320 Form

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Medical Policy Diagnosis and Treatment of Sacroiliac Joint Pain Table of Contents • Policy: Commercial • Description • Information Pertaining to All Policies
• Authorization Information • Policy History

• Coding Information • References

Policy Number: 320 BCBSA Reference Number: 6.01.23 (For Plan internal use only)

Related Policies
• InterQual Musculoskeletal Services Management, #220 • Prolotherapy, Joint Sclerotherapy and Ligamentous Injections with Sclerosing Agents, #183 • Prior Authorization Request Form for Diagnosis and Treatment of Sacroiliac Joint Pain, #927 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity

Arthrography of the sacroiliac joint is INVESTIGATIONAL.

Minimally invasive fixation/fusion of the sacroiliac joint using transiliac placement of a titanium triangular implant (eg, iFuse) may be considered MEDICALLY NECESSARY when ALL of the following criteria have been met:
• Pain is at least 5 on a 0 to 10 rating scale that impacts quality of life or limits activities of daily living; AND
• There is an absence of generalized pain behavior (eg, somatoform disorder) or generalized pain disorders (eg, fibromyalgia); AND
• Individuals have undergone and failed a minimum 6 months of intensive nonoperative treatment that must include medication optimization, activity modification, bracing, and active therapeutic exercise targeted at the lumbar spine, pelvis, sacroiliac joint, and hip, including a home exercise program; AND
• Pain is caudal to the lumbar spine (L5 vertebra), localized over the posterior sacroiliac joint, and consistent with sacroiliac joint pain; AND
• A thorough physical examination demonstrates localized tenderness with palpation over the sacral sulcus (Fortin’s point) in the absence of tenderness of similar severity elsewhere; AND
• There is a positive response to a cluster of 3 provocative tests (eg, thigh thrust test, compression test, Gaenslen sign, distraction test, Patrick test, posterior provocation test); AND
• Diagnostic imaging studies include ALL of the following:
o Imaging (plain radiographs and computed tomography or magnetic resonance imaging) of the sacroiliac joint excludes the presence of destructive lesions (eg, tumor, infection) or inflammatory arthropathy of the sacroiliac joint; AND

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o Imaging of the pelvis (anteroposterior plain radiograph) rules out concomitant hip pathology; AND
o Imaging of the lumbar spine (computed tomography or magnetic resonance imaging) is performed to rule out neural compression or other degenerative conditions that can be causing low back or buttock pain; AND
o Imaging of the sacroiliac joint indicates evidence of injury and/or degeneration; AND
• There is at least a 75% reduction in pain for the expected duration of the anesthetic used following an image-guided, contrast-enhanced intra-articular sacroiliac joint injection on 2 separate occasions; AND
• A trial of a therapeutic sacroiliac joint injection (ie, corticosteroid injection) has been performed at least once.

Note: This technically demanding procedure should only be done by surgeons who have specific training and expertise in minimally invasive sacroiliac joint fusion surgery for chronic sacroiliac joint pain and who regularly use image-guidance for implant placement.

Fusion/stabilization of the sacroiliac joint for the treatment of back pain presumed to originate from the sacroiliac joint is considered INVESTIGATIONAL under all other conditions and with any other devices not listed above.

Radiofrequency denervation of the sacroiliac joint is considered INVESTIGATIONAL.

Prior Authorization Information
Inpatient • For services described in this policy, precertification/preauthorization IS REQUIRED for all products if the procedure is performed inpatient.
Outpatient • For services described in this policy, see below for products where prior authorization might be required if the procedure is performed outpatient.

Outpatient Commercial Managed Care (HMO and POS) Prior authorization is required for minimally invasive fixation/fusion of the sacroiliac joint.
Commercial PPO
Prior authorization is required for minimally invasive fixation/fusion of the sacroiliac joint.

Requesting Prior Authorization Using Authorization Manager Providers will need to use Authorization Manager to submit initial authorization requests for services. Authorization Manager, available 24/7, is the quickest way to review authorization requirements, request authorizations, submit clinical documentation, check existing case status, and view/print the decision letter. For commercial members, the requests must meet medical policy guidelines.

To ensure the request is processed accurately and quickly: • Enter the facility’s NPI or provider ID for where services are being performed. • Enter the appropriate surgeon’s NPI or provider ID as the servicing provider, not the billing group.

