American Society of Pain and Neuroscience Best Practice (ASPN) Guideline for the Treatment of Sacroiliac Disorders [Letter]

My focus is on Surgical Techniques-Minimally Invasive Approaches and addresses the Minimally Invasive Posterior SI Fusion with Allograft.They state, using their most recent prospective publication, 2 that pain scores, ODI, and Promis 29 were all significantly improved at 12 months.The data they offer to make these statements is severely flawed.They accepted 117 implanted patients into this prospective study.At 12 months, 34 patients or 29% (34/117), were unaccounted for.They looked at VAS scores on the 83 patients that showed up for the 12-month F/U and found 51 having an improvement of at least 50%.Their calculation was a 61.4% (51/83) improvement.My calculation for this is a 44% (51/117) improvement.They looked at ODI results and state that 68.7% (57/83) had significant clinical improvement.My calculation for this is that 49% (57/117) patients had significant clinical improvement.Using their data, less than 50% of the patients they originally started with and accepted into their study had significant clinical improvement at 12 months F/U.There is much more to say, but I am restrained by the 500-word letter to Editor limit.This current publication 1 is outlining "Guidelines" for clinicians and surgeons to help guide them to make the best decisions affecting real patients.The following are my reasons why this section on the use of Allograft for SI joint fusions should be removed from this "Guidelines" publication.