What is a SI joint fusion?
Sacroiliac joint: the joint formed by the connection of the two bones in the pelvis, the sacrum and ilium.
Fusion: process of stopping motion between two bones to improve stability
So, a SI joint fusion is a minimally invasive spinal fusion that fuses the sacrum and ilium bones to prevent abnormal movement between these bones.
Performing the Fusion
- Using x-ray fluoroscopy for guidance, Dr. Webb will insert a small metal pin through the side of your pelvis.
- A special instrument called a broach will be used to enlarge this hole made in the ilium and this pin will then pass into your 2nd bone, the sacrum.
- A metal implant is then inserted over this pin and placed in the appropriate position, crossing the two bones (sacrum and ilium, hence SI) that will be fused.
- This process is repeated for a total of 3 implants that will be inserted
- 3 implants are used to provide rotational stability of the spine.
- The entire procedure takes less than an hour and is done through a very small incision, with no soft tissue stripping.
The Procedure
Infection
Very low risk (<1%) but this risk is increased if you are overweight, immunosuppressed, on chronic steroids, or diabetic. Antibiotics will be given before surgery starts and also given for 24 hours after surgery while you are in the hospital to decrease the risk of infection.
Bleeding
Very low risk, but increased if you are taking blood thinners, fish oil, herbal medications or have a clotting disorder. These medications will need to be stopped before surgery.
Sometimes, a special tube called a drain will be placed during surgery. This tube is to collect any blood or fluids that can collect after surgery. This drain will be removed before you leave the hospital, usually the next day after surgery.
Spinal cord or Nerve damage
Low risk. A neuromonitoring technician is a professional trained in the monitoring of your nerves and spinal cord. This person (along with a Neurologist) is part of the team that will be taking care of you during surgery and will help Dr. Webb monitor your nerves and spinal cord throughout the procedure. You will be able to meet this person the morning of surgery and ask any questions about their role in your care. Generally, after you are asleep from anesthesia, this technician will place small wires on your legs and arms so that the nerves and spinal cord and be monitored during surgery.
How is this minimally invasive SI joint fusion different from the more traditional open SI joint fusion?
This procedure uses a smaller and more minimally invasive incision size and causes less muscle damage. No muscles are cut, they are moved to the side and allowed to fall back into place after the procedure is done.
What is the recovery?
Patient generally stay in the hospital for <23 hours and can usually resume light activities within six weeks following surgery. Walking is highly encouraged and allowed the same day of surgery or the next morning. Fusion of the two bones (sacrum and ilium) generally takes 3 months to grow together so that they don’t move.
Closure
- The retractors that held the muscles apart will now be removed and will be allowed to fall back into their normal position.
- Dr. Webb uses absorbable sutures to close your wound. These sutures do not typically need to be removed and will absorb on their own.
Frequently asked questions
What to expect after Surgery?
After surgery you will be transferred to the recovery room, also called the PACU (post anesthesia care unit). After you have awaken from the anesthesia, you will then be transferred to your hospital room. This is typically when your family members can visit you.
Either the same day or the following morning after surgery, a physical and/or occupational therapist will begin your therapy. During your hospital stay, you will be given medications to help with pain and IV antibiotics to minimize the risk of infection. Most patients go home the same day of surgery but some patients may spend 1-2 nights in the hospital and are discharged home after:
- You are tolerating a diet
- Your pain is controlled
- After you have worked with and passed physical therapy.
Walking after surgery is highly encouraged, even the same day of surgery!
What kind of recovery can you expect after surgery?
Recovery from a SI joint fusion generally takes 12 weeks, but patients continue to heal for up to a year after surgery. This is because the bones have to fuse together which takes around 3 months. Every patient is different.
When can I return to work and/or activities?
Walking is highly encouraged, immediately after surgery and throughout your postoperative period. Most patients can return to a light desk job or household activities by 2-3 weeks after surgery. Patients with jobs that require heavy lifting, strenuous labor, or high impact activities such as running, biking, skiing, sports will not be allowed to return until Dr. Webb clears you, usually around 8-12 weeks.
