Navigating the Murk: Ethical and Practical Considerations for the Surgical Treatment of the Sacroiliac Joint Syndrome

The field of spine surgery has many controversies. The surgical treatment of the sacroiliac (SI) joint is, too, fraught with debate. The diagnosis of painful SI joints is currently limited to relief following "diagnostic" injections and pain generated from a suite of clinical maneuvers. Diagnoses of SI joint dysfunction are dependent entirely on patient-reported responses to provocative maneuvers and invasive procedures. There is a glaring lack of objective radiographic and objective physical examination findings for this syndrome. The evidence for treatment, and specifically for the surgical treatment of the SI joint is reviewed and critiqued. Although the surgical techniques are simple, consensus is elusive for both indication and optimal technique. Ethical principles for surgical innovation and practical considerations for the treatment of the SI joint syndrome are discussed at length. Discussed as well are key points to consider when providing informed consent to a patient before proceeding with surgical intervention for this procedure and diagnosis. Spine surgery is a field with considerable regional variation in practice. Even today, the precise indications for arthrodesis, extent, and approach, remain frequently debated; however, as much conversation takes place surrounding lumbar surgery, even more confusion, bias, opinion, and deliberation exists when surgical treatment of the SI joint is considered. This chapter discusses the unique challenges associated with the SI joint and provides practical considerations for the treatment thereof.