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EDITORIAL STAFF PERSPECTIVE
Our reviewers were unanimously in favor of publication of this review, despite the
controversial nature of a number of aspects of this condition—starting with uncertainty
surrounding physical examination, continuing with diagnostic confirmation and finally
treatment. The results of this systematic review point out a commonly encountered
conundrum: while there seems to be some evidence suggesting a ‘positive treatment
effect’ as reported by patients, closer inspection of the data at hand produces more
questions than answers. In summary, the role of the sacro-iliac joint in low back
pain and its management remain very much unclear to the present date and is, perhaps,
somewhat overemphasized by some. Identification of pathologic entities such as presented
by the authors—clear instability, severe degeneration, infection, neoplasia—remains
a helpful contribution to patient care by an informed practitioner. Should surgical
stabilization be chosen for a sufferer of SI-joint pain, the current state of the
literature unfortunately allows little or no real insights due to unclear handling
of several confounding variables (ie, previous spine fusion, osteoporosis, obesity,
pelvic alignment, physical fitness levels) and inconsistent definition of desired
surgical outcomes—are true fusions actually achieved in a large number of the described
techniques? That said, are solid fusions actually necessary for a satisfactory outcome?
Do the outcomes justify the means? Many questions, few real answers, much to do in
the future.
