifier-guided single injection of local anesthetic + corticosteroid with resulting pain relief, time period and % pain relief NR Clinical evaluation: Patrick test, Gaenslen test, tenderness over posterior SIJ Radiographic evaluation: plain radiographs, CT, MRI	Percutaneous sacroiliac fusion using hollow modular anchorage screws packed with demineralized bone matrix (DBX)
Al-Khayer et al² (2008)	N = 9 (12 joints) Age: 42.4 ± 6.5 (range, 35–56) y Male: 0%, unilateral (n = 6) Bilateral (n = 3) Duration of symptoms: 30 ± 21 (12–84) mo FU: mean 40 ± 15.4 (24–70) mo (% NR)	Chronic SIJ pain with pain and tenderness over sacral sulcus and posterior SIJ	Image intensifier-guided SIJ block with temporary pain relief; injectant, time period, and % pain relief NR Additional evaluations: Clinical: Patrick (Faber) test Radiographic: plain radiographs	Percutaneous sacroiliac joint arthrodesis using hollow modular anchorage screws filled with demineralized bone matrix mixed with bone reaming from surgical procedure
Wise et al (2008)⁸	N = 13 (19 joints) Age: 53.1 (range, 45–62) y Male: 7.7%, bilateral (n = 6) Unilateral (n = 7) Duration of pain: NR (patients had received conservative treatment for 6 mo to several years) FU: mean 29.5 (range 24–35) mo (% NR)	SIJ dysfunction (lumbar region excluded as pain region) Previous spine surgery: Lumbar fusion extending to sacrum, n = 8 Open SI fusion on contralateral side, n = 1	Image intensifier-guided single intraarticular injection of lidocaine + triamcinolone with pain relief of 75% on VAS scale within 30 min and lasting ≥ 2 h Additional evaluations: Clinical: physical examination, details NR; pain referral patterns, details NR	Percutaneous fusion via posterior approach in longitudinal axis of SIJ using threaded cage with BMP (INFUSE BMP2, off-label use)
Schutz et al⁶ (2006)	N = 17 (34 joints) Age: 43.2 (22–76) y Male: 29.4% Bilateral (n = 17) Duration of pain: 6.6 (range, 1–20) y FU: Mean 39 (range, 12–66) mo (% NR)	Chronic SIJ syndrome: Posttraumatic, n = 5 Idiopathic SIJ degeneration, n = 12 Previous spine surgery: Lumbar, n = 10 SIJ, n = 1	One or more of the following: Image intensifier-guided single injection of scandicaine with temporary reduction of pain Clinical evaluation: Mennell sign (hyperextension test), pain provocation by SIJ compression Radiographic: Barsony technique; CT scan; Technetium scan Psychological, social, occupational: details NR Selective immobilization of lumbar, lumbosacral, SI segments with temporary external fixator	Fusion with internal fixation and decortication of SIJ using separate approach to each joint (modified Verral and Pitkin dorsal bilateral interlocking technique); iliac crest autograft performed.
Haufe et al⁴ (2005)	N = 38 (No. of joints NR) Age: 66 (43–81, median 68) y; male: 46% Bilateral NR, unilateral NR Duration of pain: 10.4 (median, 7.5) y FU: ≥ 2 y (% NR)	NR	Image intensifier-guided single injection of bupivacaine in posterior superior iliac crest tendon with ≥ 75% reduction in pain for ≥ 1 h	Debridement: electrocautery and holmium laser to denude bone of ligamental insertions on ilium crest and remove capsular/nervous tissues of joint; hand-burr used to smooth iliac surface
Buchowski et al³ (2005)	N = 20 (No. of joints NR) Age: 45.1 ± 12.7 y Male: 15% Unilateral NR Bilateral NR Duration of symptoms: 2.6 ± 1.9 y FU: mean 5.8 ± 1.9 y (100% for radiographic outcome, 75% for functional outcome)	Low back, buttock, and/or leg pain: SIJ dysfunction, n = 13 SIJ OA, n = 5 SIJ IA, n = 1 SIJ postpartum instability, n = 1 Previous spine surgery (overlapping categories): Fusion to sacrum, n = 8 ICBG, n = 10; 9 of them developed ipsilateral SIJ symptoms Any spine surgery, n = 15; 3.5 ± 3.7 surgeries/patient (range, 1–13) Failed traditional, nonoperative treatment, n = 20 Comorbidities including hypertension, asthma, CAD, n = 10	Image intensifier-guided intraarticular injections (mean, 2.7; range, 2–4) of local anesthetic/ glucocorticosteroid with recurrence of symptoms after initial positive response, time period and % relief NR Additional evaluations: Clinical: Patrick test, Gaenslen test, palpitation over SIJ, compression test, hip abduction test Radiographic: plain radiographs; triple-phase bone scan, MRI, CT	SIJ arthrodesis using modified Smith-Petersen technique
