Interventional treatments for sacroiliac joint pain: a systematic review and network meta-analysis

BACKGROUND: Sacroiliac joint (SIJ) pain is a frequent cause of chronic low back pain, but the comparative effectiveness of available interventional treatments remains unclear. OBJECTIVE: We explored the therapeutic effects of interventional treatments on SIJ using a network meta-analysis. EVIDENCE REVIEW: A comprehensive systematic search of multiple databases was conducted to identify randomized controlled trials comparing conventional, cooled, and pulsed radiofrequency (RF) ablation; intra-articular steroid injections under different imaging guidance techniques; prolotherapy; platelet-rich plasma; sham procedures; and conservative management. METHODS: Primary outcomes were pain intensity and Oswestry Disability Index at 1, 3, and 6 months. Random-effects network meta-analysis estimated mean differences with 95% CIs, and P scores were used to rank treatments. RESULTS: 18 trials involving 1075 patients were included. RF-based interventions consistently outperformed steroid injections, sham, and conservative care. For pain relief, cooled RF ranked highest at 1 month, conventional RF at 3 months, and pulsed RF at 6 months, demonstrating significant superiority over most comparator treatments. For disability outcomes, pulsed RF provided the greatest improvement at 1 and 3 months, whereas CT-guided intra-articular steroid injection ranked highest at 6 months. However, the certainty of evidence was generally low to very low due to imprecision and study limitations. CONCLUSIONS: These findings support the overall effectiveness of RF techniques for SIJ pain while highlighting important evidence gaps that warrant further high-quality trials with longer follow-up.