Authorization Manager Resources • Refer to our Authorization Manager page for tips, guides, and video demonstrations.

Complete Prior Authorization Request Form for Diagnosis and Treatment of Sacroiliac Joint Pain (927) using Authorization Manager. For out of network providers: Requests should still be faxed to 888-282-0780.

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CPT Codes / HCPCS Codes / ICD Codes
Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable.

The following codes are included below for informational purposes only; this is not an all-inclusive list.

The above medical necessity criteria MUST be met for the following codes to be covered for Commercial Members: Managed Care (HMO and POS), PPO and Indemnity: CPT Codes CPT codes:

Code Description 27279 Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device

The following HCPCS and CPT code is considered investigational for Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity:

HCPCS Codes HCPCS codes:

Code Description C1737 Joint fusion and fixation device(s), sacroiliac and pelvis, including all system components (implantable) G0259 Injection procedure for sacroiliac joint; arthrography CPT Codes CPT codes:

Code Description 27278 Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including placement of intra-articular implant(s) (eg, bone allograft[s], synthetic device[s]), without placement of transfixation device 64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)

DESCRIPTION
Sacroiliac Joint Pain Similar to other structures in the spine, it is assumed the sacroiliac joint (SIJ) may be a source of low back pain. In fact, before 1928, the SIJ was thought to be the most common cause of sciatica. In 1928, the role of the intervertebral disc was elucidated, and from that point forward, the SIJ received less research attention.

Diagnosis Research into SIJ pain has been plagued by a lack of a criterion standard to measure its prevalence and against which various clinical examinations can be validated. For example, SIJ pain typically presents without any consistent, demonstrable radiographic or laboratory features and most commonly exists in the setting of morphologically normal joints. Clinical tests for SIJ pain may include various movement tests, palpation to detect tenderness, and pain descriptions by the patient. Further confounding the study of the SIJ is that multiple structures, (eg, posterior facet joints, lumbar discs) may refer pain to the area surrounding the SIJ.

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Because of inconsistent information obtained from history and physical examination, some have proposed the use of image-guided anesthetic injection into the SIJ for the diagnosis of SIJ pain. Treatments being investigated for SIJ pain include prolotherapy (see evidence review 2.01.26), corticosteroid injection, radiofrequency ablation, stabilization, and arthrodesis. Some procedures have been referred to as SIJ fusion but may be more appropriately called fixation due to little to no bridging bone on radiographs. Devices for SIJ fixation/fusion that promote bone ingrowth to fixate the implants include a triangular implant (iFuse Implant System) and cylindrical threaded devices (eg, Rialto, SImmetry, Silex, SambaScrew, SI-LOK). Some devices also have a slot in the middle where autologous or allogeneic bone can be inserted. This added bone is intended to promote the fusion of the SIJ.

A 2021 review identified 33 different devices that could be implanted using either a lateral transiliac approach (n=21), posterior allograft approach (n=6), posterolateral approach (n=3), or a combination of the approaches (n=3).1, The iliosacral and posterolateral approaches use up to 3 implants that pass through the ilium, while the posterior approach involves inserting implants directly into the SIJ. Many of the devices are intended to be used with allograft bone. Implants composed entirely of allograft bone are typically inserted through a posterior approach. The authors found no published evidence for 23 of the 33 devices identified.

Summary
Description Sacroiliac joint (SIJ) arthrography using fluoroscopic guidance with an injection of an anesthetic has been explored as a diagnostic test for SIJ pain. Duplication of the patient’s pain pattern with the injection of contrast medium suggests a sacroiliac etiology, as does relief of chronic back pain with an injection of local anesthetic. Treatment of SIJ pain with corticosteroids, radiofrequency ablation (RFA), stabilization, or minimally invasive SIJ fusion has also been explored.

