SI joint fixation or fusion may be considered for selected patients with confirmed sacroiliac joint pain or instability that has not improved with appropriate non-surgical care.
Learn how Dr. Siefferman explains sacroiliac (SI) joint fixation and fusion, when it may be appropriate for chronic SI joint pain, and how it can help improve stability and function.
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Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine. For patients with sacroiliac joint sprain or hypermobility that has failed to respond to regenerative medicine techniques, one option we offer is sacroiliac joint fixation. This is where we use a very specific demineralized bone to go into the joint and actually gap the joint open. As opposed to surgical fixation of the sacroiliac joint where screws or bolts are used to close the joint, we actually use a bone graft to pop the joint open a little bit so that it can still pivot and can still have some mobility and to allow those structures which are meant to have some space to maintain that space. Again, this is not something we jump to, but if you have failed every other intervention and continue to have sacroiliac joint problems, this is a reasonable solution to discuss.
Sacroiliac joint fixation and fusion are advanced procedures used to stabilize or fuse the sacroiliac joint, also called the SI joint, in carefully selected patients. The SI joint connects the sacrum at the base of the spine to the pelvis and may contribute to lower back, buttock, hip, or pelvic-region pain when it is unstable, inflamed, or mechanically irritated.
At MPM, sacroiliac joint fusion NYC evaluation begins with diagnosis-first care. The goal is to confirm whether the SI joint is truly the primary pain generator before any surgical pathway is considered.
MPM specialists evaluate whether sacroiliac joint fixation or fusion may be appropriate by reviewing the patient’s pain pattern, exam findings, imaging, prior treatment history, diagnostic injection response, functional limitations, hypermobility features, and overlapping spine, hip, pelvic, or nerve symptoms.SI joint pain can mimic disc pain, sciatica, facet pain, hip pathology, pelvic floor dysfunction, cluneal neuralgia, inflammatory arthritis, and hypermobility-related instability.
MPM’s role is to confirm the likely pain generator, review non-surgical treatment sequencing, and coordinate with qualified surgical specialists when fixation or fusion may be clinically appropriate.
Patients often search for sacroiliac joint fusion in Manhattan after months or years of lower back, buttock, hip, or pelvic-region pain that has not improved with physical therapy, bracing, medication, injections, regenerative medicine, spine care, orthopedic evaluation, or pelvic pain treatment. Some patients also have hypermobility, EDS, prior lumbar fusion, scoliosis, pelvic mechanics issues, or overlapping spine and hip pain that makes diagnosis more complex.
MPM does not frame SI joint fixation or fusion as a first-line treatment or guaranteed solution. Before surgical referral is considered, the SI joint must be carefully evaluated as the likely pain generator. Diagnostic SI joint injections, imaging review, exam findings, and treatment history may all help clarify whether fixation or fusion should be discussed. If the diagnosis is uncertain, continued conservative care, SI joint injection, prolotherapy, PRP, regenerative medicine, spine treatment, or other evaluation may be more appropriate.
Sacroiliac joint fixation and fusion fit within MPM’s Hypermobility and Musculoskeletal issues expertise because SI joint pain can involve stability, pelvic mechanics, spine alignment, ligamentous support, and load transfer between the spine and pelvis. Patients with hypermobility, EDS, joint instability, scoliosis, anterior pelvic tilt, or prior spine issues may require especially careful assessment before any surgical option is considered.
MPM evaluates SI joint pain within the broader mechanical and functional picture. Fixation or fusion may be discussed only when the SI joint appears to be a confirmed pain generator and appropriate non-surgical care has not provided enough improvement. Other options may include SI joint injection, prolotherapy, PRP, regenerative medicine, bracing, rehabilitation, spine injections, or continued conservative management. The goal is to match treatment intensity to the diagnosis, not to move toward surgery prematurely.
An SI joint fusion evaluation begins with a careful review of symptoms, exam findings, imaging, diagnostic injection response, prior treatments, medical history, surgical history, hypermobility features, and functional goals. MPM evaluates whether pain appears to be coming from the SI joint or whether another source may better explain the symptoms.
If fixation or fusion may be appropriate, MPM may coordinate care with a qualified surgical specialist. The surgical evaluation may include additional imaging, review of diagnostic injections, discussion of implant or fixation approach, medical clearance, expected recovery, rehabilitation needs, and risks. SI joint fusion is not appropriate for every patient, and it may not resolve pain caused by the spine, hip, nerves, pelvic floor, widespread inflammation, central sensitization, or another pain generator. MPM helps patients understand where surgery may fit and when continued non-surgical care may be more appropriate.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Sacroiliac joint fixation and fusion are procedures intended to stabilize or fuse the SI joint in selected patients with confirmed SI joint-mediated pain or instability. The SI joint connects the sacrum to the pelvis. Fixation generally refers to mechanically stabilizing the joint, while fusion aims to create long-term bony union across the joint. At MPM, this option is considered only after diagnosis-first evaluation and careful review of non-surgical treatment history.
SI joint fusion is a surgical procedure designed to permanently connect the sacrum and ilium across the sacroiliac joint. It may be considered for selected patients with persistent SI joint pain, dysfunction, or instability that has not improved with appropriate non-surgical care. SI joint fusion is not a first-line treatment and is not appropriate for all lower back, buttock, hip, or pelvic pain. The SI joint must be carefully confirmed as the pain generator.
