Do I Need SI Joint Stabilization? How To Tell If You’re a Candidate

If you are experiencing pain in your lower back, buttocks, or legs, you may have a problem with your sacroiliac joint (SI joint). This condition can be difficult to diagnose, but the good news is that minimally invasive SI joint stabilization surgery can provide lasting relief. Here we will help you understand more about the sacroiliac joint, how to tell if you might need SI joint stabilization, and what treatment options could improve your symptoms.

What is the SI Joint?

The sacroiliac (SI) joint connects the hip bones to the sacrum (the triangle-shaped bone at the base of your spine). This joint is what allows your pelvis to move and rotate, and it absorbs the shock between your pelvis and upper body. The SI joint is held together by a network of muscles, ligaments, and tendons that assist with shock absorption and minimize movement of the joint.

What Causes the SI Joint to Destabilize?

The SI joint can become unstable for a variety of reasons. Scoliosis or discrepancies between leg lengths can lead to an uneven gait, which over time may wear down the SI joint. In women, pelvic changes during pregnancy and childbirth (such as loosening ligaments) may destabilize the SI joint. Trauma or injury to the area, especially because of contact sports, heavy lifting, strenuous physical labor, and/or prolonged sitting or standing can cause the muscles and ligaments around the SI joint to stretch or tear, leading to instability. Arthritis, inflammation, and a previous history of lower back surgery can also lead to SI joint dysfunction.

What are the Symptoms of SI Joint Dysfunction?

The most common symptom of SI joint dysfunction is lower back pain, typically limited to one side. The pain may be mild or severe, dull or sharp, and it may radiate down into the buttocks, hips, groin, or legs. Some people also experience numbness, tingling, or weakness in the legs, as well as stiffness that reduces motion in the lower back, hip, and groin area. Excess movement is a sign of instability and may worsen pain. The pain may also worsen when lying on one side, climbing stairs, or running. You may feel as though your pelvis will buckle when you are standing, walking, or switching between standing and sitting.

How Do I Know If I Need SI Joint Stabilization?

Determining whether you need SI joint stabilization starts with an accurate diagnosis. It is difficult to correctly diagnose SI joint problems because many of the symptoms can also be caused by a herniated/degenerative lumbar disc, hip arthritis, or other conditions. At least 3 of the following tests (including an SI injection) will be used to diagnose:

  • Physical examination with medical history (symptom evaluation with a history of recent activities and any injuries)
  • Diagnostic imaging tests (MRI scans, CT scans, X-rays) to rule out other plausible causes
  • SI injection: injecting a numbing solution into the SI joint to determine whether it is the source of the pain
  • Sacral thrust test: Applying pressure to the back of the hips while lying face down, to see if it produces pain
  • Distraction test: Applying pressure to the front of the hips while lying face up, to see if it produces pain
  • FABER test: While lying face up, applying pressure to the SI joint while performing various movements to see if it produces pain or indicates limited mobility
  • Palpitation test: Applying deep thumb pressure across the SI joint on each side to see if it produces tenderness

Are There Nonsurgical Treatment Options for SI Joint Pain?

There are a few nonsurgical treatment options that may help to alleviate SI joint pain. A combination of the following treatments should be tried for at least 6 to 12 weeks before surgery is considered.

  • Rest for 1 to 2 days
  • Apply ice and heat to the lower back and SI joint area
  • Pain medications (including over-the-counter pain relievers, anti-inflammatory medications, and prescription pain medications for those with severe pain)
  • Physical therapy to facilitate normal motion and relieve pain (including stretching, strengthening exercises, and aerobic exercises to correct mobility/hypermobility issues)
  • Pelvic brace (for SI joint pain caused by hypermobility)
  • Anti-inflammatory and steroid SI injections

Am I a Candidate for SI Joint Stabilization Surgery?

If you’ve been diagnosed with SI joint dysfunction and you have tried nonsurgical treatments for a minimum of 6 to 12 weeks without success, you may be a candidate for surgery. Your doctor will consider your age, activity level, and the severity of your pain when making a recommendation for surgery.

About SI Joint Stabilization Surgery

Minimally invasive SI joint stabilization can stabilize your SI joint and reduce your symptoms. With the patient under general anesthesia, the surgeon will make a small incision near the posterior superior iliac crest. Real-time CT scans will provide advanced image guidance to allow the surgeon to operate around the muscle instead of having to cut the muscle. The surgeon will drill small holes into the bone and insert a low-profile implant and bone graft, which stabilize the SI joint and encourage new bone growth. The incisions will then be closed, and most patients can return home the same day.

Minimally invasive SI joint stabilization offers several advantages over traditional open surgery. As a minimally invasive surgery, this technique has fewer risks. The CT image guidance during the procedure results in less trauma to the tissues, leading to a quicker and easier recovery. It also allows the surgeon to be very precise, which yields superior results.

If you think you may have problems with your sacroiliac joint, schedule an appointment with an orthopedic surgeon. Dr. Stephen Pehler is a board-certified, fellowship-trained, Denver-based orthopedic spine surgeon with combined training in orthopedics and neurosurgery, offering the best treatment options and outcomes for his patients. He would be happy to help you understand this condition and whether minimally invasive SI joint stabilization surgery is the right choice for you.  

To book your appointment with Dr. Pehler, call 303-695-6060 or fill out our online contact form today.