Summary of Evidence Diagnostic For individuals who have suspected SIJ pain who receive a diagnostic sacroiliac block, the evidence includes systematic reviews. Relevant outcomes are test validity, symptoms, functional outcomes, quality of life (QOL), medication use, and treatment-related morbidity. Current evidence is conflicting on the diagnostic utility of SIJ blocks. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have SIJ pain who receive RFA, the evidence includes 6 RCTs using different radiofrequency applications and case series. Relevant outcomes are symptoms, functional outcomes, QOL, medication use, and treatment-related morbidity. Meta-analysis of available sham-controlled RCTs suggests that there may be a small effect of RFA on SIJ pain at short-term (1 to 6 months) follow-up. However, the RCTs of RFA have methodologic limitations, and there is limited data on the duration of the treatment effect. The single RCT with 6 and 12-month follow-up showed no significant benefit of RFA compared to an exercise control group at these time points. In addition, heterogeneity of RFA treatment techniques precludes generalizing results across different studies. For RFA with a cooled probe, 3 RCTs reported short-term benefits, but these are insufficient to determine the overall effect on health outcomes. An RCT on palisade RFA of the SIJ did not include a sham control. Another sham-controlled RCT showed no benefit from RFA. Further high-quality controlled trials are needed to compare this procedure in defined populations with sham control and alternative treatments. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome. For individuals who have SIJ pain who receive SIJ fixation/fusion with a transiliac triangular implant, the evidence includes 1 meta-analysis, 1 blinded sham controlled trial, 2 nonblinded RCTs of minimally invasive fusion, prospective cohorts with more than 85% follow-up, and case series. Relevant outcomes are symptoms, functional outcomes, QOL, medication use, and treatment-related morbidity. The sham- controlled RCT found no significant difference in the primary outcome of pain reduction or in any secondary outcomes through 6 months of follow-up. Both nonblinded RCTs have reported outcomes past 6 months, after which crossover was allowed. Both studies reported significantly greater reductions in

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visual analog scale pain scores and Oswestry Disability Index scores in SIJ fusion patients than in control groups. The reductions in pain and disability observed in the SIJ fusion group at 6 months were maintained out to 1 year compared with controls who had not crossed over. The RCTs were nonblinded without a placebo or an active control group. Prospective cohorts and case series with sample sizes ranging from 45 to 149 patients and low dropout rates (<15%) also showed reductions in pain and disability out to 5 years. The cohort studies and case series are consistent with the durability of treatment benefit. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome. The meta-analysis pooled data from 3 RCTs and found that SIJ fusion with triangular titanium implants resulted in statistically significant improvements in pain, disability, quality of life, and opioid use compared to nonsurgical management for SIJ dysfunction, with similar adverse event rates between groups, though long-term data beyond 12 months was limited to a single trial. For individuals who have SIJ pain who receive SIJ fusion/fixation with an implant other than a transiliac triangular implant, the evidence includes 6 prospective cohort studies and retrospective case series. Relevant outcomes are symptoms, functional outcomes, QOL, medication use, and treatment-related morbidity. Three prospective cohorts were conducted with transiliac screws and the 3 with a device inserted through a posterior approach. One cohort study compared SIJ fusion with the Torpedo device to iFuse (transiliac triangular implant) and found no differences in pain or function outcomes at 12 months between the two groups. No other controlled studies were identified. Meta-analyses of the available prospective and retrospective studies indicate improvement in subjective outcomes from before surgery to follow-up, but with a possible difference in outcomes between the more well studied triangular transiliac implant and other implant designs and approaches. There is uncertainty in the health benefit of SIJ fusion/fixation with these implant designs. Therefore, controlled studies with a larger number of patients and longer follow-up are needed to evaluate these devices. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome. Policy History Date Action 1/2026 Annual policy review. References updated. Policy statements unchanged. 1/2025 Clarified coding information. Annual policy review. Description, summary, and references updated. Policy statements unchanged. 1/2024 Annual policy review. Policy updated with literature review through September 13, 2023; references added. Policy statements unchanged. Clarified coding information. 9/2023 Policy clarified to include prior authorization requests using Authorization Manager.
7/2023 Clarified coding information. 5/2023 Policy clarified. Policy reactivated in May 2023 to reinstate policy statements on minimally invasive fixation/fusion of the sacroiliac joint. Effective 5/1/2023.
Policy statements on anesthetic injection for diagnosing SIJ pain and corticosteroid injection for treatment of SIJ pain remain retired. 1/2023 Annual policy review. Minor editorial refinements to policy statements; intent unchanged. Clarified coding information. 6/2022 Prior authorization information clarified for PPO plans. Effective 6/1/2022. 1/2022 Annual policy review. Policy clarified. "Transiliac placement" and "eg, iFuse" added to the medically necessary statement on sacroiliac joint fusion. 1/2021 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 1/2021 Medicare information removed. See MP #132 Medicare Advantage Management for local coverage determination and national coverage determination reference.
1/2020 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 1/2020 Clarified coding information. 1/2019 Annual policy review. Description, summary, and references updated. Policy statements unchanged.

