Medani Khalid, Alsalama Abdulrhman, Kumar Rakesh, Patel Shlok, Patel Megh, Manjila Sunil
Department of Occupational Medicine, Kaiser Permanente, Downey, CA, USA.
University of Sharjah College of Medicine, University City, Sharjah, United Arab Emirates.
Brain Spine. 2025 Feb 12;5:104212. doi: 10.1016/j.bas.2025.104212. eCollection 2025.
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.
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.
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.
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.
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.
骶髂关节融合术（SIJF）适用于患有慢性骶髂关节（SIJ）疼痛或不稳定的患者，通常通过外侧或后侧入路采用微创技术进行。
我们的研究旨在通过对其他研究的荟萃分析，比较SIJF中外侧入路与后侧入路。每种入路的结果使用视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）或两者进行测量。
本研究按照系统评价和荟萃分析的首选报告项目（PRISMA）2020指南进行。使用PubMed高级搜索提取截至2023年2月27日的文章。纳入的文章仅限于外侧、后侧或两种入路。非英语撰写的文章、病例报告和少于三个病例的系列研究被排除在本研究之外。使用纽卡斯尔-渥太华量表和Jadad量表评估偏倚风险。使用Stata-17软件程序进行统计分析并创建森林图。
有48篇文章可用于定量分析，共涉及2562名受试者。VAS和ODI结果的术后平均随访时间分别为21个月（3 - 72个月）和17个月（6 - 72个月）。外侧入路VAS的平均改善百分比为57%（22% - 80%），而后侧入路为58%（29% - 94%）（p = 0.986）。外侧入路ODI的平均改善百分比为42%（11% - 75%），而后侧入路为31%（11% - 65%）（p = 0.272）。2017年后发表的研究中，后侧入路的实施频率有增加趋势。
SIJF的入路选择主要取决于患者特征和外科医生的经验。我们的研究表明，外侧入路和后侧入路在VAS结果上没有差异。外侧入路在ODI结果上似乎更优，尽管无统计学意义。本研究的主要局限性是选择偏倚，因为纳入的大多数文章为观察性研究。因此，需要随机对照试验来验证这些发现。
