Sacroiliac Joint Interventions: A Systematic
Review
Authors: Hansen Hans C. 
Published: March 2021

Background: The sacroiliac joint is a diarthrodial synovial joint with abundant innervation and
capability of being a source of low back pain and referred pain in the lower extremity. There are
no definite historical, physical, or radiological features to provide definite diagnosis of sacroiliac joint
pain, although many authors have advocated provocational maneuvers to suggest sacroiliac joint as
a pain generator. An accurate diagnosis is made by controlled sacroiliac joint diagnostic blocks. The
sacroiliac joint has been shown to be a source of pain in 10% to 27% of suspected cases with chronic
low back pain utilizing controlled comparative local anesthetic blocks. Intraarticular injections, and
radiofrequency neurotomy have been described as therapeutic measures. This systematic review was
performed to assess diagnostic testing (non-invasive versus interventional diagnostic techniques) and
to evaluate the clinical usefulness of interventional techniques in the management of chronic sacroiliac
joint pain.
Objective: To evaluate and update the available evidence regarding diagnostic and therapeutic
sacroiliac joint interventions in the management of sacroiliac joint pain.
Study Design: A systematic review using the criteria as outlined by the Agency for Healthcare
Research and Quality (AHRQ), Cochrane Review Group Criteria for therapeutic interventions and
AHRQ, and Quality Assessment for Diagnostic Accuracy Studies (QUADAS) for diagnostic studies.
Methods: The databases of EMBASE and MEDLINE (1966 to December 2006), and Cochrane Reviews were searched. The searches included systematic reviews, narrative reviews, prospective and
retrospective studies, and cross-references from articles reviewed. The search strategy included sacroiliac joint pain and dysfunction, sacroiliac joint injections, interventions, and radiofrequency.
Results: The results of this systematic evaluation revealed that for diagnostic purposes, there is
moderate evidence showing the accuracy of comparative, controlled local anesthetic blocks. Prevalence of sacroiliac joint pain is estimated to range between 10% and 27% using a double block paradigm. The false-positive rate of single, uncontrolled, sacroiliac joint injections is around 20%. The
evidence for provocative testing to diagnose sacroiliac joint pain is limited.
For therapeutic purposes, intraarticular sacroiliac joint injections with steroid and radiofrequency
neurotomy were evaluated. Based on this review, there is limited evidence for short-term and longterm relief with intraarticular sacroiliac joint injections and radiofrequency thermoneurolysis.
Conclusions: The evidence for the specificity and validity of diagnostic sacroiliac joint injections
is moderate. The evidence for accuracy of provocative maneuvers in diagnosis of sacroiliac joint
pain is limited. The evidence for therapeutic intraarticular sacroiliac joint injections is limited. The
evidence for radiofrequency neurotomy in managing chronic sacroiliac joint pain is limited.
Keywords: Low back pain, sacroiliac joint pain, axial pain, spinal pain, diagnostic block, sacroiliac joint injection, thermal radiofrequency, and pulsed radiofrequency