Non-surgical Alternative to SI Joint Fusion

Have you noticed pain when sitting and standing recently? When you walk, do you notice that your gait is sometimes uneven, as if one leg was noticeably longer than the other one? Maybe you’ve always been an active in running or jogging, but you’ve started to feel pain doing these activities you once loved. Any of these signs could be symptoms of pain in your SI, or Sacroiliac joint.

While some practitioners recommend procedures such as SI joint surgery to alleviate the pain and get your joints in working order again, you should be aware of all of the side effects, success rates, and alternative options before choosing to undergo any kind of procedure affecting your SI joint. In this article, we’ll discuss the information you need to know about the joint itself, symptoms of SI joint problems, causes of SI joint pain, and different treatment options available to you.

What is the Sacroiliac joint and what does it do?

Your SI joint lives between your tailbone and the back of your hips. The joint is meant to absorb the shock that transfers forces from your leg into your pelvis and spine. It is supported by tough ligaments that allow for small amounts of motion (7), and doesn’t have a large range of motion like hip or knee joints because its function is primarily to absorb shock.

What could be causing my SI joint to be in pain?

There are a variety of reasons that your SI joint may be acting up. It can be injured through trauma, or even with repetitive use agitation, such as running or jogging. Pregnant patients may experience SI joint pain because of hormonal releases that cause joints to loosen up and move more in preparation for childbirth, while childbirth itself may also cause trouble for an SI joint. Additionally, some patients just have more lax ligaments than others, making them more prone to something like SI joint injury. One of the most common issues is SI joint instability, which happens when ligaments get stretched; ultimately, this means that the SI joint is allowed to move too much, which can cause the cartilage in the joint to be injured.

How can I tell that my SI joint is the problem? What does it feel like when the joint is out of place?

If the SI joint is unstable, it can move excessively out of its normal range. Patients often describe this feeling as something being “stuck.” That SI joint instability can impact walking, or a patient’s legs might suddenly feel weak. Other people experience pain in the back of the hip, or strange sensations down their thighs or the backs of their legs. Many patients find that these sensations can be helped by manipulation of the joint, but if the joint is unstable in the first place, the problem will return.

Will I have to have SI joint surgery? What are the common treatment options?

If conservative methods like physical therapy or chiropractic care fail, the next step is typically SI joint steroid injections. These injections are powerful anti-inflammatory corticosteroids that are x-ray-guided into the joint. Drawbacks to this care method include injury of the cartilage cells that line the joint (12,13).

Another treatment option is called radiofrequency. In this procedure, a doctor will burn the nerves that take pain from the area, referred to as ablation, and this can help chronic SI joint pain (14). However, this technique does not have detailed research or studies on long-term complications, and studies on other joints treated with radiofrequency have shown considerable problems (15). Additionally, these same nerves take information from that joint on where their position should be; when those nerves are burned, there is a concern in the long-term that radiofrequency could make the joint more and not less arthritic.

Doctors may also recommend SI joint surgery, which is a fusion-based surgical method that places screws into the joint. The goal of the SI joint surgery is to make the joint unable to move, hence the “fusion.” One such system, called the iFuse SI Joint Fusion implant, uses specialized titanium implants placed across the joint. This particular SI joint surgery is billed as “minimally invasive” because it uses a device to place the implants. However, while less invasive than, say, open surgery, the device placing the implants is large enough to cause tissue destruction, as it has to be placed through the gluteal muscles to access the SI joint in the first place.

Even though SI joint surgery may be recommended, many patients can avoid surgery altogether using alternative treatment options.

What are the alternatives to SI joint Fusion? Are any of them less invasive?

At Centeno-Schultz, we have had excellent success avoiding SI joint surgery altogether for our patients by using a procedure called a Perc-SI Ligamentoplasty, a less invasive procedure that is comprised of an injection into the ligaments and joint (6). Using this procedure as an alternative to SI joint surgery helps to strengthen the stretched-out ligaments that are causing instability and pain. By helping the weakened, stretched-out, or loose ligaments to tighten down and become more robust, they will, in turn, work to protect the SI joint while still allowing normal motion. Additionally, there is no overload or adjacent segment disease risk that comes with SI joint surgery.

Using our Perc-SI Ligamentoplasty approach as an alternative to the more traditionally offered SI joint surgery has been a game changer for our patients. Our injections have the utmost precision because they are image-guided, ensuring the best possible results for our patients. All of our procedures are backed by extensive research and published patient outcome data, and all of our doctors are musculoskeletal specialists with advanced training, meaning that our patients and their joints are truly in the best hands.

