Subject: Washington State Health Care Authority Draft Technology Report on
Sacroiliac Joint Fusion
Dear Mr. Morse:
On behalf of the American Academy of Orthopaedic Surgeons (AAOS), American Association of
Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS), AANS/CNS Joint Section on
Disorders of the Spine and Peripheral Nerves (DSPN), North American Spine Society (NASS) and
Washington State Association of Neurological Surgeons (WSANS), we appreciate the opportunity to
submit comments regarding the Washington State Health Care Authority (HCA) Draft Evidence Report
on Sacroiliac (SI) Joint Fusion Surgery, which was prepared by RTI International–University of North
Carolina Evidence-based Practice Center.
We agree with the authors of the Washington State HCA Draft Evidence Report who conclude that
minimally invasive SI joint fusion procedures provide significant benefit to carefully selected patients. We
recognize that there is a relative paucity of high quality randomized controlled studies at the current time
and the best available studies focus on one particular product from one manufacturer. These studies
show clear evidence of benefit for the procedure in terms of pain control and functional improvement
compared to conservative management. In addition, we also agree with the finding that comparative
studies between minimally invasive SI joint fusion and open joint fusion procedures show a preference
for the minimally invasive option regarding improved postoperative pain and shorter length of hospital
stay. Equally important is the fact that current evidence supports minimally invasive SI joint fusion
procedures as safe and cost-effective for pain management and improved quality of life for patients with
chronic SI joint dysfunction. Furthermore, we found the literature search and data extraction in the report
to be up to date and comprehensive.
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