Chronic lower-back pain can be debilitating, and about 15% to 30% of cases can be traced to problems with the sacroiliac joints – two C-shaped joints that connect the base of your spine (the sacrum) to your hips and support the weight of your upper body when standing.
While these 1-2cm wide joints connect moving bones, they don’t move much themselves. But if the joints are injured due to trauma such as a vehicle accident or a condition such as chronic obesity, infection, or pregnancy, even the slightest movements can intensify inflammation, causing stiffness and pain in the lower back and buttocks that radiates down the leg.
We eliminate those micromotions through a specialized keyhole sacroiliac joint fusion – a new minimally invasive procedure that fuses, or welds, together the bones of the sacroiliac joint, rendering them motionless to reduce pain. A study of this FDA-approved procedure showed successful solid fusion in almost all patients after 24 months, along with a 73% average reduction in low back pain.
But be aware: Not all so-called fusion procedures are as safe or effective as they seem. Getting a “fusion” procedure from someone other than a pelvic orthopedic surgery expert increases the risk of insufficient outcomes and potentially serious complications such as bleeding and nerve dysfunction.
Traditionally, sacroiliac joint fusion has been done as an open surgery. I am one of the few orthopedic surgeons in the U.S. and the only one in North Texas who is certified to perform true keyhole, or minimally invasive, sacroiliac joint fusion procedures. As a specialist in pelvic region surgeries, I am fellowship trained to operate around the delicate nerves, blood vessels, and tissues in that area.
While many patients can manage chronic lower-back pain through medication, steroid injections, or physical therapy, the keyhole spinal joint fusion procedure can be an effective option in patients who are eligible.
How does keyhole sacroiliac joint fusion work?
For the new keyhole sacroiliac joint fusion procedure, we use the Integrity SI Fusion System by OsteoCentric to make two incisions about the size of a thumbnail in the buttocks. Under imaging guidance, we use a blade to clear the joint of all cartilage. This leaves nothing between the bones to get in the way of them healing together.
We then place a fastener across the joint bones, using screws that are designed with unique thread geometry to generate a high compressive force that better pulls and secures the two ends of the bones together.
The procedure takes about 45 minutes, and you can go home the same day. If you have a desk job, you will likely be back to work within two weeks. If you do physical work, you may need a few months to fully return to work.
Am I a candidate for the procedure?
To rein in and protect patients from unsafe procedures, Medicare has set strict requirements that patients must meet to be considered for true sacroiliac joint fusion. We follow these guidelines for all patients, regardless of their health care coverage.
To be eligible for the procedure, you must first try a minimum of six months of conservative treatment without achieving long-term relief. Specific treatments include:
- Pain medication
- Physical therapy
- Activity modification
- At least three steroid injections into the sacroiliac joint
The level of pain relief you get from the steroid injections approximates the long-term benefit you can expect from sacroiliac joint fusion if the joint is indeed the root cause of your pain. For example, if an injection takes away 60% of your pain, the procedure should, too. If injections don't significantly relieve your pain, a joint fusion wouldn’t be appropriate.
We will also perform imaging tests to confirm degenerative changes or inflammation in the sacroiliac joint before recommending sacroiliac joint fusion.
Choose a certified surgeon
True sacroiliac joint fusion can be a game changer for people with chronic lower-back pain. However, faux “fusion” procedures are being offered throughout the U.S. by pain management specialists or other practitioners who are not trained in orthopedic surgery.
Some of these procedures involve placing a piece of metal across the joints to hold the bones together. While this approach can reduce joint motion, it doesn’t result in true fusion – and it has little to no chance of achieving long-term pain relief.
False procedures are often performed in an office setting, which is not sterile like an operating room and lacks the resources and personnel to contain infection risk and mitigate damage to the major nerves and blood vessels in the pelvis.
True fusion procedures require training and expertise in surgical techniques and the biomechanics of the pelvis. UT Southwestern orthopedic surgeons work in tandem with our specialists in pain management and physical medication and rehabilitation to give each patient the right solution for their specific condition, every step of the way.
If you are offered a fusion procedure for sacroiliac joint pain, make sure your provider fully explains the procedure and what your expected results should be. Ask about your doctor’s experience with orthopedic surgery, especially within the pelvis area – and don’t be afraid to get a second opinion.
Sacroiliac joint pain can be debilitating, preventing you from doing even the simplest everyday activities. When more conservative measures such as medication and physical therapy don’t work, a true spinal joint fusion procedure may provide the lasting pain relief you need.