References

(1) Asil K, Yaldiz C. Retrospective Assessment of Early Changes in the Sacroiliac Joint After Posterior Lumbar Fusion Surgery via Magnetic Resonance Imaging and Computed Tomography. World Neurosurg. 2018 Dec;120:e546-e550. doi: 10.1016/j.wneu.2018.08.127. 

(2) Darr E, Cher D. Four-year outcomes after minimally invasive transiliac sacroiliac joint fusion with triangular titanium implants. Med Devices (Auckl). 2018;11:287–289. Published 2018 Aug 29. doi:10.2147/MDER.S179003

(3) Lindsey DP, Kiapour A, Yerby SA, Goel VK. Sacroiliac Joint Fusion Minimally Affects Adjacent Lumbar Segment Motion: A Finite Element Study. Int J Spine Surg. 2015;9:64. Published 2015 Nov 13. doi:10.14444/2064

(4) Healthcare Bluebook. Search on “Sacroiliac Joint Fusion”. Accessed 28 August 2019. https://www.healthcarebluebook.com/ui/proceduredetails/22

(5). Cher DJ, Frasco MA, Arnold RJ, Polly DW. Cost-effectiveness of minimally invasive sacroiliac joint fusion [published correction appears in Clinicoecon Outcomes Res. 2016;8:305]. Clinicoecon Outcomes Res. 2015;8:1–14. Published 2015 Dec 18. doi:10.2147/CEOR.S94266

(6) Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract. 2017 Jul;17(6):782-791. doi: 10.1111/papr.12526.

(7) Richard L. DonTigny, B., Dysfunction of the Sacroiliac Joint and Its Treatment. The Journal of Orthopaedic and Sports Physical Therapy, 1979. 1(1): p. 13. https://www.ncbi.nlm.nih.gov/pubmed/18810188

(8) Duhon BS, Cher DJ, Wine KD, Kovalsky DA, Lockstadt H; SIFI Study Group. Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: A Prospective Study. Global Spine J. 2016;6(3):257–269. doi:10.1055/s-0035-1562912

(9) Duhon BS, Bitan F, Lockstadt H, et al. Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: 2-Year Follow-Up from a Prospective Multicenter Trial. Int J Spine Surg. 2016;10:13. Published 2016 Apr 20. doi:10.14444/3013

(10) Whang P, Cher D, Polly D, et al. Sacroiliac Joint Fusion Using Triangular Titanium Implants vs. Non-Surgical Management: Six-Month Outcomes from a Prospective Randomized Controlled Trial. Int J Spine Surg. 2015;9:6. Published 2015 Mar 5. doi:10.14444/2006

(11) Schoell, K., et al., Postoperative complications in patients undergoing minimally invasive sacroiliac fusion. Spine J. 2016 Nov;16(11):1324-1332. doi: 10.1016/j.spinee.2016.06.016. Si joint fusion complications

(12) Buchanan, P., Mehta, A. & Gerstman, B. Interventional Treatments for Sacroiliac Joint Pain. Curr Phys Med Rehabil Rep (2014) 2: 66. https://doi.org/10.1007/s40141-014-0042-5

(13) McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular synthetic corticosteroid vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA.2017;317(19):1967–1975. doi: 10.1001/jama.2017.5283

(14) Chen CH, Weng PW, Wu LC, Chiang YF, Chiang CJ. Radiofrequency neurotomy in chronic lumbar and sacroiliac joint pain: A meta-analysis. Medicine (Baltimore). 2019;98(26):e16230. doi: 10.1097/MD.0000000000016230

(15) Kanchiku T1, Imajo Y, Suzuki H, Yoshida Y, Nishida N, Taguchi T. Percutaneous radiofrequency facet joint denervation with monitoring of compound muscle action potential of the multifidus muscle group for treating chronic low back pain: a preliminary report. J Spinal Disord Tech. 2014 Oct;27(7):E262-7. doi: 10.1097/BSD.0000000000000107.

(16) Vilensky JA, O’Connor BL, Fortin JD, Merkel GJ, Jimenez AM, Scofield BA, Kleiner JB. Histologic analysis of neural elements in the human sacroiliac joint. Spine (Phila Pa 1976). 2002 Jun 1;27(11):1202-7. https://www.ncbi.nlm.nih.gov/pubmed/12045518