The sacroiliac joint is the joint that connects the hip bones that make up the pelvis to the sacrum. Although this joint is a low-motion joint, it acts as a shock absorber between the torso and the lower body. Dysfunctions affecting this joint can result in lower pain in the lower back, groin, pelvic region and hip. They can also result in inflammation and stiffness of the joint. Sacroiliac joint fusion surgery is only recommended to treat pain in this joint when other options are not effective. Below, we discuss SI joint fusion surgery and what to expect.

When is SI Joint Fusion Surgery recommended?

Surgical intervention is only recommended when:

• There is instability in the lower back and pelvis – this may make it difficult or painful to walk, sit, stand or move in various ways.
• Significant pain in the lower back, hip or groin – this may interfere with you day to day functions. Surgery may be recommended if other methods of treatment are not effective in managing the pain.
• Stiffness or limited mobility in the legs, hips, groin and lower back
• Significant pain when standing or sitting in certain positions

Before surgical intervention is recommended, various diagnostic methods must be applied. These include:

• An examination of your medical history
• A physical exam which may include applying pressure to the sacrum or moving your hips in various directions to provoke symptoms
• Diagnostic imaging tests including MRI, x-rays, CT scans and more.
• Injection of local anesthetic to manage pain. If this helps to reduce pain by between 50 and 75 percent, the joint is confirmed as the source of pain.

What to Expect with Sacroiliac Joint Fusion Surgery

SI joint fusion permanent restrictions can affect one or both sides. The sacrum and ilium are grafted to encourage the growth of bone across the joint using implanted bone grafts or instrumentation. Fusion of the joint is a result of the natural healing process. This procedure is minimally invasive and open surgery is rarely applied as it has higher rates of complication and involves an extensive and difficult healing process.

Minimally invasive procedures typically involve the following steps:

1. The patient lays on the operating table face down. They are placed under general anesthesia.
2. An incision of between 2 to 3 cm is made on the side of the buttock and into the gluteal muscles to access the ilium.
3. This is followed by the insertion of a guide pin. An opening is drilled through the ilium. This will be used to access the sacrum.
4. In cases where bone grafts will be used, the cartilage and soft tissues in the SI joint are cleared and the graft is packed into the resulting space. This graft often consists of tissues collected from a different part of the ilium or from the shavings that were removed when broaching the ilium.
5. If implant instruments are being used, they are simply guided into the passage and secured using pins, screws or a mallet.
6. Debris is removed from the site using a saline solution. The incision is then closed using sutures.

This whole procedure can last up to an hour and poses a low risk of complications.

After Surgery

Many patients that undergo this procedure are able to go home the next day. Your doctor will provide you with a prescription for pain medication to manage the pain. You may also be required to use a cane or walker to reduce stress on the joint during healing. You may also have to wear a sacral belt to provide stability for the joint.

Heat therapy and the application of ice can help to reduce inflammation, muscle tension and spasms after surgery. Physical therapy will help to restore or improve range of motion.

If you’re experiencing significant pain or loss of mobility and stability in the lower back, hips and legs, get in touch with us and schedule an appointment with Dr. Chris Boone for diagnosis. We provide sacroiliac joint surgery in Bellevue, Redmond and Seattle!