Centene has established positive coverage for minimally invasive sacroiliac (SI) joint fusion. This update to the Centene policy is a another step toward widely recognizing SI joint fusion as a medically necessary solution for SI joint dysfunction.
The SI joint connects the sacrum (spine) to the ilium (pelvis). When healthy, the joints are aided by strong ligaments and muscles, which help limit movement. Most forces from the upper body to legs are carried by these joints and they assist with shock absorption and weight transfer. Like any joint, SI joints can degenerate or become injured in what is known as SI joint dysfunction. This can be caused by traumatic injury to the joint or ligaments, past pregnancies, structural asymmetry, degenerative osteoarthritis, and sacroiliitis. Dysfunction can manifest as back pain and the SI joint has been shown to be a pain generator for up to 32% of those complaining of lower lumbar back pain1.
Prior to surgical treatment, lower back and/or buttock pain must be addressed through non-surgical treatments and a variety of exams and tests to assess if the SI joint is a source or contributor to symptoms. Medically necessary SI joint fusion may then be utilized to fuse and immobilize the joint.
The CoreLink Entasis SI Joint Fusion System incorporates a special compression threading that pulls the sacrum and ilium together, increasing stability and likelihood of fusion. The recovery process for this procedure should be less extensive than open fusion surgeries2. This Centene policy update will allow more eligible patients to receive life-changing procedures.
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(1) Samuel L. Holmes, et al; “Sacroiliac Joint Pain” from Pain Medicine: An Interdisciplinary Case-Based Approach, pages 160-177, Oxford University Press, 2015)
(2) Ledonio CG, Polly D, Swiontkowsi M, Cummins JT. Comparative effectiveness of open versus minimally invasive sacroiliac joint fusion. Med Devices (Auckl). 2014;7:187-93.