Waisbrod et al⁷ (1987)	N = 21 (22 joints) Age: 42 (20–58) y Male: 14.3% Bilateral (n = 1) Unilateral (n = 20) Duration of pain: > 2 y FU: mean 30 (range, 12–55) mo (% NR)	Overt OA (pain localized in SI area and lower back with varying radiculopathy) Previous spine surgery: Discectomy, n = 2 Posterolateral fusion, n = 5 Bilateral total hip replacement, n = 2 Chiari pelvic osteotomy, n = 2	Positive response for all the following: Provocation test: 10% NaCl solution to reproduce pain pattern Single injection of local anesthetic “under television control” to relieve pain completely for duration of drug's effect Clinical evaluation: Patrick test, Gaenslen test, tenderness in SIJ area Psychological evaluation: FAPK, MMPI, FPI Radiography: scintigraphy (technetium), plain radiographs, CT	SIJ arthrodesis: articular surfaces completely excised; corticocancellous bone graft taken from iliac crest and/or tricalciumphosphate ceramic blocks interposed under pressure between denuded cancellous bone
Injection studies
Lee et al¹² (2010)	BT: n = 20 Age: 45.1 ± 13.6 y Male: 15%, unilateral (n = 20) Duration of pain: 11.9 ± 9.1 mo Injection: n = 19 Age: 43.2 ± 12.7 y Male: 31.6%, unilateral (n = 19) Duration of pain: 11.9 ± 14.2 mo. FU: BT: 1, 2, 3 mo (85%) Injection: 1 mo (84.2%) 2, 3 mo (78.9%)	SIJ syndrome	Image intensifier-guided single periarticular injection of lidocaine with ≥ 50% pain relief (measured by NRS) within 30 min after injection Additional evaluations: Clinical: provocation tests (distraction, compression, thigh thrust, Patrick and Gaenslen tests)	Botulinum toxin: Botulinum type A Steroid injection: triamcinolone + lidocaine
Kim et al¹¹ (2010)	Prolotherapy: n = 23 (31 joints) Age: 58.7 ± 13.0 y Male: 30%, unilateral (n = 15) Bilateral (n = 8) Duration of symptoms: 40.1 (4–240) mo Injection: n = 25 (35 joints) Age: 61.6 ± 15.2 y Male: 28%, unilateral (n = 15) Bilateral (n = 10) Duration of symptoms: 44.0 (3–240) mo FU: prolotherapy: 15 mo (95.8%) Injection: 15 mo (96.2%)	History of pain lasting ≥ 2 mo in buttock, groin, or thigh, regardless of associated lower extremity measures	Image intensifier-guided single intraarticular injection of levobupivacaine with a decrease in pain intensity of ≥ 50%, measured by NRS Additional evaluations: Clinical: Patrick test, Gaenslen test, tenderness over area just below posterosuperior iliac spine	Prolotherapy: dextrose + levobupivacaine, mean 2.7 ± 1.1 injections Steroid injection: triamcinolone + levobupivacaine, mean 1.5 ± 0.8 injections
Hawkins and Schofferman¹⁰ (2009)	N = 155 (No. joints NR) Age: 48 y, male: 39%, Unilateral: NR; bilateral: NR Duration of symptoms: NR (had received SIJ injection when history suggestive of SIJ pain) FU: mean 44 (26–101) mo (98%)	All patients in single spine center who had received SIJ injection Previous spine surgery: Lumbar, n = 69	Image intensifier-guided injection (to firm endpoint or leakage) of local anesthetic and dexamethasone or betamethasone with ≥ 50% reduction of pain 1 h after injection and continuing for ≥ 2 wk 120/155 (77%) experienced pain relief, 118 of them received therapeutic injections	Local anesthetic + dexamethasone or betamethasone, mean 2.7 (1–9) injections
Chakraverty and Dias⁹ (2004)	Injection: n = 33 Age: 40 (17–74) y Male: 39.4% Duration of pain: 4 (0.5–10) y Prolotherapy: n = 19 Age: 41 (17–58) y Male: 31.6% Duration of pain: 6 y (2–15) FU: injection: ≤ 6 mo (97%) Prolotherapy: 3 mo (100%) 6, 12 mos (94.7%)	Chronic LBP patients with presumed SIJ or facet joint pain	Image intensifier-guided, contrast confirmed, single intraarticular SIJ injection of lignocaine/ triamcinolone with ≥ 50% pain relief (based on VAS score) within the first hour after injection 33/52 (63.5%) experienced pain relief and received therapeutic corticosteroid injection 19/52 (36.5%) experienced no pain relief and received therapeutic prolotherapy	Injection: SIJ intraarticular corticosteroid injection Prolotherapy: ipsilateral iliolumbar and SI interosseus ligament injection of dextrose or P2G + lignocaine, 3 injections
Slipman et al¹³ (2001)	N = 31 (No. of joints NR) Age: 44.8 (22–80) y Male: 38.7%, unilateral NR Bilateral NR Duration of pain: mean 20.6 (1.5–84) mo FU: Mean 94.4 (10–60) wk (82.9%)	LBP including sacral sulcus region regardless of associated hip or leg symptoms	Image intensifier-guided single SIJ injection of lidocaine with ≥ 80% reduction of pain within 30 min using VAS scale Additional evaluations: Clinical: positive response to ≥ 3 of the following: Patrick and Gaenslen test, pain with pressure applied to SI ligaments, shear test, Yeoman maneuver	Intraarticular injection of betamethasone and lidocaine, mean 2.14 (1–4)

