Sacroiliac (SI) Joint Fusion Q & A
What is the SI joint?
The sacroiliac (SI) joints are two strong joints in your lower back and pelvis. They connect the triangular bone at the base of your spine (the sacrum) to the large pelvic bones (the ilium) on each side. These joints carry the weight of your upper body and help transfer that load to your legs. When an SI joint becomes worn, injured, or unstable, it can cause pain in the lower back, buttock, hip, or groin, and sometimes pain that travels down the leg.
What is a SI joint fusion?
SI joint fusion is a procedure that stabilizes a painful SI joint so the bones grow together, or “fuse,” over time. Fusing the joint stops the small, painful movements that irritate the joint and surrounding nerves. Once the joint is fused, it no longer moves, which can reduce or eliminate the pain coming from it.
Who might benefit from this procedure?
This procedure is usually considered only after other, non-surgical treatments have been tried and have not worked. Before recommending fusion, Dr. Badiyan will typically:
- Confirm that the SI joint is the true source of your pain, often using physical exam tests and a numbing (anesthetic) injection into the joint to see if it relieves your pain.
- Make sure other causes of back or hip pain have been ruled out.
- Confirm that treatments such as physical therapy, medications, activity changes, and joint injections have not given you lasting relief.
What is the posterior approach?
There are different ways to reach and stabilize the SI joint. The posterior approach reaches the joint from the back of the pelvis, rather than from the side. This route is designed to avoid the important nerves and blood vessels near the joint, which is one reason it is considered a safe, minimally invasive option.
Here is what typically happens during a posterior SI joint fusion:
- You lie face down, and the area is numbed. Depending on the plan, you may receive local numbing medicine with light sedation, or you may be fully asleep under general anesthesia.
- Dr. Badiyan makes a very small incision (often just a small “stab” incision) over the lower back near the joint.
- Using live X-ray guidance (fluoroscopy) to see the joint, Dr. Badiyan places a small guide into the SI joint through the tiny opening.
- Dr. Badiyan prepares the joint surface and inserts one or more small implants, often made from specially prepared bone (an allograft), and sometimes a titanium implant, directly into the joint. These implants hold the joint steady and encourage the bones to grow together over time.
- The small incision is cleaned and closed
Because the incision is small and the surrounding muscles and tissues are disturbed very little, this approach is often done as an outpatient procedure, meaning you can usually go home the same day.
What is recovery like?
Recovery is generally quicker than with older, larger “open” surgeries. Many people are able to go home the same day. Because this is a minimally invasive procedure, some patients have few or no restrictions on putting weight on the leg, though Dr. Badiyan will give you specific instructions for walking, activity, and returning to work. It takes time for the bones to fully fuse, so it is important to follow your care team’s guidance during the healing period. Dr. Badiyan may schedule follow-up visits and imaging to check that the joint is healing.
What are the possible benefits?
In patients carefully selected because the SI joint is confirmed as the source of pain, studies have shown meaningful improvements in pain and in the ability to carry out daily activities, along with less reliance on pain medication for many people. Many patients report they would choose to have the procedure again. Results vary from person to person, and not everyone experiences the same degree of relief.
