How to Know if SI Joint Fusion Is Right for You

Sacroiliac (SI) joint dysfunction is a condition that can cause chronic lower back pain and/or radiating, sciatica-like leg pain symptoms. While there are conservative treatments that can help people who are suffering from this condition, sometimes the best option is SI joint fusion.

Jose Valerio, MD, whose practice has locations in South Miami, Hialeah, and Weston, Florida, is a highly skilled, fellowship-trained neurosurgeon who specializes in this minimally invasive surgery. In this blog, Dr. Valerio discusses what’s involved in SI joint fusion and when the treatment may be the best option.

Understanding SI joint function 

Your SI joints connect your pelvis to your lower spine and support the weight of your upper body when you’re standing. Your SI joints link the sacrum — the bony structure between your lumbar spine and your tailbone (coccyx) — to the upper part (ilium) of your pelvis.

There are SI joints on each side of the sacrum, and therefore on both the right and left sides of your lower back. Each SI joint is small, very strong, and reinforced by the tough ligaments that surround it. 

SI joints don’t have much motion. Their main role is to act as shock-absorbing structures for the spine as they transmit all the forces of your upper body to your hips (pelvis) and legs. 

Getting to the bottom of SI joint pain

SI joint dysfunction is known to cause persistent lower back pain and/or leg pain. SI-related leg pain can be particularly difficult to diagnose, because it can be mistaken for sciatica and/or radiating pain caused by a herniated disc in the lumbar spine.  

Because the SI joints are primarily weight-bearing, shock-absorbing joints, basic activities — such as walking, standing, climbing stairs, and even sitting — can be stressful for a dysfunctional SI joint. This is why many people with SI dysfunction experience worsening pain when they’re active.

While there are many potential causes of SI joint pain, ranging from degenerative arthritis (osteoarthritis) and inflammatory arthritis (ankylosing spondylitis) to pregnancy-related joint changes and trauma, all SI joint pain is essentially a product of altered joint motion, such as the following:

Too much movement 

A hypermobile or unstable SI joint usually causes pain in the lower back and/or hip that may extend all the way into the groin.

Too little movement 

A hypomobile or fixed SI joint typically causes pain on one side of the lower back, hip, or buttocks. In some cases, it radiates down the leg, much like sciatic nerve pain. 

First-line treatments for SI joint pain

SI joint pain can be challenging to treat, because there are several nerves involved in its sensations. Even so, conservative measures often go a long way in providing effective, long-term relief. Just like other spine-related conditions that trigger chronic back or leg pain, first-line treatments for SI joint dysfunction include:

Pain medication

Over-the-counter pain relievers, prescription muscle relaxants, and other pain medications may help reduce pain enough to keep you mobile and active.

Physical therapy 

Doing specific daily exercises and stretches may be able to help correct a biomechanical abnormality that causes SI joint pain. Physical therapy also incorporates a variety of “hands on” manual therapies, such as massage, to help stretch tight structures and correct SI joint mechanics. 

Occupational therapy

This approach provides daily living instructions for SI joint pain, such as the best sleep position or the correct sitting posture, to help improve body mechanics and reduce symptoms. 

SI joint injections

Anti-inflammatory corticosteroid injections in the SI joint can help relieve severe pain. For some people, joint injection therapy is what makes it possible to engage in physical therapy.

Radiofrequency ablation

This treatment can remove the nerve lesions that are causing your pain, which can provide months of relief. 

When to consider SI joint fusion

If SI joint pain persists for several months and doesn’t respond to significant trials of conservative, nonsurgical treatments, surgery may become a consideration.  

 SI joint fusion surgery may right for you if: 

• Your SI joint is unstable and fusion could provide stability
• You have significant low back, hip, groin, or leg pain that makes it hard to function in everyday life and hasn’t responded to conservative treatments
• You experience instability in your pelvis and lower back that causes pain or difficulty when you stand up from a seated position, walk, or climb stairs
• You have persistent stiffness and limited mobility in your lower back, hips, or legs
• You experience intensified pain after being in the same position (sitting, standing, or sleeping on the affected side) for too long 

There’s always a lot to consider when contemplating any surgery, even one that aims to resolve a chronic back pain problem. If you’re seriously considering SI joint fusion surgery, you’re in excellent hands with Dr. Valerio.  

Dr. Valerio specializes in the latest minimally invasive (MIS) surgical technique for SI joint fusion — the iFuse Implant System® by SI-Bone®. With this approach, Dr. Valerio inserts a titanium implant and bone graft material to stabilize the joint and promote bone growth.

To learn more about minimally invasive SI joint fusion surgery and to see if it could help you, book an appointment over the phone with the practice of Jose Valerio, MD, today.