title: Systematic Review of the Diagnostic Accuracy and Therapeutic Effectiveness of Sacroiliac Joint Interventions.
abstract: BACKGROUND
  The sacroiliac joint is well known as a cause of low back and lower extremity pain. Prevalence estimates are 10% to 25% in patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis based on multiple diagnostic studies and systematic reviews. However, at present there are no definitive management options for treating sacroiliac joint pain.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions.
  
  
  METHODS
  A systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions.
  
  
  METHODS
  The available literature on diagnostic and therapeutic sacroiliac joint interventions was reviewed. The quality assessment criteria utilized were the Quality Appraisal of Reliability Studies (QAREL) checklist for diagnostic accuracy studies, Cochrane review criteria to assess sources of risk of bias, and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) criteria for randomized therapeutic trials and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for observational therapeutic assessments. The level of evidence was based on a best evidence synthesis with modified grading of qualitative evidence from Level I to Level V. Data sources included relevant literature published from 1966 through March 2015 that were identified through searches of PubMed and EMBASE, manual searches of the bibliographies of known primary and review articles, and all other sources.
  
  
  METHODS
  For the diagnostic accuracy assessment, and for the therapeutic modalities, the primary outcome measure of pain relief and improvement in functional status were utilized.
  
  
  RESULTS
  A total of 11 diagnostic accuracy studies and 14 therapeutic studies were included. The evidence for diagnostic accuracy is Level II for dual diagnostic blocks with at least 70% pain relief as the criterion standard and Level III evidence for single diagnostic blocks with at least 75% pain relief as the criterion standard. The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is Level II to III. The evidence for conventional radiofrequency neurotomy, intraarticular steroid injections, and periarticular injections with steroids or botulinum toxin is limited: Level III or IV.
  
  
  CONCLUSIONS
  The limitations of this systematic review include inconsistencies in diagnostic accuracy studies with a paucity of high quality, replicative, and consistent literature. The limitations for therapeutic interventions include variations in technique, variable diagnostic standards for inclusion criteria, and variable results.
  
  
  CONCLUSIONS
  The evidence for the accuracy of diagnostic and therapeutic effectiveness of sacroiliac joint interventions varied from Level II to Level IV.
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Simopoulos
authors.affiliation: Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY.
authors.forename: Laxmaiah
authors.initials: L
authors.lastname: Manchikanti
authors.affiliation: Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
authors.forename: Sanjeeva
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Manhattan Spine and Pain Medicine, New York, NY, and Hofstra-North Shore/LIJ School of Medicine, New York, NY.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Aydin
authors.affiliation: West Virginia University School of Medicine, Department of Neurosurgery, Division of Pain Management, Morgantown, WV.
authors.forename: Chong Hwan
authors.initials: CH
authors.lastname: Kim
authors.affiliation: University of Texas Medical Branch, Galveston, TX.
authors.forename: Daneshvari
authors.initials: D
authors.lastname: Solanki
authors.affiliation: New York University School of Medicine, New York, NY.
authors.forename: Devi E
authors.initials: DE
authors.lastname: Nampiaparampil
authors.affiliation: Spine Pain Diagnostics Associates, Niagara, WI.
authors.forename: Vijay
authors.initials: V
authors.lastname: Singh
authors.affiliation: Premier Pain Centers, Shrewsbury, NJ and Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Staats
authors.affiliation: Massachusetts General Hospital and Harvard Medical School, Boston, MA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
mesh_terms: D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D059408:Pain Management / Q000379:methods* / Q000592:standards; D012446:Sacroiliac Joint