Do I Need Surgery for SI Joint Pain?

Medically Reviewed by Tyler Wheeler, MD on December 15, 2021

For most people with sacroiliac (SI) joint pain, medication, physical therapy, and injections are enough to take care of the problem. But if they don’t knock the pain out in 6 months, your doctor may suggest more intense treatment, including surgery.

Sacroiliac Joint Fusion

The SI joint lies between two bones, the sacrum and the ilium. The sacrum is a big, triangle-shaped bone at the base of your spine. The ilium is the big bone in your hip. The SI joint is where the sacrum meets the inside of the ilium. The idea behind SI joint fusion surgery is to join these bones together.

There are two kinds of fusion surgery: minimally invasive and open. Both happen in the hospital, and you’ll get medicine to put you to sleep for either one.

Minimally invasive surgery. Most SI joint fusion surgeries are this kind. The surgeon makes small cuts in your buttocks and uses X-ray scans to see where to go with the surgical tools. Then they drill holes in the sacrum and ilium and puts in implants to make the joint more stable.

The operation usually takes about an hour, and you’ll likely be in the hospital for a day or two to recover. You’ll need crutches for 4 to 6 weeks afterward. It can take up to 6 months to get back to full speed on all of your usual activities.

Open surgery. In this type of operation, the surgeon makes a cut about 7 or 8 inches long and opens up your muscle and tissues to get to the SI joint.

They remove tissue called cartilage from between the sacrum and the ilium. The surgeon usually takes a piece of bone from your pelvis, called a bone graft, and puts it into the joint. They will also put a few screws in the joint to hold it together while it heals. Eventually, the bone graft turns into bone and the joint is fused together.

The surgery can take up to 3 hours or more, and you might be in the hospital up to 5 days afterward.

The kind of surgery you get depends on what’s causing your SI joint pain. Some studies suggest that people who get minimally invasive surgery have less pain a year or two later than people who get open surgery. They’re also less likely than people who have open surgery to have to go back and get the implants taken out because of pain later on.

WebMD Medical Reference



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Smith, A. Annals of Surgical Innovation and Research, October 2013.

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Ledonio, C. Medical Devices: Evidence and Research, June 2014.

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