References Learn more about pain management interventions with the


SIR Expert Insights series. This summer, IRs are invited to take a deep dive into advanced interventional pain management. This comprehensive 7-week course includes a blend of lectures, case-based learning modules, technique descriptions and practice-building tips.


Week 1 Spine injections and augmentations Week 2 Spine ablations Week 3 Tumor ablations Week 4 Nerve interventions Week 5 Spine implantables Week 6 Biologics and embotherapy Week 7 Practice building


Learn more and view the course at learn.sirweb.org/page/ expertinsights


without much experience using the predicate device.


Additionally, a credentialing committee can be fraught with turf war controversies that may complicate an otherwise straightforward credentialing process. Credentialing support letters may be helpful. These letters can include a procedure technique document, a sample operative note, the appropriate CPT codes, results of a pertinent clinical trial and a training certificate. In addition to credentialing, each practitioner should determine whether their malpractice coverage is sufficient to cover an SI fusion procedure. If not, an insurance rider (insurance endorsement) may possibly be obtained to add the procedure to the list of covered items.


JH: What can SIR and its membership do to help promote percutaneous SI joint fusion as a procedure in IR? DB: SIR has effectively advocated for minimally invasive surgical and procedural techniques for many years. However, as a relatively new procedure that is in the musculoskeletal intervention category, minimally invasive SI joint fusion is somewhat outside the boundary of procedures


typically thought of as performed by interventional radiology.


The first step to assist the IRs performing SI joint fusion is to recognize that our colleagues are routinely performing this procedure, with some practitioners performing it quite often. The Society has already demonstrated support for the procedure and has instituted training courses and lecture topics at the annual meeting reflecting this interest in managing patients with SI joint dysfunction.


The primary role of SIR at this point is to continue to support its members as they expand their minimally invasive repertoire for treating SI joint dysfunction and other musculoskeletal issues. The initial improvements in this treatment and others have been profoundly positive and this trajectory should be aspired to in the future.


1. Frey ME, Warner C, Thomas SM, Johar K, Singh H, Mohammad MS, Beall DP. Sacroplasty: A ten-year analysis of prospective patients treated with percutaneous sacroplasty: Literature review and technical considerations. Pain Physician. 2017 Nov;20(7):E1063–72. PMID: 29149151.


2. Endres S, Ludwig E. Outcome of distraction interference arthrodesis of the sacroiliac joint for sacroiliac arthritis. Indian J Orthop. 2013 Sept–Oct;47(5):437–42.


3. Garras DN, Carothers JT, Olson SA. Single-leg- stance (flamingo) radiographs to assess pelvic instability: How much motion is normal? J Bone Joint Surg Am. 2008 Oct;90(10):2114–8.


4. Vogler JB III, Brown WH, Helms CA, Genant HK. The normal sacroiliac joint: A CT study of asymptomatic patients. Radiology. 1984 May;151(2):433–7. doi: 10.1148/ radiology.151.2.6709915. PMID: 6709915.


5. Szadek KM, van der Wurff P, van Tulder MW, Zuurmond WW, Perez RSGM. Diagnostic validity of criteria for sacroiliac joint pain: A systematic review. J Pain. Epub 2009 Apr;10(4):354–68. doi: 1016/j.jpain.2008.09.014.


6. Laslett M, Young SB, Aprill CN, McDonald B. Diagnosing painful sacroiliac joints: A validity study of a McKenzie evaluation and sacroiliac provocation tests. Aust J Physiother. 2003;49(2):89–97. doi: 10.1016/ s0004-9514(14)60125-2.


7. Smith AG, Capobianco R, Cher D, Rudolf L, Sachs D, Gundanna M, Kleiner J, Mody MG, Shamie AN. Open versus minimally invasive sacroiliac joint fusion: a multi-center comparison of perioperative measures and clinical outcomes. Ann Surg Innov Res. 2013 Oct 30;7(1):14. doi: 10.1186/1750-1164-7-14. PMID: 24172188. PMCID: PMC3817574.


8. Ledonio CG, Polly DW Jr, Swiontkowski MF. Minimally invasive versus open sacroiliac joint fusion: Are they similarly safe and effective? Clin Orthop Relat Res. 2014 Jun;472(6):1831–8. doi: 10.1007/s11999-014-3499-8. PMID: 24519569. PMCID: PMC4016421.


9. Hersh AM, Jimenez AE, Pellot KI, Gong JH, Jiang K, Khalifeh JM, Ahmed AK, Raad M, Veeravagu A, Ratliff JK, Jain A, Lubelski D, Bydon A, Witham TF, Theodore N, Azad TD. Contemporary trends in minimally invasive sacroiliac joint fusion utilization in the Medicare population by specialty. Neurosurgery. Epub 2023 Dec 1;93(6):1244–50. doi: 10.1227/ neu.0000000000002564. PMID: 37306413.


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