Sacroiliac Joint Inflammation After Fusion
Doctor Advice

Sacroiliac Joint Inflammation After Fusion

Question: I have heard sacroiliac joint inflammation can happen after fusion surgery…What causes this and what can I do to prevent this?

I have heard Sacroiliac joint inflammation can happen after fusion surgery, what causes this? More importantly, what can I do to prevent this? I don’t want to go through the ordeal of my upcoming fusion to get rid of my sciatica from my spondy only to get new sciatica from sacroiliitis! So really I guess there are two questions. 1. What can my orthopedic surgeon do during the fusion to help prevent sacroiliac joint pain down the line, and 2. What can/should I do after the surgery to avoid developing SI joint pain and new sciatica? Thanks for your help!!!

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Doctor’s Response: The primary reason sacroiliac joint inflammation or dysfunction occurs after fusion surgery of the lower lumbar spine is due to the increased stresses that cross the sacroiliac joint.

The primary reason sacroiliac joint inflammation or dysfunction occurs after fusion surgery of the lower lumbar spine is due to the increased stresses that cross the sacroiliac joint after a lumbosacral fusion. It is thought that the longer the fusion the greater the stress, although this needs to be proven.

Also, what needs to be proven is that if instrumentation is used in the lumbosacral fusion, it is also thought that this further increases the stress across the sacroiliac joint. The other consideration is that the sacroiliac joint could have the same pathology that the lumbar spine had, but just was not fused at the same time the lumbosacral spine was fused.

So, your orthopedic surgeon, prior to your surgery for fusing the lumbosacral spine, could order an injection under image with a Novocain solution and a cortisone solution into the sacroiliac joint to: 1) prove that this is or is not a pain generator, and 2) try to offer it some relief with the injection.

If the sacroiliac joint is an active pain generator, then the options are to go ahead and fuse the lumbosacral spine for the pathology that warrants it and see what happens with the sacroiliac joint after the fusion, or to fuse the sacroiliac joint at the same time the lumbosacral spine is fused. This is not considered standard treatment at this time; and, if you do a literature search, you will most likely find no cases similar to that. In my practice, we do fuse the sacroiliac joint occasionally at the same time as the lumbar spine, based on our extensive experience with finding pathology in both sites, and having followed literally hundreds of patients postoperatively.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.