Nationwide Analysis of Sacroiliac Joint Fusion Trends: Regional Variations in Utilization and Population Characteristics

Andy Ton; Kevin Mertz; Marc Abdou; Nicole Hang; Emily S Mills; Raymond J Hah; Ram K Alluri; Jeffrey C Wang

doi:10.1177/21925682231196448

Nationwide Analysis of Sacroiliac Joint Fusion Trends: Regional Variations in Utilization and Population Characteristics

Global Spine J. 2025 Mar;15(2):518-525. doi: 10.1177/21925682231196448. Epub 2023 Aug 17.

Authors

Andy Ton¹, Kevin Mertz¹, Marc Abdou¹, Nicole Hang¹, Emily S Mills¹, Raymond J Hah¹, Ram K Alluri¹, Jeffrey C Wang¹

Affiliation

¹ Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, CA, USA.

Abstract

Study design/setting: Retrospective cohort analysis.

Objectives: This study evaluates utilization and demographic trends for sacroiliac joint (SIJ) fusions across the United States (US).

Methods: Patients who underwent SIJ fusion from 2010-2021 were identified within the PearlDiver national database using International Classification of Disease (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes. Indications for trauma, malignancy, or infection were excluded. Demographic, clinical, and procedure characteristics were recorded along with annual utilization rates. Annual percent change (APC) was calculated to identify increasing or decreasing utilization from prior years. Negative binomial regression was performed to project subsequent utilization for 2022-2028. Chi-squared analysis followed by post-hoc comparisons were used to compare differences in diagnostic indications and clinical features associated with SIJ fusion across regions. Bonferroni adjustments were applied to P-values for pairwise analyses.

Results: Overall, 18 032 patients (69.8% female, mean age = 51.0 + 13.4 years) underwent SIJ fusion between 2010 and 2021. Annual utilization increased by 33.5% on average. The South comprised the largest proportion of cases (48.9%). Projections for 2022-2028 predict continued growth in procedures, with an overall increase of 1100% from 1350 cases in 2021 to 16 195 by end of 2028. Spondyloarthropathy-induced sacroilitis was the most prevalent diagnostic indication nationwide (51%). Of patients undergoing SIJ fusion, 18% had a prior lumbar fusion, and only 45% received a preoperative diagnostic SIJ injection.

Conclusion: As SIJ fusion is increasingly utilized to treat refractory SIJ-based pain, establishing evidence-based guidelines, improving diagnostic strategies, and defining indications are imperative to support growing applications within clinical practice.

Keywords: fusion; sacroiliac joint; sacroiliitis; trends; utilization.