SACROILIAC JOINT STABILIZATION THROUGH SURGICAL TREATMENT:
***CONTINUED HYPERMOBILITY AFTER CONSERVATIVE THERAPY METHODS HAVE BEEN APPLIED MAY INDICATE THE NEED FOR A SURGICAL SACROILIAC JOINT FIXATION CONSULTATION…
I. Sacroiliac Joint Screw Fixation
II. Sacroiliac Joint Fusion
NOTE: ESSENTIAL TO THE SUCCESSFUL OUTCOME OF SI SURGERY IS TWO THINGS:
1. TO ALIGN THE SI JOINTS AT THE TIME OF SURGERY JUST PRIOR TO FIXATION. THUS, ASSURING THE SI JOINT IS NOT PERMANENTLY FIXATED IN A SUBLUXATED (PARTIALLY DISLOCATED) POSITION!
2. HAVE A GOOD POST-OP THERAPY PROGRAM AIMED AT PROGRESSIVELY RETRAINING THE MUSCLES WHILE ALSO ADDRESSING THE SOFT TISSUES WHICH HAVE BEEN AFFECTED.
SI FIXATION with Implants: to stabilize the sacroiliac joint, cannulated screws will be placed through the ilium and sacrum. The cannulated screws that your physician will use for stabilization are approved by the U.S. Food and Drug Administration (FDA) for fixation of fractures of large bones. It is inferred from this that they are solid enough for sacroiliac stabilization for which they are commonly used.
SI FIXATION LEADING TO FUSION with ifuse Implants:>iFUSE Implant System by SI-BONE: TRIANGULAR SHAPED IMPLANT RODS-> are titanium devices which are coated with a porous plasma spray. It is an SI Fixation procedure which leads to SI Fusion.
SI (Traditional, open back) FUSION: between the sacrum and the ilium fusion may also be necessary. This is done by scraping the bone on both sides and placing a graft taken from the iliac crest at the surgical site between the two sides. Artificial graft can also be used. If your physician determines that a fusion is not necessary in your case, the joint will be fixed in place using only the screws.
PIRIFORMIS SURGERY: often inflamed or swollen as a result of SIJD. Among other symptoms, the Piriformis Muscle can irritate the sciatic nerve causing radiating leg pain and butt pain.
CRITERIA FOR SURGICAL STABALIZATION OF THE SACROILIAC JOINTS commonly include the following (by Alan Lippitt, MD):
1. Pain must be disabling.
2. Pain must be localized to the SIJ and not relieved by conservative modalities.
3. Pain should be relieved on a transient basis by a fluoroscopically controlled SIJ block.
4. Other causes of lumbopelvic pain such as herniated nucleus pulposus, facet arthropathy, trapped nerve root, spinal stenosis, hip disorders, etc. should be ruled out.
5. Associated conditions must be treated before, in conjunction with, or after treating the SIJ dysfunction.
GLOSSERY OF TERMS commonly associated with Sacroiliac Surgeries:
>SI FIXATION: SCREW IMPLANTS->the placement of cannulated titanium screws screws across reduced (properly positioned) Sacroiliac Joints
>SI FUSION: TRADITIONAL FUSION-> sacroiliac joint fusion involves open surgery to access the SI joint, bone removal, and adding bone graft to help the joint heal.
*note: for traditional SI Fusion to be succesful, it should be combined with SI Fixation to ensure joint stabalization during bone growth.
>iFUSE Implant System by SI-BONE: TRIANGULAR SHAPED IMPLANT RODS-> are titanium devices which are coated with a porous plasma spray. It is an SI Fixation procedure which leads to SI Fusion.
>PIRIFORMIS RELEASE: the piriformis muscle goes from the sacrum to the hip joints where it inserts. Piriformis surgery typically involves cutting the tendon of the muscle at its site of insertion.
>SACROILIAC JOINT ALIGNMENT: it is believed to be an important procedure to have this done on the operating table just prior to the Sacroiliac Surgery. It is a MANUAL technique to ‘reposition’and align the SI Joints. The pelvic complex is brought back in it anatomically right position, before being securing it with harware.
>”bilateral”: both sides
>”unilateral”: one side