Navigated and robotic-assisted sacroiliac joint fusion: a narrative review

INTRODUCTION: Sacroiliac joint (SIJ) dysfunction accounts for up to 30% of axial low back pain and is increasingly managed surgically after failure of conservative care. While traditional open SIJ fusion carried significant morbidity, minimally invasive (MIS) approaches have transformed outcomes. More recently, stereotactic navigation and robotic assistance have emerged to enhance implant placement accuracy and reduce radiation exposure. AREAS COVERED: We conducted a narrative review of the literature (PubMed, EMBASE, Cochrane Reviews, inception) on SIJ fusion techniques, implant accuracy, complications, fusion rates, and patient-reported outcomes. MIS SIJ fusion now predominates over open approaches, with lateral and posterior techniques both achieving >90% fusion at 12-18 months. Navigation and robotic systems achieve 92-98% implant accuracy (vs. 76-87% with fluoroscopy) and reduce intraoperative radiation exposure by up to 85%, especially in anatomically complex or revision cases. EXPERT OPINION: Navigated and robotic-assisted SIJ fusion represents significant technical progress. While short-term clinical outcomes remain comparable to fluoroscopic MIS fusion, navigation, and robotics improve safety, reproducibility, and radiation safety. Future multicenter trials should assess long-term outcomes, cost-effectiveness, and integration of augmented reality, AI, and novel implants to define their optimal role in sacroiliac joint surgery.