Surgical Treatment for Sacroiliac Joint Pain

The standard surgery used to address SI joint pain is sacroiliac joint fusion. The goal of this procedure is to completely eliminate movement at the sacroiliac joint by grafting together the ilium and sacrum.

Sacroiliac fusion involves the use of implanted screws or rods, as well as a possible bone graft across the joint. Minimally-invasive procedures have been developed in recent years that improve outcomes in pain and disability, and reduce recovery time.¹Ledonio CG, Polly DW, Swiontkowski MF, Cummings JT. Comparative effectiveness of open versus minimally invasive sacroiliac joint fusion. Med Devices (Auckl). 2014;7:187-93.^,2Kube RA, Muir JM. Sacroiliac Joint Fusion: One Year Clinical and Radiographic Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery. Open Orthop J. 2016;10:679-689.

Deciding on Sacroiliac Joint Fusion

Sacroiliac joint fusion is only recommended once non-surgical treatments have been tried for at least 8 to 12 weeks and are generally ineffective. In most cases, non-surgical treatments are tried for several months before surgery is advised.

The biggest risk of sacroiliac joint fusion is the possibility that surgery won’t alleviate pain, and/or that fusion of the joint will be unsuccessful. There is also the possibility that the fused sacroiliac joint will displace pressure typically absorbed in the pelvis to the lower spine, creating pain and pressure in the lower back (called adjacent segment disease). This complication has been reported in about 5% of sacroiliac joint fusion patients within 6 months of surgery.³Schoell K, Buser Z, Jakoi A, Pham M, Patel NN, Hsieh PC, Liu JC, Wang JC. Postoperative complications in patients undergoing minimally invasive sacroiliac fusion. Spine. Nov 2016; 16 (11): 1324-1332.

Sacroiliac Joint Fusion Procedure and Recovery

There are two surgical systems used for sacroiliac joint fusion, which include the implants that fuse the joint as well as other tools needed to perform the surgery. All minimally-invasive sacroiliac joint fusion procedures consist of the following:

• Under general anesthesia, a small incision is made over the lower back and muscles are gently moved to the side.
• A device is used to drill a small hole through the ilium and access the joint.
• The sacroiliac joint is cleared of ligaments and muscles, and a bone graft and surgical implants are put in place across the joint to encourage bone growth.
• Muscles are put back in place, and the surgical site is closed using standard sutures.

A hospital stay of 1 to 2 nights may be needed following surgery.

Recovery from sacroiliac joint fusion typically includes a combination of pain medications, physical therapy, and at-home treatments such as applying heat and ice. Additionally, a pelvic brace may be prescribed to stabilize the pelvis and limit painful movements during healing. The recovery period for sacroiliac joint fusion typically lasts between 3 and 6 months.