American Society of Pain and Neuroscience Best Practice (ASPN) Guideline for the Treatment of Sacroiliac Disorders

Abstract

Clinical management of sacroiliac disease has proven challenging from both diagnostic and therapeutic perspectives. Although it is widely regarded as a common source of low back pain, little consensus exists on the appropriate clinical management of sacroiliac joint pain and dysfunction. Understanding the biomechanics, innervation, and function of this complex load bearing joint is critical to formulating appropriate treatment algorithms for SI joint disorders. ASPN has developed this comprehensive practice guideline to serve as a foundational reference on the appropriate management of SI joint disorders utilizing the best available evidence and serve as a foundational guide for the treatment of adult patients in the United States and globally.

Keywords:

• sacroiliac joint
• sacroiliitis
• chronic pain
• best practices
• radiofrequency ablation
• sacroiliac joint fusion

Abbreviations

ASAS20, 20% improvement from baseline of ASA response criteria; ASDAS, Ankylosing Spondylitis Disease Activity Score; ASPN, American Society of Pain and Neuroscience; BASFI, Bath Ankylosing Spondylitis Functional Index; BASMI, Bath Ankylosing Spondylitis Metrology Index; BMAC, Bone marrow aspirate stem cell concentrate; CT, Computed tomography; DSIJQ, Denver Sacroiliac joint questionnaire; EQ-5D, Euro quality of life health questionnaire; FABER test, Flexion, abduction and external rotation; FACIT, Functional Assessment of Chronic Illness Therapy; FDA, United States Food and Drug Administration; GPE, Global Perceived Effect; HMA, Hollow modular anchorage; IA, Intraarticular; MAUDE, Manufacturer and User Facility Device Experience; MODQ, Modified Oswestry Disability Questionnaire; MRI, Magnetic resonance imaging; NRS, Numeric rating scale; NSAID, Non-steroidal anti-inflammatory drug; ODI, Oswestry Disability Index; PAK, Pedicle access kit; PDGF, Platelet-derived growth factors; PDQQ, Pain Disability Quality of Life Questionnaire; PRF, Platelet rich fibrin; PRP, Platelet rich plasma; PSN, Posterior sacral network; RAND-36, Research and Development Corporation 36-Item Health Survey; RCT, Randomized controlled trial; RFA, Radiofrequency ablation; RMDQ, Roland Morris Disability Questionnaire; SANE, Single assessment numeric evaluation; SD, Standard deviation; SF, Short-form health questionnaire (eg, SF-36, SF-12); SI, Sacroiliac; SID, Sacroiliac disorders; SIJ, Sacroiliac joint; SRS22, Scoliosis Research Society; SVF, Stromal vascular fraction; US, Ultrasound; USPSTF, United States Preventative Services Task Force; VAS, Visual analog scale.

Acknowledgments

Editing was provided by Allison Foster, PhD, of Foster Medical Communications.

Disclosure

DS is a consultant to Abbott, PainTEQ, Saluda, Mainstay, Surgentec, Nevro, and holds stock options with PainTEQ, Neuralace, Mainstay, Vertos, and SPR. TRD is a consultant PainTEQ, CornerLoc, and Spinal Simplicity. VTF receives research funding from Nevro Corporation part of an investigator-initiated study grant that is not related to this manuscript. TEW is a consultant for Medtronic and has received research funding from Medtronic, SPR Therapeutics, Nevro, and Boston Scientific. JSW is a consultant for Abbott, SI Bone, Vertos Medical, Biotronik, Saluda, and AbbVie, receives research funding from Abbott, SI Bone, Saluda, and Medtronic, serves on an advisory board for Abbott, SI Bone, Vertos Medical, and Biotronik, and serves on a speaker board for Abbott, SI Bone, & Abbvie. RSD receives investigator-initiated research grant funding from Nevro Corp and Saol Therapeutics that is paid to his institution. KA is a consultant for Nevro, Saluda, Biotronik, Boston Scientific, and Presidio, reports minor options from PainTEQ. MJD is a consultant for Globus, Camber, LifeSpine, Vyrsa, PainTEQ, Nevro, Abbott, and Biotronik. DTDN is a consultant for SI Bone, Stratus Medical, and Neurovassis. CB is a consultant for Nevro, Abbott, Vertos, Spinal Simplicity, and PainTEQ; reports personal fees from Nevro, Spinal Simplicity, PainTEQ, and Boston Scientific, outside the submitted work. AA is a consultant for Curonix, Medtronic and Avanos. The authors report no other conflicts of interest in this work.

Additional information

Funding

Development of this guideline was supported by unrestricted educational grants from SI Bone and PainTEQ.