SI Joint Pain
Question: I have SI joint pain. They want to do surgery involving putting a wedge in the joint to try and stabilize the it. I have a lot of arthritis and Cortisone shots are no longer an option. Please help me consider the surgery.
Answer:
First of all, let me explain what the SI (sacro-iliac) joint is. We often think of the pelvis as one solid single bone but in adults it is really three bones (two “hip” bones and the sacrum). The part of the pelvis that we put our hands on when we are expressing disgust is the iliac part of the hip bone (one on each side) and the sacrum is a triangular bone formed by fusion of several vertebrae in the middle of the back. The SI joint is where the iliac portions of the pelvis and the sacrum join on each side. This joint usually only allows minimal motion, but the ligaments lashing the two parts together can become loose in some circumstances such as the stress put on this joint by walking with a leg length difference or softening of the ligaments by the hormones of pregnancy.
Surgery is infrequently done to treat SI pain and always should be a last resort.
Various nonsurgical attempts have been made to fuse the joint and not allow motion at the SI joint; sometimes with good results and sometimes with little to no benefit. Before considering surgery a person should try to eliminate as many causes of the pain as possible— it always makes sense to eliminate the cause, if possible, before treating the symptoms.
It also would be helpful to know what role pelvic motion plays in YOUR ability to walk. This is particularly important if you have had any fusion or rods placed in your lower back that limit the movement of your vertebrae. I’d ask the surgeon if there is any non-surgical way to give you a trial of how you would move/walk with a fused SI joint.