CURRENT CONCEPTS IN THE DIAGNOSIS AND MANAGEMENT OF SACROILIAC JOINT PAIN: A SYSTEMATIC REVIEW

Abstract

Background: Sacroiliac joint (SIJ) pain is an underrecognized cause of chronic low back pain. Diagnostic uncertainty and variable treatment durability complicate management as interventional options expand. This systematic review aims to synthesize contemporary evidence on diagnostic approaches and interventional management of SIJ pain, focusing on clinical outcomes and durability.

Methodology: A PRISMA 2020–compliant systematic review was conducted. PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched for studies published between January 2010 and December 2025. Randomized controlled trials, prospective cohorts, and comparative observational studies evaluating radiofrequency ablation (RFA), minimally invasive SIJ fusion, or image-guided intra-articular injections in adults were included. Primary outcomes were pain (VAS/NRS) and disability (ODI). Risk of bias was assessed using NIH tools, and findings were narratively synthesized.

Results: Of 144 records, 14 studies were included (n=26–351; follow-up 3 months–5 years). RFA provided consistent short- to intermediate-term pain relief with durability up to 12 months. Injection therapies yielded reliable short-term benefit, though long-term effects were inconsistent and technique-dependent. Minimally invasive SIJ fusion demonstrated the largest and most sustained improvements in pain and function in randomized and prospective studies.

Conclusion: A stepwise strategy is supported: image-guided injections for diagnosis and short-term relief, RFA for intermediate benefit, and fusion for durable improvement in carefully selected patients.