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6/2018 Annual policy review. New medically necessary indications described for SIJ fusion/stabilization with a titanium triangular implant under the specific conditions. Clarified coding information. Effective 6/1/2018. 12/2016 Annual policy review. New references added.
11/2016 Annual policy review. New references added.
10/2016 Annual policy review. First medically necessary policy statement clarified.
1/2016 Annual policy review. New references added.
6/2015 Annual policy review. New references added.
1/2015 Clarified coding information. 10/2014 Annual policy review. New medically necessary and investigational indications described. Coding information clarified. Effective 10/1/2014. 6/2014 Annual policy review. New medical policy describing investigational indications. Effective 6/1/2014. Information Pertaining to All Blue Cross Blue Shield Medical Policies Click on any of the following terms to access the relevant information: Medical Policy Terms of Use Managed Care Guidelines Indemnity/PPO Guidelines Clinical Exception Process Medical Technology Assessment Guidelines

References

1. Himstead AS, Brown NJ, Shahrestani S, et al. Trends in Diagnosis and Treatment of Sacroiliac Joint Pathology Over the Past 10 Years: Review of Scientific Evidence for New Devices for Sacroiliac Joint Fusion. Cureus. Jun 2021; 13(6): e15415. PMID 34249562
2. Dreyfuss P, Michaelsen M, Pauza K, et al. The value of medical history and physical examination in diagnosing sacroiliac joint pain. Spine (Phila Pa 1976). Nov 15 1996; 21(22): 2594-602. PMID 8961447
3. Simopoulos TT, Manchikanti L, Gupta S, et al. Systematic Review of the Diagnostic Accuracy and Therapeutic Effectiveness of Sacroiliac Joint Interventions. Pain Physician. 2015; 18(5): E713-56. PMID 26431129
4. Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. Apr 2013; 16(2 Suppl): S49-283. PMID 23615883
5. Manchikanti L, Datta S, Derby R, et al. A critical review of the American Pain Society clinical practice guidelines for interventional techniques: part 1. Diagnostic interventions. Pain Physician. 2010; 13(3): E141-74. PMID 20495596
6. Manchikanti L, Datta S, Gupta S, et al. A critical review of the American Pain Society clinical practice guidelines for interventional techniques: part 2. Therapeutic interventions. Pain Physician. 2010; 13(4): E215-64. PMID 20648212
7. Rupert MP, Lee M, Manchikanti L, et al. Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature. Pain Physician. 2009; 12(2): 399-418. PMID 19305487
8. Chou R, Atlas SJ, Stanos SP, et al. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976). May 01 2009; 34(10): 1078-93. PMID 19363456
9. Chou R, Loeser JD, Owens DK, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976). May 01 2009; 34(10): 1066-77. PMID 19363457
10. Hansen H, Manchikanti L, Simopoulos TT, et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012; 15(3): E247-78. PMID 22622913
11. Patel A, Kumar D, Singh S, et al. Effect of Fluoroscopic-Guided Corticosteroid Injection in Patients With Sacroiliac Joint Dysfunction. Cureus. Mar 2023; 15(3): e36406. PMID 37090293
12. Visser LH, Woudenberg NP, de Bont J, et al. Treatment of the sacroiliac joint in patients with leg pain: a randomized-controlled trial. Eur Spine J. Oct 2013; 22(10): 2310-7. PMID 23720124

