Dr. Peter William D'amore, MD

Occasionally, the SI joint can become irritated, painful, or arthritic. Problems with the sacroiliac joint can be caused by trauma, infection, or other issues. The main symptom of SI joint damage is pain in the lower back, hips, and thighs. This pain may become worse when rising from a sitting position. When non-surgical treatments such as medications and physical therapy are not effective at relieving pain, surgery may be considered as an option.

During SI joint fusion, a small incision is made on the side of the buttock near the hip. The surgeon removes the cartilage, a firm, smooth substance between the bones. Then the joint is fused by the placement of rods, screws, or plates that hold the sacrum and the pelvis together. This reinforces the joint, stabilizing the pelvis and helping to support the upper body. Patients may be able to stand and walk the very next day after surgery but will need crutches to get around for the first few weeks. Full recovery and return to normal activities takes up to a year as the tissue around the joint grows and heals.

There are several different types of spinal fusion surgery available, mostly depending on where a patient's pain is located and whether his or her surgeon will perform the procedure through the back, front, or side. In general, a fusion is performed by packing the vertebrae to be fused with grafted bone. This bone may be taken from the patient's hip, may be donated from a cadaver, or it may be a manufactured synthetic material. The bone is placed along the vertebrae, and sometimes, the disc that lies in between the vertebrae is removed and replaced with grafted bone. The bone material will grow and cement the two vertebrae together. After the bone graft is placed, the vertebrae are sometimes held in place with rods, screws, plates, or cages, depending on the weakness of the spine and needs of the graft.

Spinal fusion is a significant surgery and can take three to four hours or more. Recovery is typically two to four days in the hospital. After surgery, it is important to remember that the fusion takes time to grow from the bone graft. So, the actual fusion is not complete for several months. Patients will probably feel somewhat better right away, but it may take a while to feel the full effects of the fusion as the bone grows into place. In the meantime, doctors might have patients wear a brace to protect their spine and keep it properly aligned.

Spinal fusion is not used for all kinds of back pain. Changing the way the spine moves can lead to strain on the other joints in the back, and fusion is only performed when the benefits outweigh the risks. Some spine disorders that are treated with fusion include:

• Curvature disorders, such as scoliosis and kyphosis
• Degenerative disc disease
• Spondylolisthesis, a disorder that causes vertebrae to slip over each other
• Significant spinal fractures that cause instability
• Weakened spine due to infection or tumor
• Some cases of spinal stenosis, a narrowing of the spinal column
• Chronic lower back pain (although the use of fusion to treat this is controversial)

Regardless of the diagnosis, there is always a possibility of 'failure' with spinal fusion, or of the surgery not fully solving the pain. This is more likely when fusion is used primarily to treat pain instead of structural problems. Patients can improve their chances of a successful outcome by stopping smoking, maintaining a healthy weight, moving their body every day, and following their doctor's instructions for any physical therapy that they are prescribed.