Sacroiliac Joint Fusion

Sacroiliac joint fusion stabilizes a joint that has been proven — not assumed — to be the source of the pain.

It sits at the end of a sequence, not the start

The sacroiliac joint accounts for a substantial share of chronic low back pain and is the single most under-diagnosed source, because it looks normal on MRI even when it is generating everything.

Fusion is the last step in a defined sequence, and skipping any part of it is how this procedure ends up done on the wrong patient:

1. Clinical examination using a cluster of provocation tests — no single test is reliable on its own.
2. Image-guided diagnostic injection, with contrast confirming the medication is genuinely inside the joint. A landmark-guided injection that missed proves nothing.
3. Repeat confirmation, because a single positive block carries a real false-positive rate.
4. Conservative treatment — physical therapy, therapeutic injection, and radiofrequency ablation of the lateral branches where appropriate.
5. Fusion, only where the joint is confirmed and the relief from the steps above has been real but temporary.

Who it is for

• Confirmed sacroiliac joint pain, established by image-guided diagnostic block
• Pain persisting beyond six months despite proper conservative treatment
• Good but temporary relief from injections or lateral branch ablation
• Commonly, patients with pain after a lumbar fusion, where load has transferred to the joint below
• Post-traumatic sacroiliac injury that has not settled

What the procedure involves

It is performed through a small incision at the side of the buttock under fluoroscopic guidance. Implants are placed across the joint to stabilize it and allow the two bone surfaces to fuse. Several implant systems exist; the choice depends on your anatomy and the pattern of the joint.

It is a day procedure in most cases. Weight-bearing is restricted for a period afterwards while the fusion consolidates, and physical therapy follows.

What to expect afterwards

• Restricted weight-bearing on that side for a defined period, with crutches or a walker initially.
• Physical therapy once the early restrictions lift.
• Improvement over months rather than days, as the fusion consolidates.
• A driver and someone to help at home for the first days.

Risks

This is a surgical procedure rather than an injection, and the risk profile reflects that: bleeding, infection, nerve irritation from implant position, implant loosening or malposition, and the possibility of continued pain if the joint was not the true source. Recovery involves a period of protected weight bearing. Because the sacroiliac joint sits close to the L5 and S1 nerve roots, transient nerve irritation afterwards is not unusual.

To find out whether this applies to you, call (314) 310-5577 or text (314) 886-5902. We are at 12174 Natural Bridge Road, St. Louis, MO 63044.

How we judge whether it worked

It sits at the end of a diagnostic sequence, never at the start. Confirmation requires repeated image-guided intra-articular blocks showing substantial, reproducible relief — not a single positive injection and not imaging findings.

The reason for that rigour is simple: fusing a joint that was not generating the pain leaves the patient with the original pain plus a fused joint. Getting the diagnosis right is the entire safeguard.