Sacroiliac joint fusion

Sacroiliac joint fusion was first reviewed by the HTA program in 2019.
  • In 2020, a review of sacroiliac joint fusion medical literature was conducted to determine if newly available published evidence could change the original coverage determination. 
  • In 2021, the HCA director selected sacroiliac joint fusion for rereview based on newly available published evidence that could change the original coverage determination.
  • A rereview of femoroacetabular impingement syndrome was completed later in 2021.

Status: Decision completed

Policy context

The Washington Health Technology Assessment program (HTA) selected Sacroiliac joint fusion as a topic for assessment because of high concerns for safety, efficacy and cost.

Primary criteria ranking

  • Safety = High
  • Efficacy = High
  • Cost  = High

Assessment update (2021)

Update literature search (2020)

Assessment (2019)

Assessment timeline (2021)

  • Draft key questions published: January 26, 2021

  • Public comment period: January 26 to February 11, 2021

  • Final key questions published: February 25, 2021

  • Draft report published: April 2, 2021

  • Public comment period: April 2 to  May 3, 2021

  • Final report published: May 19, 2021

  • HTCC public meeting: June 18, 2021


Sacroiliac joint fusion is a surgical treatment sometimes used to address pain that may be originating from the joint between bones in the spine and hip (sacrum and ilium). The sacroiliac joint (SIJ) is a diarthrodial joint with two surfaces and a fibrous capsule containing synovial fluid. Numerous ligaments support the joint and provide it with strength, but also limit its mobility.

SIJ pain and dysfunction is thought to be the primary source of pain for between 10 to 30 percent of cases of mechanical low back pain. Surgery, specifically SIJ fusion, is typically reserved for persons who fail conservative and less invasive treatments. Fusion of the SIJ can be performed as an open procedure, or since the late 1990's, as a minimally-invasive procedure using proprietary surgical systems consisting of two to three specialized implants or screws inserted directly into the SIJ through small incisions under imaging guidance.