Fluoroscopically Guided Sacroiliac Interventions: Appropriate Use Criteria

In a review published in Pain Medicine, the Spine Intervention Society reported an overview of appropriate use criteria for fluoroscopically guided injections and radiofrequency procedures for the diagnosis and treatment of sacroiliac joint and posterior sacroiliac complex pain developed in a multi-society effort.

The Appropriate Use Criteria Committee of the Spine Intervention Society used the RAND/University of California in Los Angeles Appropriateness Method to develop appropriate use criteria for image-guided injections and radiofrequency procedures of the sacroiliac joint and posterior sacroiliac ligament. The criteria were based on 2 systematic reviews that addressed diagnostic and therapeutic intra-articular sacroiliac and posterior sacroiliac interventions. To capture clinical judgement, the rating panel members independently evaluated >10,000 clinical scenarios, which were scored according to intervention appropriateness.

Five modules were created based on the results of the systematic reviews and clinical scenarios and are available for clinicians on the Appropriate Use Criteria Portal of the Spine Intervention Society. The modules cover clinical indications and imaging, anticoagulants, timing of injections, number of injections, and lateral branch radiofrequency neurotomy.

Clinicians can also access the portal and input clinical indications so that patients can obtain information about the appropriateness of the intervention under consideration.

The review authors explained that past studies have been conflicting regarding the best use of fluoroscopically-guided interventions for sacroiliac joint and posterior sacroiliac complex pain, so appropriate use criteria “define areas of appropriate use, along with identifying potential overuse and underuse of procedures.”

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Reference

MacVicar J, Kreiner DS, Duszynski B, Kennedy DJ. Appropriate use criteria for fluoroscopically guided diagnostic and therapeutic sacroiliac interventions: results from the Spine Intervention Society convened multispecialty collaborative [published online October 27, 2017]. Pain Med. doi:10.1093/pm/pnx253