What complications should I be aware of?
There are risks to any surgery that you should be aware of:
Inadequate relief of symptoms
Dr. Webb is very particular about making sure we target the right area of your spine that may be causing your symptoms. If the SI joint is the cause of your symptoms, then a SI joint fusion may recommend. If your pain is coming from another part of your spine (rather than the SI joint) then, surgery may not provide relief. Injections are confirmatory and are very predictive of how well you will do with surgery. These SI joint injections, usually done before surgery in the conservative treatment period, are essential in confirming the SI joint as the source of your pain.
Nerve damage, causing leg weakness or pain
There are small nerves that control the muscles in your legs and foot that are close to where Dr. Webb will be working. Dr. Webb carefully works around these nerves and ensures they are not damaged during surgery. If these nerves become irritated during surgery (sometimes just by touching or moving them), these nerves may cause pain for weeks to months after surgery until the nerve recovers. During this time, Dr. Webb may prescribe you nerve medication or steroids to help calm the inflammation down.
Infection
Very low risk (<1%) but this risk is increased if you are overweight, immunosuppressed, on chronic steroids, or diabetic. Antibiotics will be given before surgery starts and also given for 24 hours after surgery while you are in the hospital to decrease the risk of infection.
Bleeding
Very low risk, but increased if you are taking blood thinners, fish oil, herbal medications or have a clotting disorder. These medications will need to be stopped before surgery.
Sometimes, a special tube called a drain will be placed during surgery. This tube is to collect any blood or fluids that can collect after surgery. This drain will be removed before you leave the hospital, usually the next day after surgery.
Spinal cord or Nerve damage
Low risk. A neuromonitoring technician is a professional trained in the monitoring of your nerves and spinal cord. This person (along with a Neurologist) is part of the team that will be taking care of you during surgery and will help Dr. Webb monitor your nerves and spinal cord throughout the procedure. You will be able to meet this person the morning of surgery and ask any questions about their role in your care. Generally, after you are asleep from anesthesia, this technician will place small wires on your legs and arms so that the nerves and spinal cord and be monitored during surgery.
How is this minimally invasive SI joint fusion different from the more traditional open SI joint fusion?
This procedure uses a smaller and more minimally invasive incision size and causes less muscle damage. No muscles are cut, they are moved to the side and allowed to fall back into place after the procedure is done.
What is the recovery?
Patient generally stay in the hospital for <23 hours and can usually resume light activities within six weeks following surgery. Walking is highly encouraged and allowed the same day of surgery or the next morning. Fusion of the two bones (sacrum and ilium) generally takes 3 months to grow together so that they don’t move.
How long will the surgery take?
The length of the surgery varies depending on each individual patient’s circumstances and spinal complexity. Dr. Webb will take however long it takes to complete the surgery in the safest and most efficient manner, but generally takes anywhere between 1-2 hours.
Will I be in a lot of pain after surgery?
Everyone responds to pain differently depending on their tolerance for pain, prior pain medication usage, and other factors to include how quickly or slowly your body metabolizes the medication in your liver or kidneys. Most patients tend to be sore at the incisional site from surgery, but their pain is manageable with IV and oral pain medications. After surgery, you will be able to receive oral pain medications every 4-6 hours supplemented by IV medication for breakthrough pain. At discharge, you will be given a prescription for oral pain medication, a muscle relaxant, and a stool softener. Please make sure to include a laxative, as your oral pain medications can make you constipated at times.
Can I walk after surgery?
Yes, Dr. Webb encourages walking as soon as you wake up from anesthesia. The more you walk, the better. While in the hospital, a physical therapist will work with you and teach you how to walk, get in and out of bed, to and from the bathroom.
What restrictions will I need to abide by after surgery?
