You might not even know what your sacroiliac joint is—until it acts up. When it is injured, this joint, which connects the base of your spine to your pelvis, can cause intense pain that radiates down into the leg. “I have seen people who are quite debilitated by this kind of pain to the point where they have trouble standing and walking,” says Peter G. Whang, MD, a Yale Medicine orthopedic surgeon. 

Sacroiliac joint fusion is one of the newest and best  procedures to provide relief for sacroiliac pain, and it is routinely performed by orthopedic surgeons at Yale Medicine. 

There are two sacroiliac joints that connect the sacrum, located at the base of the spine, to the iliac bones, which  make up the pelvis. When the ligaments or bony surfaces are damaged, due to trauma, arthritis or other conditions, the sacroiliac joints can be the source of intense pain that may radiate into the leg. 

A medical history and physical exam with “provocative maneuvers” tests (intended to stress the sacroiliac joints) are routinely used to diagnose sacroiliac joint problems. In addition, an injection of a local anesthetic that numbs the joint, with steroids to reduce inflammation, may also provide important information.

“If this injection gives rise to pain relief, even temporarily, it may confirm the diagnosis,” says Dr. Whang.

Initial treatment for sacroiliac joint pain may involve physical therapy, pain medications, injections or bracing with a belt. Another intervention is  radiofrequency ablation, an image-guided procedure that interrupts the pain signal traveling from the sacroiliac joint to the brain,” Dr. Whang. 

If these treatments don’t bring relief, patients may ultimately choose a surgery called sacroiliac joint fusion.

Sacroiliac joint fusion is a minimally invasive procedure that involves a small incision, usually less than two inches long. “Under image-guidance, we insert titanium implants across the sacroiliac joint to provide stability,” says Dr. Whang. 

The procedure takes about 45 minutes and is often performed in an outpatient setting. “Most patients are back to their normal routine within a few weeks,” Dr. Whang says. He calls the procedure a “definitive treatment” for these patients, and one that should not impact their range of motion.

Dr. Whang says Yale Medicine doctors have specialized training and expertise that  is invaluable to patients because it means they have access to novel treatments.

Sacroiliac fusion is still in its infancy, he says. “It’s a cutting edge technique that is still not widely available. At Yale Medicine, we have world-class physicians who are also researchers participating in the original clinical trials for this procedure.”

Yale Medicine researchers continue to focus on developing new surgical techniques that are both more effective and safer,  he says. “That will hopefully bring about improvements in pain, so that patients can get back on their feet faster.”