Sacro-iliac Chronic Pain

Very often it is difficult to identify the source of the back pain. Lower back pain is caused by sacroiliac joint problems about 15% of the time. Diagnosing it is difficult and involves making sure that nothing else is the cause of the problem. There are some physical examination tests which can implicate the sacroiliac joint as the cause of your pain. Most of the time it is off to one side, is around the size of the little dimple on either side of your lower back.

If your sacroiliac joint is suspected to be the cause of your lower back pain, we can treated with local physical therapy, the sacral belt, and possibly an injection of steroid medication into the sacroiliac joint. If your pain keeps coming back and is unmanageable, you may wish to consider surgical treatment.

Minimally invasive sacroiliac joint fusion needed as indicated by ALL of the following:

  1. Significant sacroiliac joint pain (pain rating of at least 5 on a 0-10 numeric scale) and/or significant activity limitations due to sacroiliac joint pain
  2. Unilateral pain localized over the sacroiliac joint
  3. Sacroiliac joint pain confirmed with response (pain) to three or more provocative examination maneuvers that stress the sacroiliac joint (e.g., FABER test, thigh thrust, pelvic gapping test, pelvic compression or Gaenslen test)
  4.     Confirmation of diagnosis of sacroiliac disease via pain relief of at least 75 percent (i.e., on visual analogue scale) due to fluoroscopy-guided needle injection of local anesthetic into sacroiliac joint   (expected time frame of pain relief depends on anesthetic chosen, dose and concentration)
  5. Failure to respond to at least six months of alternative treatments consisting of analgesics (g., nonsteroidal anti-inflammatory medication) and one or more of the following:

o     Physical therapy

o    Sacroiliac joint steroid injection

o    Radiofrequency rhizotomy

  •       Alternative or contributing diagnoses absent (e.g., hip osteoarthritis, L5-S1 spine degeneration, tumor, infection or fracture)


  1. Dengler J, Kools D, Pflugmacher R, Gasbarrini A, Prestamburgo D, Gaetani P, Van Eeckhoven E, Cher D, Sturesson B. 1-Year Results of a Randomized Controlled Trial of Conservative Management vs. Minimally Invasive Surgical Treatment for Sacroiliac Joint Pain. Pain Physician. 2017;20:537-550. DOI: 10.1186/s12891-017-1549-6.
  2. Polly DW, Swofford J, Whang PG, Frank CJ, Glaser JA, Limoni RP, Cher DJ, Wine KD, Sembrano JN, and the INSITE Study Group. Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction. Int J Spine Surg. 2016;10:Article 28. DOI: 10.14444/3028.
  3. Darr E, Meyer SC, Whang PG, Kovalsky D, Frank C, Lockstadt H, Limoni R, Redmond A, Ploska P, Oh MY, Cher D, Chowdhary A. Long-term Prospective Outcomes After Minimally Invasive Trans-iliac Sacroiliac Joint Fusion Using Triangular Titanium Implants. Med Devices (Auckl). 2018;11:113-121. DOI:  10.2147/MDER.S160989.
  4. MCG Health – Musculoskeletal Surgery or Procedure GRG [GRG: SG-MS (ISC GRG)]. Care Planning – Inpatient Admission and Alternatives, Clinical Indications for Procedure. General Recovery Care, 22nd Edition. 2018.
  5. Bono C, et al. for the NASS Coverage Committee. North American Spine Society, Coverage Policy Recommendations: Percutaneous Sacroiliac Joint Fusion. June 9, 2015.
  6. Lorio MP. ISASS Policy 2016 Update – Minimally Invasive Sacroiliac Joint Fusion. Int J Spine Surg. 2016;10:Article 26. DOI: 10.14444/3026.
  7. AIM Specialty Health – Musculoskeletal Program: Clinical Appropriateness Guidelines – Sacroiliac Joint Fusion. Effective: July 1, 2018.
  8. BCBS Association – Diagnosis and Treatment of Sacroiliac Joint Pain (6.01.023). January 1, 2018.