In general, we recommend you follow the “No BLT” (bending, lifting >10 pounds, or twisting) protocol for 6 weeks following surgery. If you do have to lift an object, following proper lifting mechanics is essential.
Can I remove my dressing after surgery?
Dr. Webb prefers that you keep any and all dressings on until he sees you back in the clinic, which is usually 2 weeks after surgery. Your wound will be closed typically with absorbable sutures that do not need to be removed and will absorb on their own. At times, dressings can have some “strikethrough” meaning you can see speckles of either blood or fluid through the dressing which is considered normal after surgery (especially the more you get up and move around). Most wounds take about 10-14 days to heal and fully close. Keeping your dressing in place for during this time ensures that your wound is not introduced to the outside world and minimizes your chance of infection. If your dressing becomes saturated, please reinforce this dressing and/or call our office.
Can I get my dressing wet after surgery?
Activities such as bathing, swimming, and hot-tubs should be avoided after surgery until you are given the clearance by Dr. Webb. This is usually after your wound is healed. Showers are usually allowed right after surgery depending on which dressing is used to protect your incision after surgery.
Can I drive or fly after surgery?
Driving after surgery is allowed once you are off all narcotics. Dr. Webb recommends that you start back driving by starting in an empty parking lot to ensure your braking time has returned. You can be a passenger in a car or fly immediately after surgery. If you are driving or flying long distances, Dr. Webb recommends that you stop and get up every 30 mins to pump your calves and walk around. Having surgery places you at risk for blood clots. This is to ensure that you do not get a blood clot.
When can I resume my home medications after surgery?
Generally, any heart and blood pressure medications are continued throughout the surgical period. There are a certain number of immunosuppressive medications that must be stopped 1-2 weeks prior to surgery and restarted 1-2 weeks after. Blood thinners are usually held a few days before and restarted a few days after surgery. A discussion with your treating physician may help answer some of these questions.
How long will I stay in the hospital after surgery?
Very few patients may be candidates to go home the same day of surgery. Most patients undergo what is called “same day surgery” meaning they will be in the hospital for 23 hours or less. Some patients require an additional 1-2 days in the hospital for logistical, pain, or medical reasons.
Will I need physical therapy one discharged from the hospital?
Physical therapy is important to “rehab” you back to your pre-surgery state. Our physical therapists will begin working with you in the hospital either the same day of surgery or the following morning. You may be given a prescription for outpatient physical therapy or home physical therapy, usually started after your incisions have healed and x-rays show stability of your implants.
Still have questions or concerns, contact us today. We’d be happy to answer them!
The Procedure
Infection
Very low risk (<1%) but this risk is increased if you are overweight, immunosuppressed, on chronic steroids, or diabetic. Antibiotics will be given before surgery starts and also given for 24 hours after surgery while you are in the hospital to decrease the risk of infection.
Bleeding
Very low risk, but increased if you are taking blood thinners, fish oil, herbal medications or have a clotting disorder. These medications will need to be stopped before surgery.
Sometimes, a special tube called a drain will be placed during surgery. This tube is to collect any blood or fluids that can collect after surgery. This drain will be removed before you leave the hospital, usually the next day after surgery.
Spinal cord or Nerve damage
Low risk. A neuromonitoring technician is a professional trained in the monitoring of your nerves and spinal cord. This person (along with a Neurologist) is part of the team that will be taking care of you during surgery and will help Dr. Webb monitor your nerves and spinal cord throughout the procedure. You will be able to meet this person the morning of surgery and ask any questions about their role in your care. Generally, after you are asleep from anesthesia, this technician will place small wires on your legs and arms so that the nerves and spinal cord and be monitored during surgery.
How is this minimally invasive SI joint fusion different from the more traditional open SI joint fusion?
This procedure uses a smaller and more minimally invasive incision size and causes less muscle damage. No muscles are cut, they are moved to the side and allowed to fall back into place after the procedure is done.
What is the recovery?
