Question: I have had previous trauma to my hip and sacrum... Is it time for sacroiliac fusion surgery?

I have had previous trauma to my hip and sacrum, including fracture to my sacrum. Every form of treatment has been ineffective or lasts only hours or days. I have tried chiropractic, injections (3 of them, which helped for awhile), pain medications and physical therapy exercises. From what I can tell, sacroiliac fusion surgery is a last resort, but I don’t know what other options I would have. Are there special indications for this fusion surgery? What can you tell me to help me decide?

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Doctor’s Response: Sacroiliac fusion surgery is your most probable next option

It is sounding as though you do have sacroiliac joint dysfunction. The fact that the injections gave you significant temporary relief, as long as they were done under image from a qualified professional, this is the mechanism by which the diagnosis needs to be made before surgery. It sounds like you have exhausted all the conservative treatment measures up to the point of surgery.

There are alternative therapies that can be tried prior to having a fusion. These are treatments, which have been tried in the past, but which have not achieved a success rate that could elevate them to standard treatment. Of these alternative treatments, the most common is prolotherapy and radiofrequency ablation. Prolotherapy is where a glucose or sugar solution is injected into the connective tissue, posteriorly, that supports the sacroiliac joint and its attachment from the pelvis to the sacrum. The glucose or sugar solution causes irritation and inflammation, which then causes the collagen fibers in the connective tissue to shrink. This is what theoretically then stabilizes the joint. Radiofrequency ablation is injecting the same area of connective tissue, to literally destroy the sensory nerves that come from the dorsal foramina of the sacrum and go down into the sacroiliac joint to feed it and give it sensation.

Both of these alternative treatments have been used extensively, but have rendered overall few successes. It is sounding like, other than those two treatments, in my mind, a fusion surgery is your most probable next option, should you decide to go for a definitive treatment.

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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.