Sacroiliac Joint Fusion
Surgical stabilization of the sacroiliac joint is indicated when the SI joint is the cause of significant, limiting pain which has not been adequately treated by nonsurgical means. Years ago, the failure rate of sacroiliac fusion was very high, largely due to the technique in use at that time. Today, the SI joint can be stabilized through a far less invasive approach with a much higher success.
Stabilization of the SI joint with today’s less invasive technique involves placing
devices across the joint which bond to bone on both sides of the joint providing stability. The devices are very durable, and are semi-porous allowing bone to grow directly into them over time. They are placed in a press fit manner which provides immediate stability. The surgery is done through an insicion approximately 1.5 – 2 inches in length laterally over the gluteal or buttock region. X-ray guidance is used to place the devices safely.
Recovery
Sacroiliac fusion is generally an outpatient procedure that can be performed at a surgical center or hospital. Walking can be somewhat painful initially, and often a cane, crutches or a walker is helpful. As the pain decreases, normal weight bearing can resume. This generally takes a few weeks.
The typical postoperative course is as follows:
- Partial weight bearing for 2-3 weeks depending on pain.
- Postoperative visit at 3 weeks for incision check.
- Clinic visit at 2 months to follow progress and advancement to full activity if symptoms allow. Physical therapy often helpful at this point.
Risks of Surgery
Fortunately, risks associated with sacroiliac fusion surgery are rare. The more common potential risks include:
- Infection – possibly requiring antibiotics or even washing out of incision.
- Failure of fixation/fusion – may require revision with larger devices or other procedures
- Bleeding/hematoma/seroma – possibly requiring drainage.
- Scarring – although the incision is small, some individuals create significant scar tissue which can be painful or disfiguring.
- Continued pain – although highly successful, most patients will have some residual pain long term.
More severe but very uncommon risks include:
- Nerve injury – very rare. Usually associated with abnormal sacral or pelvic anatomy.
- Blood vessel injury – also very rare and commonly associated with abnormal pelvic and/or sacral anatomy.
- Fracture – more common in individuals with fragile bones such as osteoporosis or osteopenia, but even in these patients fracture is rare.
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