See full table in the Web Appendix. CoE indicates class of evidence; CT, computed tomography; MRI, magnetic resonance imaging; NR, not reported; FU, follow-up; SIJ, sacroiliac joint; OA, osteoarthritis; IA, inflammatory arthritis; LBP, low back pain; P2G, phenol, glycerine, glucose; BT, Botulinum toxin type A; NRS, numeric rating scale for pain; MMPI, Minnesota Multiphasic Personality Inventory; FPI, Freiburg personality inventory; FAPK, questionnaire for recognition of psychosomatic diseases; ICBG, iliac crest bone graft. Although these studies were designed to compare injection treatments, for the purpose of this review they are considered case series, with each arm addressed separately, since the study question focuses on comparing surgery with injection.⁹^,¹¹^,¹²

^†

Demographics applicable to patients analyzed;¹¹ patients completing all discharge questionnaires;¹³ and patients before diagnostic block performed (n = 118 patients had positive diagnostic block and were included in study).¹⁰ Study also included 42 patients who received a lumbar facet joint injection and 10 patients who received a medial branch block.⁹

Table 1. Summary of patient and study characteristics for case series (CoE IV) on surgical or injection treatment for chronic sacroiliac joint pain.*.

Table 1. Summary of patient and study characteristics for case series (CoE IV) on surgical or injection treatment for chronic sacroiliac joint pain.^*.