Patients who have newly diagnosed SI pain, those who have had failed SI surgery, and others who have developed SI pain as a result of prior spinal surgery have found relief through our novel surgical techniques.
Nonsurgical management of SI pain consists of physical therapy, medications, and injections. For patients in whom these treatments provide substantial and lasting pain relief, surgery is not needed.
If you have tried and failed these treatments, surgery is likely the next best option for you.
A comprehensive history and physical examination is the first step in this process. Understanding the location, nature, and pattern of your pain is critical in differentiating SI joint pain from other spinal problems, such as, herniated discs, degenerative disc disease, and lumbar stenosis, as well as hip problems. During your physical examination, care is taken check the spine and hip joints, and well as the SI joint through provocative maneuvers (thigh thrust, compression and distraction tests, FABER and Gaenslen positioning).
Imaging studies are needed to visualize the SI joint, and ensure that other problems in the lumbar spine and hip joints are not contributing to the problem. X-rays, CT scans, and MRI studies are often used.
The last component in diagnosis involves image-guided injections into the SI joint. Diagnostic injections typically include an arthogram (injection of dye into the joint) combined with local anesthetic to provide pain relief. If there is at least 50% reduction in pain, then the SI joint is the likely source of your pain. Occasionally steroids are injected into the joint for prolonged pain relief and therapeutic purposes.
There are two types of SI fusions, minimally invasive and open. It is very rare for us to
recommend open surgery, unless a patient has failed a minimally invasive operation, has a nonunion, or has anatomical issues that make a minimally invasive technique problematic.
In a minimally invasive SI fusion, the patient is placed under general anesthesia and has electrodes placed on them to monitor the spinal and sacral nerve function. We then placed them face down, in the prone position, on a specialized table that achieves neutral alignment of the SI joint.
Next, using image guidance, we make a 1 inch incision in the buttock, and place three pins across the SI joint. Measurements are taken to select the correct size implants, and each implant is then delivered over each pin, across the SI joint, under image guidance. The incision is closed with dissolving suture and glue.
Once the patient is taken off the operating table and anesthesia reversed, they are brought to the recovery area and monitored by our team. Patients are mobilized and discharges within 1 to 3 hours of surgery.