Surgery for sacroiliitis is rare and mainly indicated to manage instability of the sacroiliac (SI) joint. Surgical treatment may be considered in select cases when non-surgical methods have been exhausted and the patient's quality of life is significantly impacted.

Watch this Sacroiliac Joint Steroid Injection Video in our Video Center.

A sacroiliac joint injection is designed to diagnose and treat pain and inflammation from sacroiliac joint dysfunction.

Either too much or too little movement in one of the sacroiliac joints, which are located at the bottom of the spine on each side of the sacrum, can cause lower back pain and/or leg pain.

An injection in the sacroiliac joint usually has two goals: to confirm the sacroiliac joint as the source of the pain, and to alleviate that pain.

The procedure begins with the patient lying on his or her stomach. The area around the sacroiliac joint is numbed with an injection of a local anesthetic.

Then, using fluoroscopy dye and X-rays to assist in guiding the injection, a needle is inserted into the sacroiliac joint to deliver medicine directly to the source of pain.

The medication injected into the joint can be a local anesthetic, such as lidocaine or bupivacaine, and may also include an anti-inflammatory medication, such as a corticosteroid. If the local anesthetic provides immediate pain relief, it diagnoses the sacroiliac joint as the source of the patient’s pain.

The anti-inflammatory steroid may relieve pain in the sacroiliac joint over a longer period of time, possibly for weeks or months, allowing the patient to pursue physical therapy.

Patients should carefully review and discuss the potential risks, benefits, and surgical alternatives of SI joint surgery with the physician.

Surgery for Sacroiliitis: Indications

3D rendering of the lower body. Nerves of left leg highlighted in red and pink.

Surgery may be recommended for chronic symptoms of severe pain, stiffness, and limited mobility.

SI joint surgery may be recommended in the following cases:

Chronic pain that is not relieved by non-surgical treatments for at least 6 months ¹ Lorio M, Kube R, Araghi A. International Society for the Advancement of Spine Surgery Policy 2020 Update—Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity. International Journal of Spine Surgery. 2020; 14(6):860-895. http://doi.org/10.14444/7156
Limited function and mobility that significantly impacts daily activities and the patient’s quality of life
Severe sacroiliac joint damage that causes persistent or severe pain, stiffness, and limited mobility ² Fenton DS. Chapter 63 – Sacroiliitis. In: Czervionke LF, Fenton DS, eds. Imaging painful spine disorders. 1st ed. Saunders; 2011:476-481. https://doi.org/10.1016/B978-1-4160-2904-5.00063-X

Surgery may sometimes be necessary due to an acute injury or medical emergency caused by a fall or car accident.

Physicians who perform sacroiliitis surgery

Sacroiliitis surgery is typically performed by an orthopedic surgeon or neurosurgeon specializing in spinal surgeries. These specialists have extensive training and experience in performing surgeries on the spine and the surrounding areas, including the SI joint.

SI Joint Fusion Surgery for Sacroiliitis

Hip and pelvis, with a metal implant connecting the SI joint.

In rare cases, SI joint fusion surgery may be required to better stabilize the SI joint.

SI joint fusion surgery is a minimally invasive surgical treatment for sacroiliitis that is performed under general anesthesia.

The procedure involves removal of the damaged cartilage from the sacroiliac joint surfaces and fusing the two bones.
The fusion can be done using bone grafts or metal implants.
Fusion surgery aims to eliminate the movement in the sacroiliac joint.

SI joint fusion surgery typically has a high success rate, with most patients experiencing significant pain relief and improvement in function. ³ Baronio M, Sadia H, Paolacci S, et al. Etiopathogenesis of sacroiliitis: implication fo r assessment and management. Korean J Pain. 2022;33(4):294-304. http://doi.org/10.3344/kjp.2020.33.4.294 ^, ⁴ Sachs D, Capobianco R. Minimally invasive sacroiliac joint fusion: one-year outcomes in 40 patients. Adv Orthop. 2013;2013:536128. http://doi.org/10.1155/2013/536128

Recovery after SI joint fusion surgery

A hospital stay of 1 to 2 nights may be needed following joint fusion surgery; however, the recovery time may vary depending on the patient's overall health. Typically, SI joint fusion takes about 12 weeks for the bones to fuse, but patients continue to heal for up to a year after surgery. ¹ Lorio M, Kube R, Araghi A. International Society for the Advancement of Spine Surgery Policy 2020 Update—Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity. International Journal of Spine Surgery. 2020; 14(6):860-895. http://doi.org/10.14444/7156

Recovery from SI joint fusion involves a combination of pain medications, physical therapy, and lifestyle modifications to help improve healing. A pelvic brace may be prescribed to stabilize the pelvis and limit painful movements during the initial 12-week period. ¹ Lorio M, Kube R, Araghi A. International Society for the Advancement of Spine Surgery Policy 2020 Update—Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity. International Journal of Spine Surgery. 2020; 14(6):860-895. http://doi.org/10.14444/7156

Read more about Sacroiliac Joint Fusion Recovery

Spinal Cord Stimulator Impact Surgery for Sacroiliitis

3D rendering of a human skeleton, with an electronic device placed over the lower back.

