Vicki Sims, PT, CHT
Gainesville Physical Therapy
1296 Sims Street, Suite A
Gainesville, GA 30501
Phone: 770.297.1700
sijd@gainesvillept.com
www.gainesvillept.com
David Mesnick, PT, cMDT
Body Mechanics Physical Therapy
550 Peachtree Street, Suite 1760
Atlanta, Georgia 30308
Phone: 404.817.0734
dmesnick@bodymechanicsatl.com
www.bodymechanicsatl.com
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SIJD Surgical Interventions
Technique of Sacroiliac Joint Stabilization
Injuries to the sacroiliac joint can be intra-articular (fracture or "sacroilitis") or extra-articular (ligamentous). The
primary lesion that we are discussing is concerning extra-articular ligament disruption with subsequent destabilization of the sacroiliac
joint. These lesions cannot be demonstrated with normal imaging studies. The diagnosis is made purely with clinical means based
on thorough knowledge of manual medicine. Various techniques have already been discussed concerning the treatment of extra-articular
sacroiliac joint destabilization via physical therapy means. If these fail, more drastic measures must be taken. Sacroiliac joint surgery
is drastic if it is done incorrectly. The major cause of the failure of surgery is the failure of the surgeon to understand
the presence of secondary pain generators that also need to be treated. Stabilization of the joint by reinforcing these ligaments is most important
if there is evidence of SI joint injury. It is esstential that the joint be fixed in its normal anatomic
position or pain will continue. Thus a thorough knowledge of manual techniques is required for anyone contemplating doing
sacroiliac surgery. The joint must be aligned before surgery for optimal outcomes.
The Surgery: A Brief Description
Fixation: To stabilization the sacroiliac joint, cannulated screws will be placed through the ilium and sacrum.
The cannulated screws that your physician will use for stabilization are approved by the U.S. Food and Drug Administration
(FDA) for fixation of fractures of large bones. It is inferred from this that they are solid enough for sacroiliac stabilization
for which they are commonly used.
Fusion: Fusion between the sacrum and the ilium may also be necessary. This is done by scraping the bone on both sides and placing
a graft taken from the iliac crest at the surgical site between the two sides. Artificial graft can also be used. If your physician determines
that a fusion is not necessary in your case, the joint will be fixed in place using only the screws.
SI FIXATION with Implants: to stabilize the sacroiliac joint, cannulated screws will be placed through the ilium and sacrum. The
cannulated screws that your physician will use for stabilization are approved by the U.S. Food and Drug Administration (FDA) for
fixation of fractures of large bones. It is inferred from this that they are solid enough for sacroiliac stabilization for which
they are commonly used.
SI FIXATION LEADING TO FUSION with ifuse Implants: iFUSE Implant System by SI-BONE: TRIANGULAR SHAPED IMPLANT RODS are titanium
devices which are coated with a porous plasma spray. It is an SI Fixation procedure which leads to SI Fusion.
SI (Traditional, open back) FUSION: between the sacrum and the ilium fusion may also be necessary. This is done by scraping the bone on
both sides and placing a graft taken from the iliac crest at the surgical site between the two sides. Artifical graft can also be used.
If your physician determines that a fusion is not necessary in your case, the joint will be fixed in place using only the screws.
PIRIFORMIS SURGERY: often inflamed or swollen as a result of SIJD. Amond other symptoms, the Piriformis Muscle can irritate the sciatic
nerve causing radiating leg pain and butt pain.
CRITERIA FOR SURGICAL STABILIZATION OF THE SACROILIAC JOINTS commonly include the following (by Alan Lippitt, MD):
1. Pain must be diabling.
2. Pain must be localized to the SIJ and not relieved by conservative modalities.
3. Pain should be relieved on a transient basis by a fluoroscopically controlled SIJ block.
4. Other causes of lumbopelvic pain such as herniated nucleus pulposus, facet arthropathy, trapped nerve
root, spinal stenosis, hip disorders, etc. should be ruled out.
5. Associated conditions must be treated in conjunction with, or after treating the SIJ dysfunction.
Vicki Sims, PT, CHT
David Mesnick, PT, cMDT
