The past two decades have witnessed tremendous growth in the appreciation and treatment of sacroiliac joint (SIJ) complex pain, including anatomical dissections that shed light on innervation, an appreciation for the contribution of extra-articular components to SIJ complex pain, the advent of radiofrequency ablation (RFA) and a host of minimally-invasive surgical techniques. Yet, there is no standardization of diagnosis and treatment paradigms.

These multispecialty guidelines address 21 key questions spanning diagnostic criteria, non-interventional and interventional treatments (including surgery), technical parameters to optimize outcomes, and definitions of treatment success. The work was conducted by a committee representing 25 professional organizations, in addition to the Departments of Defense and Veterans Affairs. Evidence was evaluated using a modified Delphi process, with statements noted when >50% agreement was achieved and formal recommendations requiring ≥75% consensus.

Answers to many questions were limited by low-quality evidence, indicating the need for better research. SIJ complex pain is a multifarious condition (ie, pain can be from different portions of both the intra- and extra-articular components of the joint) for which an interdisciplinary, multimodal treatment plan can optimize treatment outcomes.

Read the guidelines here.