Spinal cord stimulation may provide relief by interfering with pain signals.

Spinal cord stimulation (SCS), also called neurostimulation, is a minimally invasive surgical treatment that helps provide pain relief through the modulation of the nervous system. SCS for sacroiliitis involves surgically implanting a pulse generator device and wired electrodes under the skin in the upper buttock below the hip bone.

The pulse generator generates controlled frequencies of electric current that pass through the electrodes to interfere with pain signals reaching the brain. ⁵ Polsunas PJ, Sowa G, Fritz JM, Gentili A, Morone NE, Raja SN, et al. Deconstructing chronic low back pain in the older adult-step by step evidence and expert-based recommendation for evaluation and treatment: part X: sacroiliac joint syndrome. Pain Med. 2016;17:1638-47. http://doi.org/10.1093/pm/pnw151 ^, ⁶ Chakrabortty S, Jumar S, Gupta D, Rudraraju S. Intractable sacroiliac joint pain treated with peripheral nerve field stimulation. J Anaethesiol Clin Pharmacol. 2016;32:392-4. http://doi.org/10.4103/0970-9185.173336

Watch Spinal Cord Stimulation for Chronic Back Pain Video

Recovery after spinal cord stimulation

A spinal cord stimulator implant surgery is an outpatient procedure, and most patients return home the same day after the treatment. ⁷ Dydyk AM, Tadi P. Spinal Cord Stimulator Implant. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555994/ The average time to resume driving a motor vehicle is about 2 to 3 weeks after the surgery, but may take about 6 weeks to recover and return to an office or sedentary job. ⁸ Simopoulos TT, Rosa H, Wootton J, Eichman DS, Gill JS. A survey of spinal cord stimulator use by chronic pain patients while driving. Neuromodulation: Technology at the Neural Interface. 2016;19(5):487-491. http://doi.org/10.1111/ner.12367

See Recovery After Spinal Cord Stimulator Implant Surgery

Dr. Mary George is an Internist and the Founder and Medical Director of an Illinois-based internal medicine and wellness practice. She practices internal medicine with special focus on obesity medicine and wellness training.

1 Lorio M, Kube R, Araghi A. International Society for the Advancement of Spine Surgery Policy 2020 Update—Minimally Invasive Surgical Sacroiliac Joint Fusion (for Chronic Sacroiliac Joint Pain): Coverage Indications, Limitations, and Medical Necessity. International Journal of Spine Surgery. 2020; 14(6):860-895. http://doi.org/10.14444/7156
2 Fenton DS. Chapter 63 – Sacroiliitis. In: Czervionke LF, Fenton DS, eds. Imaging painful spine disorders. 1st ed. Saunders; 2011:476-481. https://doi.org/10.1016/B978-1-4160-2904-5.00063-X
3 Baronio M, Sadia H, Paolacci S, et al. Etiopathogenesis of sacroiliitis: implication fo r assessment and management. Korean J Pain. 2022;33(4):294-304. http://doi.org/10.3344/kjp.2020.33.4.294
4 Sachs D, Capobianco R. Minimally invasive sacroiliac joint fusion: one-year outcomes in 40 patients. Adv Orthop. 2013;2013:536128. http://doi.org/10.1155/2013/536128
5 Polsunas PJ, Sowa G, Fritz JM, Gentili A, Morone NE, Raja SN, et al. Deconstructing chronic low back pain in the older adult-step by step evidence and expert-based recommendation for evaluation and treatment: part X: sacroiliac joint syndrome. Pain Med. 2016;17:1638-47. http://doi.org/10.1093/pm/pnw151
6 Chakrabortty S, Jumar S, Gupta D, Rudraraju S. Intractable sacroiliac joint pain treated with peripheral nerve field stimulation. J Anaethesiol Clin Pharmacol. 2016;32:392-4. http://doi.org/10.4103/0970-9185.173336
7 Dydyk AM, Tadi P. Spinal Cord Stimulator Implant. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555994/
8 Simopoulos TT, Rosa H, Wootton J, Eichman DS, Gill JS. A survey of spinal cord stimulator use by chronic pain patients while driving. Neuromodulation: Technology at the Neural Interface. 2016;19(5):487-491. http://doi.org/10.1111/ner.12367