Minimally invasive Sacroiliac (SI) Joint Fusion

Introduction

Sacroiliac joint fusion is performed to stabilize a dysfunctional joint in the pelvic region. The procedure helps alleviate pain when conservative methods fail to provide relief.

Disease Overview

The sacroiliac joint is a junction between the spine and the pelvic bones. There is one joint on either side formed between the sacrum of the spine and the ilium of the pelvis. The sacroiliac joints acts a like shock absorber transmitting the forces of the upper body to the hips and legs. The joints are reinforced by ligaments and provide limited movement.

Dysfunction of the sacroiliac joint can cause pain in the lower back, groin or leg on the affected side. This may be related to excessive mobility or restriction of the joint due to injuries, overuse, or posture-related strain such as sitting or bending for extended periods.

Sacroiliac joint dysfunction is difficult to diagnose as symptoms are often similar to other conditions such as disc herniation or sciatica. To obtain a diagnosis your doctor will review your symptoms and perform a physical examination using maneuvers to reproduce your symptoms. To confirm the diagnosis, an anesthetic injection is administered to the sacroiliac joint under image guidance. The diagnosis is made if symptoms resolve.

Indications

Sacroiliac joint dysfunction is treated initially with conservative measures such as physical therapy, medications, or injections. Surgery is recommended if conservative treatment does not relieve the symptoms.

Surgical Procedure

Your doctor may perform a sacroiliac joint fusion or stabilization by making a large open incision to access the joint or with minimally invasive surgery. Both procedures are performed under general anesthesia.

While performing open surgery, a 7-8 inch incision is made over the side of your buttock. The tissues are spread apart to access the SI joint. Cartilage is removed from the joint and a bone graft, usually obtained from the pelvic bone is fixed across the joint with screws to help it fuse. Surgery usually takes about 3 hours and you may need to remain in the hospital for up to 5 days.

Minimally invasive surgery uses a smaller incision and is carried out under live X-ray imaging. A 2-3 cm incision is made in the side of your buttock and implants are placed across the joint by drilling holes in the bones.  The implants stabilize the bones allowing them to fuse while protecting the surrounding soft tissues. The procedure takes about an hour to perform. You will usually be well enough to return home the next day with activity and weight bearing restrictions. You will begin rehabilitation in about 4-6 weeks. Complete recovery usually takes about 6 months.

Risks and Complications

As with any surgery, SI joint fusion may be associated with certain risks such as:

  • Infection
  • Injury to the surrounding structures
  • Instrument or implant failure