Minimally Invasive SIJ Fusion

What is Minimally Invasive SIJ Fusion? 

Minimally Invasive Sacroiliac Joint (SIJ) Fusion is a surgical procedure used to treat pain and dysfunction in the sacroiliac joint. The sacroiliac joints are located at the base of the spine, where the sacrum (the bottom of the spine) connects with the ilium (part of the pelvis). Problems with these joints can cause lower back, hip, groin, or sciatica-like pain.

In a minimally invasive SIJ fusion, small incisions are made at the top of the patient's buttocks, and the surgeon uses these to insert cages that stabilise and fuse the sacroiliac joint, reducing its movement and the associated pain. As this is done using minimally invasive techniques, there is generally less blood loss, less postoperative pain, and a quicker recovery time than traditional open surgery.

Who is Suitable for Minimally Invasive SIJ Fusion?

Minimally Invasive SIJ fusion is usually considered for patients who have:

• Persistent and significant SIJ pain has not improved with non-surgical treatments such as physical therapy, pain medication, or injection therapy.
• Confirmed diagnosis of SIJ dysfunction: This can be diagnosed through patient history, physical examination, and positive response to diagnostic SIJ injections.
• No significant health issues that would prevent surgery or recovery. This would be determined by the patient's healthcare team, considering factors such as overall health, age, and specific medical conditions.

Benefits of Minimally Invasive SIJ Fusion

• Pain relief: One of the primary goals of the procedure is to reduce or eliminate sacroiliac joint pain that has not responded to other treatments.
• Increased Mobility and Function: By stabilising the joint, patients often find improved mobility and can return to activities they enjoyed before their SIJ dysfunction.
• Shorter Hospital Stay: Because the procedure is minimally invasive, the hospital stay is often shorter than traditional open surgery.
• Faster Recovery: The smaller incisions in this procedure usually result in less postoperative pain and faster recovery.
• Less Blood Loss: Minimally invasive procedures typically result in less blood loss than open surgeries.

Alternatives to Minimally Invasive SIJ Fusion

Before considering surgery, non-surgical treatments are usually tried first. These could include:

• Physical Therapy: Specific exercises can help strengthen the muscles that support the SIJ and improve flexibility.
• Pain Medication: Over-the-counter or prescription medications can help manage pain.
• Injections: Steroids or other medications can be injected into the SIJ to reduce inflammation and pain.
• Braces: A tight SIJ brace fitted by a physiotherapist and worn low over the iliac crests can reduce symptoms by stabilising the SIJs.

If these non-surgical treatments are not effective, and surgery is not an option or not desired, some other alternatives could include:

• Radiofrequency Ablation: This procedure uses an electrical current to heat up a small area of nerve tissue to decrease pain signals. This usually lasts up to 6 months.
• Neuromodulation involves implanting a device that delivers electrical signals to the spinal cord to help manage pain.
• Prolotherapy or Platelet-Rich Plasma (PRP) Injections: These regenerative medicine techniques stimulate the body's healing processes but often require repeat treatment. However, these alternative treatments may not be appropriate or effective for all patients, and the best course of treatment should be decided in consultation with a surgeon.

Preparation for Minimally Invasive SIJ Fusion

• Medical Evaluation: Before the surgery, your doctor will likely conduct a thorough medical evaluation to ensure you are healthy enough for the procedure. This might involve blood tests, imaging studies, or other diagnostic tests.
• Discuss Medications: Inform your doctor about any medications you're currently taking. You may need to stop certain medications, especially those that can increase the risk of bleeding, a few days before surgery.
• Stop Smoking: If you smoke, you will be advised to quit as it can interfere with your healing ability after surgery.
• Fasting: You will likely need to fast (no food or drink) for a certain period before your surgery, typically from midnight the night before.
• Arrange Transportation: You'll need someone to drive you home after the procedure as you will be under anaesthesia.

Minimally Invasive SIJ Fusion Procedure

• Anaesthesia: The procedure is usually performed under general anaesthesia, so you'll be asleep and not feel pain.
• Intra-operative imaging: An intra-operative CT is taken to allow guidance during surgery.
• Accessing the Joint: The surgeon makes a small incision in the upper buttock and uses stealth guidance to drill and tap across the SIJ.
• Implant Insertion: Special implants are inserted into the joint. These implants help to stabilise the joint and promote fusion.
• Closing the Incision: Once the implants are in place, the surgeon withdraws the instruments, and the incision is closed with sutures.

Minimally Invasive SIJ Fusion Recovery Plan

• Recovery Room: After surgery, you'll be moved to a recovery room where healthcare professionals will monitor your vital signs as the anaesthesia wears off.
• Pain Management: You may feel pain at the incision site after surgery. You will be given pain medication as needed.
• Physiotherapy: Once your surgeon clears you, you will likely start a physical therapy program to strengthen your back and improve flexibility.
• Follow-Up Appointments: You will have follow-up appointments with your surgeon to monitor your progress and ensure the joint is healing properly.
• Recovery Time: The recovery time can vary depending on the individual, but many patients feel near immediate improvement and can return to normal activities within six weeks, with continued improvement for up to a year.
• Activity Restrictions: After surgery, you'll be advised to avoid activities that strain your back excessively, such as heavy lifting and strenuous exercise.

Minimally Invasive SIJ Fusion Prognosis

The prognosis for minimally invasive SIJ fusion is generally positive, with many patients experiencing significant pain relief and improved function. However, like any medical procedure, success depends on various factors, including the patient's overall health, the severity of the SIJ dysfunction, and compliance with post-surgery instructions and physical therapy.

Minimally Invasive SIJ Fusion Risks

While minimally invasive SIJ fusion is generally considered safe, as with any surgery, there are potential risks. These could include:

• Infection: Although steps are taken to prevent it, there's always a risk of infection with any surgery.
• Bleeding: There's a risk of bleeding during and after surgery.
• Nerve damage: Though rare, there's a chance of nerve damage during surgery.
• Implant problems: There could be problems with the implants used in the procedure, such as malposition, loosening, or breakage.
• No relief or worsening of symptoms: In some cases, the surgery may not provide the expected relief, or symptoms could worsen.

What if Minimally Invasive SIJ Fusion is Delayed?

Delaying the procedure may lead to continued pain and dysfunction in the sacroiliac joint. In some cases, the symptoms worsen over time, affecting the quality of life and the ability to perform daily activities. However, the decision to have surgery should always be made in consultation with your surgeon, weighing the potential benefits against the risks and considering the effectiveness of non-surgical treatments.