Sacroiliac ligament surgery can address the dysfunctional ligament directly or might target the entire joint for fusion. Let’s make it clear from the start of this essay that the information contained herein is designed to be used by patients who have been diagnosed with sacroiliac joint dysfunction due to ligamentous laxity (most often) or tension (rarely). Hypermobility of the joint is a far more usual diagnosis than hypomobility when it comes to surgical treatment of ligament issues.
Ligaments within the sacroiliac can create major problems in terms of pain, instability and functional deficits. While many ligament-enacted pain syndromes respond very well to conservative care consisting of exercise, stretching and possibly prolotherapy or pharmaceutical injections, some cases are unresponsive. These are the profiles that are usually recommended for surgical intervention if the pain remains unabated for more than 6 to 12 months or is debilitating.
This discussion provides important details on the 2 major approaches to treating dysfunctional ligaments in the sacroiliac joint. We will discuss the risks and benefits of both ligament-targeting treatments, as well as general SIJ fixation.
Sacroiliac Ligament Targeting Surgery
Ligament-targeting surgeries are the last invasive options that also create the least amount of collateral damage to the anatomy. These procedures seek to address SIJ dysfunction by normalizing ligament tension within the SI joint. This treatment is most often utilized for hypermobility diagnoses, where the ligaments require tightening in order to stabilize the joint and provide adequate structural support. However, there are also procedures that can loosen hypomobile ligaments, although these are far less often performed for various reasons, including the controversy surrounding the accuracy of the diagnosis.
Ligament-targeting techniques do not change the functionality of the overall SI joint, which is highly beneficial. All they seek to accomplish is to normalize the tension of the ligament(s) being treated using the least invasive methods available. Ligament-targeting surgeries are generally successful, but require adequate healing time and the application of rehabilitative physical therapy in virtually all cases. For hypermobility, ligamentous tensioning procedures are successful in more than 80% to 85% of successfully treated patients. The remainder of patients are usually treated successfully from a structural viewpoint, but might continue to experience pain due to misdiagnosis of the causative process.
Sacroiliac Ligament Surgery via Fusion
For many cases of hypermobility, even when the condition is caused completely by ligament laxity, fusion surgery is recommended and performed. Sacroiliac joint fusion is a more invasive technique that permanently bonds the joint into a fixed state that is incapable of movement. Fusion can be utilized for hypermobility diagnoses of all varieties, as well as hypomobility conditions where a more solid and neutral SI position is deemed to be beneficial for pain amelioration.
Fusion can be accomplished using a variety of techniques, as there are several noted product systems that are designed expressively for this task. Fusion is more risky, since it tends to increase stress on regional structures, but is certainly better tolerated that spinal fusions, being that the normal SIJ does not move much anyway.
Fusion is generally successful in the majority of operated patients, but does create a loss of flexibility and possible activity restrictions. When fusion fails, due to misdiagnosis or complication, additional operations are likely and the damage created can never be undone. Therefore, fusion should always be a last resort option, despite its general efficacy and relatively minimally-invasive approach for most procedures.
Sacroiliac Ligament Surgery Guidance
Sacroiliac joint disorders tend to enjoy good results from conservative, nonsurgical care. SIJ dysfunction, in particular, responds very well to exercise, stretching and prolotherapy, which are all natural and mostly constructive therapeutic interventions. Since surgery is far more dangerous and fusion will inherent change many aspects of physical functionality negatively, we tend to recommend exhausting noninvasive care before even thinking about surgical fixes. This advice is both widely supported by treatment research, as well as clinical statistics. Remember, if conservative care fails time and time again, there is a good chance that surgical intervention will also fail, usually due to a mistaken diagnostic verdict.
If the specific diagnosed condition is indicated for ligament-specific surgery, this might be the better path for most patients. Results are good, risks are decreased and collateral effects are minimized when compared to SIJ fusion. If all else fails, joint fixation can be a last option, but just know that fusion does entail risks that predispose postoperative patients to certain problems, as well as the susceptibility to SI joint injury later in life.