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13. Kim WM, Lee HG, Jeong CW, et al. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. Dec 2010; 16(12): 1285-90. PMID 21138388
14. Kennedy DJ, Engel A, Kreiner DS, et al. Fluoroscopically Guided Diagnostic and Therapeutic Intra- Articular Sacroiliac Joint Injections: A Systematic Review. Pain Med. Aug 2015; 16(8): 1500-18. PMID 26178855
15. Ab Aziz SNF, Zakaria Mohamad Z, Karupiah RK, et al. Efficacy of Sacroiliac Joint Injection With Anesthetic and Corticosteroid: A Prospective Observational Study. Cureus. Apr 2022; 14(4): e24039. PMID 35547453
16. Al Khayyat SG, Fogliame G, Barbagli S, et al. Ultrasound guided corticosteroids sacroiliac joint injections (SIJIs) in the management of active sacroiliitis: a real-life prospective experience. J Ultrasound. Jun 2023; 26(2): 479-486. PMID 36229757
17. Chandrupatla RS, Shahidi B, Bruno K, et al. A Retrospective Study on Patient-Specific Predictors for Non-Response to Sacroiliac Joint Injections. Int J Environ Res Public Health. Nov 23 2022; 19(23). PMID 36497595
18. Ciaffi J, Papalexis N, Vanni E, et al. Minimally invasive interventional procedures for osteoarthritis and inflammatory arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. Oct 2024; 68:
19. PMID 39137511
20. Janapala RN, Knezevic E, Knezevic NN, et al. Systematic Review and Meta-Analysis of the Effectiveness of Radiofrequency Ablation of the Sacroiliac Joint. Curr Pain Headache Rep. May 2024; 28(5): 335-372. PMID 38472618
21. Chou R, Fu R, Dana T, Pappas M, Hart E, Mauer KM. Interventional Treatments for Acute and Chronic Pain: Systematic Review. Comparative Effectiveness Review No. 247. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.) AHRQ Publication No. 21-EHC030. Rockville, MD: Agency for Healthcare Research and Quality; September
22. PMID: 34524764
23. Chappell ME, Lakshman R, Trotter P, et al. Radiofrequency denervation for chronic back pain: a systematic review and meta-analysis. BMJ Open. Jul 21 2020; 10(7): e035540. PMID 32699129
24. Juch JNS, Maas ET, Ostelo RWJG, et al. Effect of Radiofrequency Denervation on Pain Intensity Among Patients With Chronic Low Back Pain: The Mint Randomized Clinical Trials. JAMA. Jul 04 2017; 318(1): 68-81. PMID 28672319
25. Chen CH, Weng PW, Wu LC, et al. Radiofrequency neurotomy in chronic lumbar and sacroiliac joint pain: A meta-analysis. Medicine (Baltimore). Jun 2019; 98(26): e16230. PMID 31261580
26. Cohen SP, Kapural L, Kohan L, et al. Cooled radiofrequency ablation versus standard medical management for chronic sacroiliac joint pain: a multicenter, randomized comparative effectiveness study. Reg Anesth Pain Med. Mar 04 2024; 49(3): 184-191. PMID 37407279
27. Mehta V, Poply K, Husband M, et al. The Effects of Radiofrequency Neurotomy Using a Strip- Lesioning Device on Patients with Sacroiliac Joint Pain: Results from a Single-Center, Randomized, Sham-Controlled Trial. Pain Physician. Nov 2018; 21(6): 607-618. PMID 30508988
28. van Tilburg CW, Schuurmans FA, Stronks DL, et al. Randomized Sham-controlled Double-Blind Multicenter Clinical Trial to Ascertain the Effect of Percutaneous Radiofrequency Treatment for Sacroiliac Joint Pain: Three-month Results. Clin J Pain. Nov 2016; 32(11): 921-926. PMID 26889616
29. Zheng Y, Gu M, Shi D, et al. Tomography-guided palisade sacroiliac joint radiofrequency neurotomy versus celecoxib for ankylosing spondylitis: a open-label, randomized, and controlled trial. Rheumatol Int. Sep 2014; 34(9): 1195-202. PMID 24518967
30. Patel N, Gross A, Brown L, et al. A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med. Mar 2012; 13(3): 383-98. PMID 22299761
31. Patel N. Twelve-Month Follow-Up of a Randomized Trial Assessing Cooled Radiofrequency Denervation as a Treatment for Sacroiliac Region Pain. Pain Pract. Feb 2016; 16(2): 154-67. PMID 25565322
32. Ghaddaf AA, Alsharef JF, Alsharef NK, et al. Minimally invasive sacroiliac joint fusion using triangular titanium implants versus nonsurgical management for sacroiliac joint dysfunction: a systematic review and meta-analysis. Can J Surg. 2024; 67(1): E16-E26. PMID 38278549

