Education and teaching of SIJ pathology and anatomy has often been neglected within the major medical societies. Surgical level indication was mainly referred to traumatologic strategies or to preventing measures when long distance spinal instrumentation was involved (e.g. scoliosis surgery). To avoid post fusion degeneration a common technique is to add a spino-pelvic bridge.
The complexity of neurovascular structures are a challenge during the guide pin placement. Limited options for bone preparation required for solid fusion as well as comorbidities, osteoporosis or other factors might prevent expected bone healing. In these cases revisions will become necessary, which often cannot be done by surgeons who are not familiar with these methods.
"Hopefully, the increasing numbers of reports on the treatment for SI joint problems will not misguide surgeons to perform uncontrolled interventions and I wish we do not have to state (following Nachemson) that too many SI joints are damaged by surgeons for undefined pain problems.“ (Reviewer’s comment concerning ‘‘the percutaneous stabilization of the sacroiliac joint with hollow modular anchorage screws: a prospective outcome study’’ Paul F. Heini Eur Spine J (2013) 22:2332)