Minimally invasive fusion of the sacroiliac (SI) joint

An inflammatory process of the SI joint (sacroileitis) can be a significant pain generator in the buttocks and thighs, especially when standing up from a sitting position and during walking. Conservative treatment (i.e. physiotherapy, SI joint blocks, pain medication, etc.) is usually the first step treating SI joint pathology and pain, while it usually requires at least 6 months of continuous conservative treatment to assess its efficacy.

However, there are cases for which conservatove treatment and/or even non-fusion surgical treatments (i.e. radiofrequency ablation of the SI joint and endoscopic neurotomy of the SI joint) fall short in improving SI joint pain or the effect is limited in time, resulting in treatment failure and patient frustraion due to continuing pain.

When conservative treatment failes, the next step of treatment usually is a minimally invasive fusion of a painful SI joint. Surgical treatment with SI fusion is usually the last step in an incremental ladder of treatments for the SI joint.

This minimally invasive surgery consists of a ipercutaneous insertion of two or three titanium devices of a traingular shape using a lateral or posterior approach to fixate the ilium bone with the sacrum. This results in a complete block of the SI joint in all its freedom of movements and the patient usually feels an immediate relief of pain. After this surgery the hospital discharge is usually in less than 24 hours.

Most clinical studies and publication have shown a significant decrease in pain and increase in life quality after SI joint fusion surgery compared to patients that were treated without surgery. Thousands of patients have already undergone SI joint fusion world-wide with excellent results.

Left image: X-ray of the pelvis showing a bilateral SI joint fusion with percutaneous titanium implants crossin the SI joint.

Right image: animation of a left-sided SI joint fusion with  3 triangular-shaped titanium devices.

Dr. Morgenstern is an internationally recognized spine surgeon certified in minimally invasive fusion surgery of the SI joint.

Occasionally, there are cases with a failed SI joint fusion. Si joint fusion failure can be caused by painful implant loosening within the bone (osteolysis), incomplete bone fusion of the SI joint (pseudo-arthrosis) and/or other causes for SI joint fusion failure (i.e. infection, trauma with a fracture, etc.).

These complex cases usually require revision surgery with complete or partial removal of the initial SI joint implants and a more robust re-fixation of the SI joint to achieve a successful SI joint fusion.

X-ray of a pelvis showing a revision surgery for bilateral SI joint fusion performed by Dr. Morgenstern. This patient had been previously operated for SI joint fusion and resulted in loosening of some the implants which were removed using a lateral approach. New implants were introduced using a posterior approach to ensure SI joint fusion. 

Dr. Morgenstern is an experienced spine surgeon in revision surgery of the SI joint and has obtained excellent results after revision surgery of failed SI joint fusion.