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31. Whang P, Cher D, Polly D, et al. Sacroiliac Joint Fusion Using Triangular Titanium Implants vs. Non- Surgical Management: Six-Month Outcomes from a Prospective Randomized Controlled Trial. Int J Spine Surg. 2015; 9: 6. PMID 25785242
32. Polly DW, Cher DJ, Wine KD, et al. Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion Using Triangular Titanium Implants vs Nonsurgical Management for Sacroiliac Joint Dysfunction: 12-Month Outcomes. Neurosurgery. Nov 2015; 77(5): 674-90; discussion 690-1. PMID 26291338
33. Polly DW, Swofford J, Whang PG, et al. Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction. Int J Spine Surg. 2016; 10: 28. PMID 27652199
34. Darr E, Meyer SC, Whang PG, et al. Long-term prospective outcomes after minimally invasive trans- iliac sacroiliac joint fusion using triangular titanium implants. Med Devices (Auckl). 2018; 11: 113-121. PMID 29674852
35. Sturesson B, Kools D, Pflugmacher R, et al. Six-month outcomes from a randomized controlled trial of minimally invasive SI joint fusion with triangular titanium implants vs conservative management. Eur Spine J. Mar 2017; 26(3): 708-719. PMID 27179664
36. Dengler J, Sturesson B, Kools D, et al. Referred leg pain originating from the sacroiliac joint: 6-month outcomes from the prospective randomized controlled iMIA trial. Acta Neurochir (Wien). Nov 2016; 158(11): 2219-2224. PMID 27629371
37. Dengler JD, Kools D, Pflugmacher R, et al. 1-Year Results of a Randomized Controlled Trial of Conservative Management vs. Minimally Invasive Surgical Treatment for Sacroiliac Joint Pain. Pain Physician. Sep 2017; 20(6): 537-550. PMID 28934785
38. Dengler J, Kools D, Pflugmacher R, et al. Randomized Trial of Sacroiliac Joint Arthrodesis Compared with Conservative Management for Chronic Low Back Pain Attributed to the Sacroiliac Joint. J Bone Joint Surg Am. Mar 06 2019; 101(5): 400-411. PMID 30845034
39. Randers EM, Gerdhem P, Stuge B, et al. The effect of minimally invasive sacroiliac joint fusion compared to sham operation: a double-blind randomized placebo-controlled trial. EClinicalMedicine. Feb 2024; 68: 102438. PMID 38328752
40. Duhon BS, Cher DJ, Wine KD, et al. Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: A Prospective Study. Global Spine J. May 2016; 6(3): 257-69. PMID 27099817
41. Duhon BS, Bitan F, Lockstadt H, et al. Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: 2-Year Follow-Up from a Prospective Multicenter Trial. Int J Spine Surg. 2016; 10: 13. PMID 27162715
42. Whang PG, Darr E, Meyer SC, et al. Long-Term Prospective Clinical And Radiographic Outcomes After Minimally Invasive Lateral Transiliac Sacroiliac Joint Fusion Using Triangular Titanium Implants. Med Devices (Auckl). 2019; 12: 411-422. PMID 31576181
43. Patel V, Kovalsky D, Meyer SC, et al. Prospective Trial of Sacroiliac Joint Fusion Using 3D-Printed Triangular Titanium Implants. Med Devices (Auckl). 2020; 13: 173-182. PMID 32607011
44. Vanaclocha V, Herrera JM, Sáiz-Sapena N, et al. Minimally Invasive Sacroiliac Joint Fusion, Radiofrequency Denervation, and Conservative Management for Sacroiliac Joint Pain: 6-Year Comparative Case Series. Neurosurgery. Jan 01 2018; 82(1): 48-55. PMID 28431026
45. Spain K, Holt T. Surgical Revision after Sacroiliac Joint Fixation or Fusion. Int J Spine Surg. 2017; 11(1): 5. PMID 28377863
46. Rainov NG, Schneiderhan R, Haritonov D. Triangular titanium implants for sacroiliac joint fusion. Acta Neurochir (Wien). Nov 18 2024; 166(1): 462. PMID 39557713
47. Schoell K, Buser Z, Jakoi A, et al. Postoperative complications in patients undergoing minimally invasive sacroiliac fusion. Spine J. Nov 2016; 16(11): 1324-1332. PMID 27349627
48. Acevedo-Gonzalez JC, Lacouture-Silgado I. Utility of minimally invasive percutaneous arthrodesis of the sacroiliac joint for the treatment of low back pain: systematic review of the literature. Eur Spine J. Mar 2025; 34(3): 974-1003. PMID 39885048
49. Tran ZV, Ivashchenko A, Brooks L. Sacroiliac Joint Fusion Methodology - Minimally Invasive Compared to Screw-Type Surgeries: A Systematic Review and Meta-Analysis. Pain Physician. Jan 2019; 22(1): 29-40. PMID 30700066
50. Lorio M, Kube R, Araghi A. International Society for the Advancement of Spine Surgery Policy 2020 Update-Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain):

