Choosing the Right Path: Lateral vs. Posterior SI Joint Fusion—And the Risk You Rarely Hear About
- Taylor Headley
Minimally invasive sacroiliac joint fusion (SIJF) is a powerful option for patients with chronic SIJ pain, but the surgical approach—lateral vs. posterior—can affect both outcomes and risk.
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A 2023 meta-analysis of 48 studies and over 2,500 patients found that pain relief was nearly identical between the two approaches, with about a 57–58% improvement on the Visual Analog Scale. Functionally, the lateral approach showed a modest edge, with a 42% improvement in disability (ODI) compared to 31% with the posterior. Though not statistically significant, the trend suggests possible real-world benefits.
But outcomes tell only part of the story.
What’s often overlooked is the vascular risk associated with the lateral approach—specifically, potential injury to the superior gluteal artery. Because the lateral technique passes near critical neurovascular structures, implant misplacement can lead to bleeding, hematoma, or gluteal ischemia. This risk, though rare, is serious and underreported in most studies.
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While both approaches remain viable, this analysis underscores the importance of surgeon experience and anatomical awareness. As SIJF becomes more common, particularly in outpatient settings, understanding both the benefits and risks is essential for safe, effective care.
Source: Meta-analysis comparing lateral vs. posterior approach for SIJ fusion, February 2023.
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