At tne end of the 1980s spinal surgery was boosted by the development of pedicle screws which allowed short segment stabilization and reduction of severe VB fractures. The 'comprehensive care' algorithm taught by Guttman and Böhler could be completed by a surgical component which led to earlier rehabilitation of paraplegic patients. Rapidly the application was considered to be used for degenerative indications, and the increasing number of interventions led to a fast growing spinal market which caused the foundation of Spine Societies and specialized spine centers to improve and ensure quality.
Discussion: we propose to qualify 'SIJ-Centres' likewise. The development of appropriate education and training modules is one of the SIMEG projects to be worked on.
A similar development can be observed today in the progression of sacroiliac joint surgery: there is an undoubted need to perform surgical treatment in cases of painful degenerative SIJ dysfunction if nonsurgical therapies continue to fail. The introduction of new surgical techniques and medical devices causes new challenges to the spinal surgeon.
Non detected SIJ pain leads to extreme physiological and psychological pressure for the patient. Diagnosis takes time, requires repeated visits and examinations including complex diagnostic imaging to discriminate other pain sources. Not all of these measures are paid by health insurers, hospital staff members are not trained and their time frames do not allow to perform these investigations with demanded thoroughness. Education and spcecialization might be the answer to this dilemma.