Sacroiliac Joint Fusion for Low Back Pain

Sacroiliac Joint Fusion for Low Back Pain

Sacroiliac joint fusion is a treatment approach for low back and pelvic pain. The sacrum and hip bone naturally form a joint—and this fusion procedure fuses them together. If conservative treatment methods such as drugs, exercise, and injections do not help back pain, surgical treatment in the form of sacroiliac joint fusion can help.

Innovations in sacroiliac joint fusion have meant that doctors can perform surgery using a minimally invasive approach. Keep reading to learn how and for whom sacroiliac joint fusion can help.

Benefits of a sacroiliac joint fusion

Researchers estimate that 15 to 30 percent of all lower back pain is caused by sacroiliac joint dysfunction. This is probably because the sacroiliac joint is responsible for helping you bend and also resist pressure, transferring force and pressure from your lower back to your legs. Unfortunately, the sacroiliac joint is vulnerable to stress and injury that can lead to pain. The goal of this surgery is to strengthen this joint and reduce this pain.

In addition to pain relief, other benefits of a sacroiliac, joint fusion include:

  • better quality of life

  • enhanced daily function

  • reduced disability

Side effects or complications of a sacroiliac joint fusion

Adverse side effects aren’t usual following a sacroiliac joint fusion, but the most common risks of sacroiliac joint fusion are:

  • new-onset back pain in another location

  • trochanteric bursitis (hip pain)

  • postprocedure wound infection

  • bone fracture

  • “nonunion” or failure of the bone to heal

Another potential, but less common, side effects include:

  • bleeding

  • hematoma (bruising/collection of blood)

  • nerve pain

  • blood clots in your legs or lungs

The ability to perform the surgery in a minimally invasive fashion has helped to improve outcomes and reduce serious effects

Sacroiliac joint fusion procedure

Surgeons can perform sacroiliac joint fusion using an open or minimally invasive approach. Although there are different techniques, an open surgical procedure involves:

  • A person goes to sleep under general anesthesia, where they’re asleep and unaware the surgery is taking place.

  • The surgeon makes an incision in the lower back to expose the sacroiliac joint.

  • A surgeon removes a block of bone to access the sacrum’s cartilage-covered surface.

  • The surgeon removes the cartilage that’s over the sacrum.

  • A surgeon replaces the block of bone and uses plates and screws to fix the bone in place to stabilize the joint.

Surgeons may also opt to perform sacroiliac joint fusion as minimally invasive surgery. Advancements in equipment have meant the surgery doesn’t have to require a large incision or prolonged recovery times.

Minimally invasive approach

The steps for a minimally invasive sacroiliac joint fusion are similar and may include

  • The patient goes to sleep under general anesthesia, where they’re asleep and unaware of the procedure is taking place.

  • A surgeon makes a small, 3- to 5-centimeter

  • The incision on the side of the buttock.

  • The surgeon dissects (cuts) through gluteal muscles to access the ilium or upper portion of the pelvis.

  • A surgeon uses a special guide pin to access the ilium and drill so implants can be passed toward the sacrum.

  • A surgeon guides the instruments for implantation through the passage created in the ilium. The surgeon secures the implants using screws and pins.

  • The surgeon irrigates (uses saline to clean) the surgical site to ensure there are no extra bits of bone or tissue. They then close the wound using sutures.

Is sacroiliac joint fusion surgery covered by insurance or Medicare?

Medicare usually covers sacroiliac joint fusion surgery, and the Medicare code for this surgery is 27279. Insurance companies also usually cover this surgery, but you may need to be pre-certified before having the surgery. The cost to the patient of this surgery usually depends on where the surgeon performs it.

If the surgery is performed at an ambulatory surgery center, the patient will typically pay $2,769 under Medicare. If the surgery is in the hospital's outpatient department, the patient usually pays $1,661. However, your costs may vary depending on your location, medical needs, and surgeon fees.

Efficacy and outlook after a sacroiliac joint fusion

Sacroiliac joint fusion seems to be more effective in some people and less effective in others. The surgery seems to be most effective in

  • older adults who have had back pain symptoms for a significant amount of time

  • patients who haven’t had spine surgery before

The surgery seems to be less effective in

  • those who take opioids (pain medication) most of the time

  • those who smoke

  • those who’ve undergone previous spinal fusion

A doctor will carefully study your symptoms to determine the likelihood the surgery will relieve your discomfort. While you may not experience complete pain relief after sacroiliac joint fusion surgery, people typically experience significant pain relief lasting 5 years or more.