الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
C
hronic sacroiliac joint (SIJ) pain represents a vexing challenge in the realm of orthopedic and spine care, impacting individuals’ quality of life. The decision-making process involves evaluating conservative measures against surgical interventions that aim to stabilize the joint surgically, and the choice between conservative management and SIJ fusion is an ongoing debate.
The potential causes of sacroiliac joint pain can be either traumatic or atraumatic.
The dynamic nature of SIJ pain management requires evidence-based recommendations, considering patient preferences and ethical principles. Further research is needed to refine treatment recommendations and enhance patient outcomes.
This systematic review aims to compare the effectiveness and safety of conservative management and SIJ fusion in patients with SIJ pain of degenerative origin or following lumbar fusion, in addition to providing valuable insights for clinicians and decision-makers and promoting optimal care and evidence-based decision-making when choosing between SIJ fusion and conservative management for patients, thus contributing to improved patient care and better treatment outcomes.
In this study, we conducted a comprehensive analysis of various subgroups undergoing different procedures, focusing on key outcome measures including Vas Score, Oswestry Disability Index (ODI), and Short Form-36 Physical Component Summary (SF-36 PCS) and Mental Component Summary (SF-36 MCS) at various time points. The Risk of bias was assessed using Cochrane’s risk of bias tool for randomized clinical trials and modified Cochrane for case series studies and NIH for observation clinical trial.
For early pain relief, the Model Fusion procedure shows promise, while the Conservative approach excels in improving disability at 3 months. Both Model Fusion and Minimal Intervention procedures demonstrate effectiveness in reducing disability at 6 months and beyond, with a slight advantage for the Model Fusion procedure. Additionally, the Model Fusion procedure may be preferable for improving SF-36 PCS scores, while the Minimal Intervention procedure may be favored for SF-36 MCS scores after 12 months.
CONCLUSION
T
he choice of the most suitable procedure for sacroiliac joint dysfunction should be tailored to the specific outcome and goals of the patient. For early pain relief, the Model Fusion procedure shows promise, while the Conservative approach excels in improving disability at 3 months. Both Model Fusion and Minimal Intervention procedures demonstrate effectiveness in reducing disability at 6 months and beyond, with a slight advantage for the Model Fusion procedure. Additionally, the Model Fusion procedure may be preferable for improving SF-36 PCS scores, while the Minimal Intervention procedure may be favored for SF-36 MCS scores after 12 months. Ultimately, treatment decisions should consider individual patient needs and the desired outcomes.
RECOMMENDATIONS AND CLINICAL CONSIDERATIONS
I
ndividualized Approach: Given the varying outcomes observed in this study, clinicians should adopt an individualized approach when managing patients with chronic sacroiliac joint (SIJ) pain. Tailoring treatment decisions to the specific needs and circumstances of each patient is essential.
Initial Conservative Management: Conservative treatment may be considered as an initial option for patients with SIJ pain, especially for those with mild to moderate symptoms. This approach includes physical therapy, analgesics, and other non-invasive interventions. Monitoring patients’ response to conservative treatment is crucial before considering more invasive procedures.
Patient Education: Clinicians should prioritize patient education to help individuals understand the nature of their SIJ pain and the potential treatment options. Informed patients are more likely to actively participate in their care and make decisions that align with their goals and preferences.
Multidisciplinary Approach: In complex cases, a multidisciplinary team, including orthopedic surgeons, pain specialists, and physical therapists, may be beneficial to provide a comprehensive assessment and treatment plan.
Invasive Procedures: When conservative treatments prove ineffective, SIJ fusion or minimal intervention procedures should be considered. The choice between these interventions should be based on a thorough evaluation of the patient’s clinical presentation, including pain intensity, functional limitations, and patient-reported outcomes.
Outcome Assessment: Regular assessment of pain intensity (e.g., VAS scores) and functional status (e.g., ODI) is crucial to monitor treatment effectiveness and adjust the management plan accordingly. Clinicians should pay attention to patient-reported outcomes and quality of life measures, such as SF-36 scores, to comprehensively evaluate the impact of treatment on the patient’s well-being.
Shared Decision-Making: Engage in shared decision-making with patients when discussing treatment options. Present the available evidence and ensure that patients understand the potential benefits and risks associated with both conservative and invasive treatments.
Long-Term Follow-Up: Patients should be followed up for an extended period to assess the durability of treatment effects, especially when considering SIJ fusion. This will help identify any recurrence of symptoms or complications over time.
Further Research: As the field of SIJ pain management continues to evolve, additional research is needed to provide more robust evidence for guiding clinical decisions. Future studies should focus on comparing different fusion techniques, exploring innovative conservative approaches, and investigating patient-specific factors that influence treatment outcomes.
Ethical and Safety Considerations: Ensure that all clinical decisions are made in accordance with ethical principles and with the safety and well-being of the patient as the top priority. Obtain approval from an ethical committee before conducting any invasive procedures and adhere to data confidentiality and protection standards.