Clinical outcome measures following lateral versus posterior sacroiliac joint fusion: Systematic review and meta-analysis

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Introduction: Sacroiliac joint fusion (SIJF) is indicated in patients with chronic Sacroiliac joint (SIJ) pain or instability and is usually performed using minimally invasive techniques through lateral or posterior approach. Research question: Our study aims to compare the lateral approach to the posterior one in SIJF through meta-analysis of other studies. The outcome of each approach is measured using the visual analog scale (VAS), Oswestry disability index (ODI), or both. Materials and methods: The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Articles were extracted using Pubmed advance search till February 27th, 2023. Articles included were those limited to either lateral, posterior or both approaches. Articles written in a non-English language, case reports and smaller-than-three case series were excluded from the study. Risk of bias was assessed using the Newcastle-Ottawa and Jadad scales. Stata-17 software program was used for statistical analysis and creation of forest plots. Results: Forty-eight articles were available for the quantitative analysis, which represents a total of 2562 subjects. The average duration of postoperative follow-up was 21 months (3-72 months) and 17 months (6-72 months) for the VAS and ODI outcomes, respectively. The average percentage of improvement in the VAS was 57% (22-80%) in the lateral approach versus 58% (29-94%) in the posterior approach (p = 0.986). The average percentage of improvement in the ODI was 42% (11-75%) in the lateral approach versus 31% (11-65%) in the posterior one (p = 0.272). A trend towards performing posterior approaches more frequently was noted in studies published after 2017. Discussion and conclusion: Approach selection for SIJF depends mainly on patient's characteristics and surgeon's experience. Our study demonstrated no difference in VAS outcome between lateral and posterior approach. Lateral approach appeared to be superior in ODI outcome although not statistically significant. The main limitation of the study is the selection-bias as the majority of articles included were observational. Therefore, randomized procedural trials are needed to validate these findings.

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