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Coverage Indications, Limitations, and Medical Necessity. Int J Spine Surg. Dec 2020; 14(6): 860-

895. PMID 33560247
896. Rappoport LH, Luna IY, Joshua G. Minimally Invasive Sacroiliac Joint Fusion Using a Novel Hydroxyapatite-Coated Screw: Preliminary 1-Year Clinical and Radiographic Results of a 2-Year Prospective Study. World Neurosurg. May 2017; 101: 493-497. PMID 28216399
897. Rappoport LH, Helsper K, Shirk T. Minimally invasive sacroiliac joint fusion using a novel hydroxyapatite-coated screw: final 2-year clinical and radiographic results. J Spine Surg. Jun 2021; 7(2): 155-161. PMID 34296027
898. Fuchs V, Ruhl B. Distraction arthrodesis of the sacroiliac joint: 2-year results of a descriptive prospective multi-center cohort study in 171 patients. Eur Spine J. Jan 2018; 27(1): 194-204. PMID 29058134
899. Calodney A, Azeem N, Buchanan P, et al. Safety, Efficacy, and Durability of Outcomes: Results from SECURE: A Single Arm, Multicenter, Prospective, Clinical Study on a Minimally Invasive Posterior Sacroiliac Fusion Allograft Implant. J Pain Res. 2024; 17: 1209-1222. PMID 38524688
900. Kucharzyk D, Colle K, Boone C, et al. Clinical Outcomes Following Minimally Invasive Sacroiliac Joint Fusion With Decortication: The EVoluSIon Clinical Study. Int J Spine Surg. Feb 2022; 16(1): 168-175. PMID 35217586
901. Splitt T, Pflugmacher R, Soliman O, et al. Surgical Treatment of Patients with Sacroiliac Joint Syndrome: Comparative Study of Two Implants. Z Orthop Unfall. Dec 2024; 162(6): 592-599. PMID 37992733
902. Davies M, Dreischarf M, Yusufbekov R. Catamaran SI Joint Fusion System (R) MAINSAIL TM Study: a prospective, single-arm, multi-center, post-market study of six-month clinical outcomes and twelve- month radiographic findings. Expert Rev Med Devices. Sep 2024; 21(9): 851-858. PMID 39161110
903. Davies M, Christopher A, Edwards J, et al. Twelve-month clinical and radiographic outcomes following inferior-posterior sacroiliac joint fusion using the Catamaran SI Joint Fusion System: a prospective, multi-center evaluation. Expert Rev Med Devices. Oct 2025; 22(10): 1117-1125. PMID 40773478
904. Abbasi H, Moore D, Rusten MA, et al. Efficacy of Lateral Sacroiliac Joint Fusion With the Trident™ Screw System: A Retrospective Analysis. Cureus. Jan 2025; 17(1): e77793. PMID 39981446
905. North American Spine Society. Diagnosis and Treatment of Adults with Sacroiliac Joint Pain: A Protocol for a Systematic Review and Clinical Guidelines by the North American Spine Society. n.d. https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/SacroiliacJointPa in-Protocol.pdf. Accessed October 2, 2025.
906. Benzon HT, Connis RT, De Leon-Casasola OA, et al. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. Apr 2010; 112(4): 810-33. PMID 20124882
907. Lee DW, Pritzlaff S, Jung MJ, et al. Latest Evidence-Based Application for Radiofrequency Neurotomy (LEARN): Best Practice Guidelines from the American Society of Pain and Neuroscience (ASPN). J Pain Res. 2021; 14: 2807-2831. PMID 34526815
908. Sayed D, Deer TR, Tieppo Francio V, et al. American Society of Pain and Neuroscience Best Practice (ASPN) Guideline for the Treatment of Sacroiliac Disorders. J Pain Res. 2024; 17: 1601-
909. PMID 38716038
910. National Institute for Health and Care Excellence. Minimally invasive sacroiliac joint fusion surgery for chronic sacroiliac pain [IPG578]. 2017; https://www.nice.org.uk/guidance/ipg578. Accessed October 1, 2025.
911. National Institute for Health and Care Excellence. iFuse for treating chronic sacroiliac joint pain [MTG39]. 2022; https://www.nice.org.uk/guidance/mtg39. Accessed October 1, 2025.