A treatment approach for low back pain

Fusion of the sacroiliac joint is a therapeutic approach for lumbar and pelvic pain. The sacrum and ilium naturally form a joint – and this fusion procedure connects the two together. If conservative treatment methods such as medications, exercises, and injections do not relieve back pain, surgical treatments in the form of sacroiliac joint fusion may help.

Innovations in sacroiliac joint fusion have allowed doctors to perform the surgery using a minimally invasive approach. Keep reading to find out how and for whom a sacroiliac joint fusion can help.

Researchers estimate that 15-30% of all lower back pain is due to sacroiliac joint dysfunction. This is likely because the sacroiliac joint is responsible for helping you bend and also resists pressure while transferring force and pressure from your lower back to your legs.

Unfortunately, the sacroiliac joint is vulnerable to stress and injury which can lead to pain. The goal of this surgery is to strengthen this joint and reduce this pain.

Besides pain relief, other benefits of a sacroiliac joint fusion include:

  • better quality of life
  • improved daily function
  • reduced disability

Adverse side effects are not common after sacroiliac joint fusion, but the most common risks of sacroiliac joint fusion are:

  • new back pain in another location
  • trochanteric bursitis (hip pain)
  • wound infection after the procedure
  • bone fracture
  • “pseudarthrosis” or failure of the bone to heal

Other potential, but less common, side effects include:

  • bleeding
  • hematoma (bruise/collection of blood)
  • nerve pain
  • blood clots in the legs or lungs

The ability to perform the surgery in a minimally invasive manner has helped improve outcomes and reduce serious effects.

Surgeons can perform sacroiliac joint fusion using an open or minimally invasive approach.

Open approach

Though there is different technicsopen surgery involves:

  • A person falls asleep under general anesthesia, where they sleep and are unaware that the surgery is taking place.
  • The surgeon makes an incision in the lower back to expose the sacroiliac joint.
  • A surgeon removes a block of bone to gain access to the cartilage-covered surface of the sacrum.
  • The surgeon removes the cartilage that sits above the sacrum.
  • A surgeon replaces the block of bone and uses plates and screws to fix the bone in place to stabilize the joint.

surgeons can also opt to perform sacroiliac joint fusion as minimally invasive surgery. Thanks to advances in equipment, surgery doesn’t have to require a large incision or lengthy recovery times.

Minimally invasive approach

The stages of a minimally invasive sacroiliac arthrodesis are similar and May include:

  • falls asleep under general anesthesia, where he sleeps and is unaware that the procedure is in progress.
  • A surgeon makes a small, 3 to 5 centimeters incision on the side of the buttock.
  • The surgeon dissects (cuts) the gluteal muscles to gain access to the ilium, or upper part of the pelvis.
  • A surgeon uses a special guide pin to access the ilium and drill so that the implants can be passed to the sacrum.
  • A surgeon guides the instruments to be implanted through the passage created in the ilium. The surgeon fixes the implants using screws and pins.
  • The surgeon irrigates (uses saline solution to clean) the surgical site to make sure there are no extra bits of bone or tissue. They then close the wound with sutures.

Medicare will usually cover sacroiliac joint fusion surgery, and the Medicare code for this surgery is 27279. Insurance companies will also usually cover this surgery, but you may need to get pre-certified before undergoing surgery. The costs to the patient for this surgery usually depend on where the surgeon performs it.

If the surgery takes place at an outpatient surgery center, the patient typically pays $2,769, according to Medicare. If the surgery takes place in an outpatient department of a hospital, the patient typically pays $1,661. However, your costs may vary depending on your location, health needs, and surgeon fees.

When the procedure is performed in a minimally invasive way, surgeons usually encourage you to get up and walk around as quickly as possible after surgery. You may need an ambulatory assistive device, such as a cane or crutches, to prevent excessive pressure on the surgical site.

Surgeons generally recommend limiting weight-bearing activities (the amount of heavy objects you hold and move) for up to 6 weeks after surgery. However, some doctors may recommend avoiding heavy lifting for up to 12 weeks after surgery to ensure that the bone and surgical implants heal properly.

Doctors may recommend activity limitations, including refraining from lifting more than 10 pounds or bending excessively at the waist. A surgeon may recommend follow-up imaging about 6 months after surgery before you can resume full physical activity.

Sacroiliac joint fusion seems to be more effective in some people and less effective in others. The surgery seems to be most effective in:

  • older people who have had back pain symptoms for a long time
  • patients who have never had spinal surgery

The surgery seems to be less effective in:

  • those who take opioids (painkillers) most of the time
  • those who smoke
  • those who have had a spinal fusion before

A doctor will carefully study your symptoms to determine the likelihood that surgery will relieve your discomfort.

Although you may not experience complete pain relief after sacroiliac joint fusion surgery, people generally experience significant pain relief that lasts 5 years or more.

Sacroiliac joint dysfunction can contribute to lower back pain in some people. Sacroiliac joint fusion performed with a minimally invasive approach has improved outcomes and reduced recovery times.

If you are experiencing significant lower back pain that conservative measures have not helped, you may want to speak with a doctor about this potential treatment approach.

About Antoine L. Cassell

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