Patient generally stay in the hospital for <23 hours and can usually resume light activities within six weeks following surgery. Walking is highly encouraged and allowed the same day of surgery or the next morning. Fusion of the two bones (sacrum and ilium) generally takes 3 months to grow together so that they don’t move.
How long will the surgery take?
The length of the surgery varies depending on each individual patient’s circumstances and spinal complexity. Dr. Webb will take however long it takes to complete the surgery in the safest and most efficient manner, but generally takes anywhere between 1-2 hours.
Will I be in a lot of pain after surgery?
Everyone responds to pain differently depending on their tolerance for pain, prior pain medication usage, and other factors to include how quickly or slowly your body metabolizes the medication in your liver or kidneys. Most patients tend to be sore at the incisional site from surgery, but their pain is manageable with IV and oral pain medications. After surgery, you will be able to receive oral pain medications every 4-6 hours supplemented by IV medication for breakthrough pain. At discharge, you will be given a prescription for oral pain medication, a muscle relaxant, and a stool softener. Please make sure to include a laxative, as your oral pain medications can make you constipated at times.
Can I walk after surgery?
Yes, Dr. Webb encourages walking as soon as you wake up from anesthesia. The more you walk, the better. While in the hospital, a physical therapist will work with you and teach you how to walk, get in and out of bed, to and from the bathroom.
What restrictions will I need to abide by after surgery?
In general, we recommend you follow the “No BLT” (bending, lifting >10 pounds, or twisting) protocol for 6 weeks following surgery. If you do have to lift an object, following proper lifting mechanics is essential.
Can I remove my dressing after surgery?
Dr. Webb prefers that you keep any and all dressings on until he sees you back in the clinic, which is usually 2 weeks after surgery. Your wound will be closed typically with absorbable sutures that do not need to be removed and will absorb on their own. At times, dressings can have some “strikethrough” meaning you can see speckles of either blood or fluid through the dressing which is considered normal after surgery (especially the more you get up and move around). Most wounds take about 10-14 days to heal and fully close. Keeping your dressing in place for during this time ensures that your wound is not introduced to the outside world and minimizes your chance of infection. If your dressing becomes saturated, please reinforce this dressing and/or call our office.
Can I get my dressing wet after surgery?
Activities such as bathing, swimming, and hot-tubs should be avoided after surgery until you are given the clearance by Dr. Webb. This is usually after your wound is healed. Showers are usually allowed right after surgery depending on which dressing is used to protect your incision after surgery.
Can I drive or fly after surgery?
Driving after surgery is allowed once you are off all narcotics. Dr. Webb recommends that you start back driving by starting in an empty parking lot to ensure your braking time has returned. You can be a passenger in a car or fly immediately after surgery. If you are driving or flying long distances, Dr. Webb recommends that you stop and get up every 30 mins to pump your calves and walk around. Having surgery places you at risk for blood clots. This is to ensure that you do not get a blood clot.
When can I resume my home medications after surgery?
Generally, any heart and blood pressure medications are continued throughout the surgical period. There are a certain number of immunosuppressive medications that must be stopped 1-2 weeks prior to surgery and restarted 1-2 weeks after. Blood thinners are usually held a few days before and restarted a few days after surgery. A discussion with your treating physician may help answer some of these questions.
How long will I stay in the hospital after surgery?
Very few patients may be candidates to go home the same day of surgery. Most patients undergo what is called “same day surgery” meaning they will be in the hospital for 23 hours or less. Some patients require an additional 1-2 days in the hospital for logistical, pain, or medical reasons.
Will I need physical therapy one discharged from the hospital?
Physical therapy is important to “rehab” you back to your pre-surgery state. Our physical therapists will begin working with you in the hospital either the same day of surgery or the following morning. You may be given a prescription for outpatient physical therapy or home physical therapy, usually started after your incisions have healed and x-rays show stability of your implants.
Still have questions or concerns, contact us today. We’d be happy to answer them!