When Would I Need Sacroiliac Joint Surgery?

The sacroiliac joints connect the spine to the hips, they are located between the iliac bones and the sacrum. These two joints offer support and stability and play a significant role in absorbing impact as you walk or lift. The cartilage covering the joints wears out as you age, allowing the bones to rub together, causing pain. Sometimes sacroiliac joint dysfunction may be due to an infection or a traumatic injury like a motor vehicle accident. Medication, injection, or physical therapy alleviates the pain for most people with sacroiliac joint pain. However, San Bernardino SI joint surgery may be needed to eliminate movement by grafting the ilium and sacrum together.

When is sacroiliac joint surgery an option?

If the following symptoms persist for weeks or months and don’t improve with nonsurgical treatments, you may discuss surgery with your specialist

  • Intense pain in your lower back, hips, or groin that affects your productivity and does not respond to nonsurgical methods. You may have sacroiliac joint pain on one or both sides of your body; on one side, low back pain may indicate that the SI joint is the pain generator. Usually, the pain is confined to the lower back and pelvis, but it can radiate to your legs through the buttocks.
  • Reduced range of motion or stiffness in your lower back, hips, groin, or legs
  • Pain or trouble standing, walking, or moving from standing to sitting or vice versa; this is usually due to instability in the pelvis and lower back.
  • Pain that exacerbates after long hours of sitting, standing, or lying on the affected side for too long.

Diagnosing SI joint pain before surgery

Before your surgeon schedules you for surgery, diagnosis is essential to determine if the SI joint is the source of your pain. Evaluation is necessary because sacroiliac joint pain can sometimes mimic pain similar to pinched nerves, lumbar disc herniation, hip bursitis, and degenerative hip disease. Evaluation usually involves a physical exam and a medical history. When deciding on sacroiliac joint fusion, your physician considers the location of your pain, problems standing or sleeping, and any history of injury.

Your healthcare provider may manipulate your joints to check for areas of tenderness over the SI joint. You may also need to make different movements to point to where you feel the pain. Your doctor may also order imaging tests, including CT, X-rays, and MRI, to help diagnose and check for spine and hip-related problems. However, sacroiliac joint dysfunction usually does not show well on imaging tests the same way bone spurs or a herniated disc might. For this reason, imaging tests may not be necessary to diagnose SI joint pain.

Injection tests are usually the last step in confirming that the SI joint is the pain generator. Your doctor injects local anesthetic into the joint space through the buttock or lower back for this test. If there is a significant reduction in pain, the SI joint is likely the pain generator. According to most recommendations, a 50% to 70% pain score reduction is needed to confirm the SI joint as the pain generator.

Consult your surgeon at Ali H. Mesiwala, MD, FAANS, to learn more about sacroiliac joint surgery.

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