SI Joint Fusions: One Solution to Solving SI Pain

What is a Sacroiliac Joint Fusion? 

The Sacroiliac (SI) joints connect the iliac bones (pelvis) to the sacrum, which is the lowest part of the spine, just above the tailbone. The SI joint is responsible for movement, balance, and shock absorption between the upper and lower body. When the SI joint becomes inflamed, it can cause pain in the lower back or groin area. This pain can be caused by injuries, arthritis, previous lower back surgery, or tissue loosening due to pregnancy.

A sacroiliac joint fusion   reduces pain by connecting the ilium to the sacrum using titanium implants along the sacroiliac joint. This procedure maximizes weight bearing capacity and stability while reducing excess motion at the joint, thereby reducing irritation and improving a patient's pain.

What can an SI Joint Fusion treat? 

Patients experiencing low back or groin pain may be candidates for sacroiliac joint fusion. A person with SI joint issues may also experience hip and leg pain or burning, weakness, and numbness in the buttocks and legs if the sciatic nerve is irritated by SI joint inflammation. Thus, SI joint pain may falsely present as discogenic or low back pain and mimic conditions such as lumbar radiculopathy. Ruling out the low back as the pain’s epicenter and correctly diagnosing the SI joint as the problem region becomes a critical part of ensuring candidacy for an SI joint fusion. SI joint fusions are often pursued when more conservative treatments such as physical therapy, injections, and oral medications have failed to provide significant, lasting pain relief.

What about SI Joint Injections?

As part of determining if a patient is a good candidate for SI joint fusion, a provider may first recommend an SI joint injection. With the injection, guided X-ray imaging and contrast medication are first used to confirm proper needle placement for the injection and maximize coverage of the medication being used. Once placement is confirmed, the provider will inject a mix of local anesthetic and corticosteroids. The anesthetic will provide immediate relief while the corticosteroid is used to reduce inflammation and provider longer lasting pain relief. The corticosteroids will not have an effect immediately; it may take 3-5 days after the injection before a patient starts to notice any improvements. These positive effects of an SI injection are unlikely to be permanent; however, patients that experience relief from their symptoms may be good candidates for an SI joint fusion. 

What To Expect: The SI Joint Fusion Procedure

The SI joint fusion procedure is minimally invasive and usually takes 45 minutes to an hour to complete. It is performed in the operating room under general or spinal anesthesia, with the patient lying on their stomach. An incision is made in the buttock, and the gluteal muscles are dissected for access to the ilium (pelvis). A guide pin is inserted, and the ilium is drilled to create access to the sacrum (lower back). Titanium implants are then inserted and connected to both the ilium and sacrum with screws or pins. Typically, three implants are used in SI joint fusion to maximize stability at the joint. The incision site is irrigated and closed with sutures, and most patients will be discharged from the hospital the next day.  Recovery will take about 12 weeks and involve physical therapy to improve motion and strength at the joint. Approximately 77-85% of patients will experience significant relief of their back pain after the procedure.

Overall, if an individual wishes to pursue treatment beyond SI joint injections, the SI joint fusion may be a good option. If you have chronic low back or hip pain and believe you may be a candidate for sacroiliac joint fusion, book your consultation with Ospina today to get started on your pain relief journey and determine your next steps.

Written By: Ashley Knebel

Edited By: Camden Rowe

This content was in-part edited by OpenAI's ChatGPT and ultimately reviewed, edited, and approved for publication by Ospina Medical's blog manager.