 |
When sacroiliac dysfunction does not respond to conservative treatment, including physical therapy, injections and possibly prolotherapy, sacroiliac surgery may be indicated. |
The amount of surgery deemed necessary is determined by our team during the preoperative evaluation. All surgeries are done under general anesthesia and patients are placed face down for the procedure.
| Before the surgery, we will align the sacroiliac joints and the pelvic girdle. We believe this alignment to help better healing. Most surgeons do not bother to do it. |
|
This is again verified once the patient is under anesthesia and positioned. We believe in aligning the joints as well as we can before fixating and fusing them.
The surgery can as simple as percutaneous screw fixation on only one side, where 2 cannulated titanium bone screws are placed across the joint using XRs and guiding pins, straight through the skin, using tiny incisions (about ¼ inch). The nerves and nerve roots are monitored with electricity during the surgery to minimize the chance of injury or irritation. This usually takes about 30 to 45 minutes on the average. Patients can go home on the day of surgery. This relatively simple procedure is reserved for the easiest cases.
The next step is to place screws on both sides. This stabilizes the pelvic girdle further when there
is pain on both sides
. Usually, the painful side is fused, using the patient's own bone (harvested at the surgical site) and also artificial bone. When the patient is at higher risk for poor bone fusion (for example where there is a strong history of smoking), "bone morphogenic protein" (BMP) may be used. It is a new chemical that improves the chance of bone fusion but is extremely expensive and we usually use it only if indicated. The screw fixation on both sides with a one sided fusion is, by large, the most frequent scenario. The surgery takes a couple of hours and an extra incision, usually 2.5 to 3 inches long, for the fusion. The incisions for the screws are usually ¼ to 1/3 of an inch. The hospitalization is from 2 to 3 days.
| The wounds are usually closed with deep dissolvable stitches and skin glue to try to obtain a better looking scar. The advantage is that the wounds can be cleaned with soap and water (actually, this is the only things that must be used to clean them) and that the patient may take showers. |
|
We discourage soaking the wounds in the bathtub until they are fully healed (this usually takes a couple of weeks) to minimize the chance of infection.
More rarely, we might also fuse both sacroiliac joints. This is reserved for those who have bilateral problems with severe loosening of the ligaments. This adds to the surgery (about 1 more hour) but not to the hospitalization.
Concomitant piriformis surgery adds another 45 minutes to the procedure in general and often, an extra day of hospitalization. Please check the link titled "Piriformis Surgery" for more details.
