The sacroiliac joint, located where the lower part of the spine meets the pelvis, is a common source of lower back pain. When the sacroiliac joint becomes damaged or inflamed due to arthritis, injury or other causes, it can lead to chronic pain. Sacroiliac joint fusion is a surgical procedure that fuses or joins the sacrum and ilium bones of the pelvis together, eliminating motion at the joint to relieve pain.
Anatomy of the Sacroiliac Joint
The Sacroiliac Joints is a synovial joint that is comprised of the sacrum of the spine fused to the ilium bones of the pelvis. Unlike other joints in the body, the sacroiliac joint has very little hyaline cartilage and instead relies on fibrous connective tissue to allow for a small amount of movement. Ligaments provide stability to the joint while muscles like the piriformis and gluteus maximus act on the pelvis and sacrum influencing movement. Any injury or degeneration of the joint tissues can lead to sacroiliac joint dysfunction and pain.
Causes of Sacroiliac Joint Dysfunction
Common causes of sacroiliac joint problems include direct trauma from a fall, repetitive stress injuries from activities like running, and degenerative changes from arthritis. Women are more prone to sacroiliac joint issues due to changes in hormone levels during and after pregnancy which can cause joint laxity. Aging can also take a toll on the fibrous connective tissues leading to degeneration and inflammation of the joint. In some cases, the exact cause may be unclear and could be due to a combination of factors over time contributing to sacroiliac joint dysfunction.
Determining If Surgery Is Needed
Before undergoing sacroiliac joint fusion surgery, most surgeons will first try nonsurgical treatments like physical therapy, chiropractic manipulation, steroid injections and pain medications. If conservative measures fail to alleviate pain over 6-12 months, imaging tests like X-rays, CT scans and bone scans are done to determine if the sacroiliac joint is the source of pain. Diagnostic sacroiliac joint blocks using local anesthesia can help identify if fusing the joint will effectively treat the underlying cause of pain. Only when all these diagnostic tests clearly point to the sacroiliac joint as the source will fusion surgery be recommended.
Surgical Technique For Sacroiliac Joint Fusion
Sacroiliac joint fusion surgery is typically performed as an outpatient procedure under general or regional anesthesia. Using microscopes and imaging guidance, the surgeon will first prepare the joint surfaces by removing any damaged cartilage or bone. Then various graft materials like bone grafts, metal implants or screws are used to fuse the joint and stop any motion. The goal is to achieve a solid fusion and heal the joint as one fixed piece of bone. In most cases, a minimally invasive surgical approach is utilized requiring only small incisions of 1-2 inches. External fixation devices may be applied temporarily to immobilize the joint during healing. Recovery is usually within 4-6 months as the bones fuse together.
Outcomes And Long Term Prognosis
Studies show that sacroiliac joint fusion effectively relieves pain and improves function in over 80% of patients when performed for appropriate diagnoses. About 15-20% may continue having some residual pain. Full fusion of the joint and permanent elimination of motion usually occurs within 6 months to 2 years as the graft materials integrate and turn to bone. Long term follow up has demonstrated lasting pain relief for 5-10 years or more in most patients. Complications from the surgery are quite low but may include infection, neurological injury, non-union of the joint and hardware issues. Overall sacroiliac joint fusion is considered a low risk and highly successful procedure when utilized judiciously for well selected sacroiliac joint pain patients.
Global Rise In Sacroiliac Joint Fusion Surgeries
With an aging population and rising cases of spinal arthritis worldwide, sacroiliac joint problems and the need for fusion surgery is expected to significantly increase globally over the next two decades. According to recent estimates by leading orthopedic organizations, over 500,000 sacroiliac joint fusion procedures are performed annually worldwide with numbers growing at 10-15% each year. The U.S currently leads performing over 150,000 fusions yearly followed by Western European countries, Japan, Australia and Canada. Emerging markets like China, India, Brazil and Mexico are also rapidly scaling up capacity to meet the rising joint disorder burden. Leading medical device companies have responded by developing new minimally invasive fusion implant technologies to simplify procedures and help more surgeons address this patient segment globally. With ongoing research into alternative joint preservation methods as well, sacroiliac joint care is advancing to serve patients suffering from chronic lower back issues linked to this important spinal Biomechanical component.
Outlook For The Future
As the world population ages and risk factors for sacroiliac joint disorders multiply, sacroiliac joint fusion surgery is expected to remain an important treatment option for effectively managing debilitating sacral/pelvis pain over the next decade and beyond. Surgeons continue refining surgical techniques to minimize invasiveness while industry focuses on developing new generation bone graft substitutes, implant designs and navigation tools to optimize fusion outcomes. Non-fusion therapies like arthrodesis, denervation and joint distraction also show promise based on ongoing clinical trials. With appropriate patient selection criteria followed, sacroiliac joint fusion surgery will likely retain its efficacy and safety profile as the gold standard when more conservative therapies fail to alleviate symptoms. Overall, an evolving multi-disciplinary approach combining surgical and non-surgical joint stabilization options tailored for each individual promises to enhance sacroiliac pain management on a global scale in the future.
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- Source: CoherentMI, Public sources, Desk research
- We have leveraged AI tools to mine information and compile it