SI joint fixation generally refers to stabilizing the SI joint using an implant or fixation system. SI joint fusion refers to encouraging the sacrum and ilium to heal together across the joint over time. In practice, the terms may overlap depending on the procedure and device used. MPM focuses less on device language and more on whether the diagnosis, pain pattern, injection response, and treatment history support surgical evaluation.
A candidate for SI joint fusion may be someone with persistent SI joint-mediated pain or instability that has been carefully diagnosed and has not improved with appropriate non-surgical care. This may include physical therapy, bracing, medication, SI joint injections, rehabilitation, or other interventions. Candidacy depends on symptoms, exam findings, imaging, diagnostic injection response, medical risk factors, bone healing considerations, and whether other pain sources have been reasonably ruled out.
SI joint fusion is generally considered after the SI joint has been confirmed as a major pain generator and non-surgical treatments have not provided enough improvement. It may be discussed when pain significantly limits function and the clinical evidence supports SI joint dysfunction or instability. MPM helps determine whether continued conservative care, SI joint injection, regenerative
SI joint fusion or fixation may be considered for selected cases of SI joint instability when the joint appears to be a confirmed source of persistent pain and other treatments have not been sufficient. Instability may be related to trauma, mechanics, prior surgery, hypermobility, or connective tissue factors. However, instability symptoms can overlap with spine, hip, pelvic floor, or nerve-related pain, so careful evaluation is needed before considering surgery.
SI joint fixation or fusion may be discussed in selected patients with hypermobility-related SI joint pain or instability, but it is not automatically appropriate. Patients with EDS or hypermobility spectrum disorder may have multiple overlapping pain generators, including joint instability, muscle compensation, pelvic mechanics, spine pain, and nerve sensitivity. MPM evaluates the broader clinical picture before recommending surgical coordination or continued non-surgical care.
SI joint fusion may help selected patients when the SI joint is confirmed as the primary source of lower back, buttock, hip, or pelvic-region pain. It is less likely to help if symptoms are mainly caused by lumbar disc disease, sciatica, facet pain, hip pathology, pelvic floor dysfunction, cluneal neuralgia, inflammatory disease, or central sensitization. MPM evaluates these possibilities before surgical referral is considered.
SI joint pain may be evaluated through history, physical exam, provocative SI joint testing, imaging review, assessment of nearby pain sources, and diagnostic SI joint injections when appropriate. Imaging alone may not be enough because SI joint pain can mimic spine, hip, nerve, and pelvic conditions. A meaningful response to a targeted diagnostic injection may help support the SI joint as a clinically important pain generator.
Diagnostic SI joint injections can help determine whether numbing the SI joint reduces the patient’s typical pain. If relief is clear, meaningful, and matches the expected pain pattern, it may support SI joint involvement. This information can be important before considering advanced options such as fixation or fusion. If the injection does not help, MPM may reassess whether another pain generator is more likely.
SI joint injections are less invasive procedures that may help diagnose SI joint pain or temporarily reduce inflammation and symptoms. SI joint fusion is a surgical procedure intended to stabilize or fuse the joint for selected patients with confirmed persistent SI joint pain. Injections may be used before fusion consideration to help confirm the pain source. Fusion carries different risks, recovery expectations, and long-term implications.
Prolotherapy and PRP are regenerative medicine approaches that may be considered for selected musculoskeletal or instability-related pain patterns. SI joint fusion is a surgical stabilization procedure. These options differ in treatment intensity, recovery, evidence, risks, goals, and candidacy. MPM evaluates whether the patient’s SI joint pain is inflammatory, mechanical, instability-related, spine-related, nerve-related, or mixed before recommending any specific pathway.
Some SI joint fusion procedures may be performed using minimally invasive techniques, while others may require a different surgical approach depending on anatomy, diagnosis, surgeon preference, device selection, and patient-specific factors. MPM does not frame minimally invasive surgery as automatically low risk or appropriate for everyone. A qualified surgical specialist should review the procedure, expected recovery, risks, and alternatives before any decision is made.
Risks may include infection, bleeding, anesthesia complications, persistent pain, new or worsening pain, implant-related issues, nonunion or incomplete fusion, adjacent pain, nerve or vascular injury, limited SI joint motion, need for revision surgery, and rehabilitation demands. Surgery may not relieve pain if the SI joint is not the main generator. MPM reviews diagnostic confidence and alternatives before surgical coordination is considered.
If SI joint fusion is not appropriate, MPM may recommend continued conservative care, physical therapy, bracing, SI joint injection, steroid injection, prolotherapy, PRP, regenerative medicine, spine evaluation, hip evaluation, rheumatology coordination, pelvic pain care, or nerve-focused assessment. The next step depends on the diagnosis and why fusion is not the right fit. The goal is to avoid unnecessary surgery and continue refining the care plan.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If you are considering sacroiliac joint fusion in NYC for persistent SI joint pain, SI joint instability, lower back pain, buttock pain, pelvic-region pain, or hypermobility-related SI dysfunction, MPM can help determine whether surgical evaluation may be appropriate. Your care will begin with diagnosis-first assessment, review of prior treatments, diagnostic injection history, safety factors, and your broader functional goals.
Sacroiliac joint fixation and fusion are advanced treatment options for selected patients with persistent sacroiliac joint pain, SI joint dysfunction, or SI joint instability that has not improved with appropriate non-surgical care. The sacroiliac joint, also called the SI joint, connects the sacrum at the base of the spine to the ilium of the pelvis. It helps transfer load between the spine, pelvis, and legs.
At Manhattan Pain Medicine (MPM), sacroiliac joint fusion NYC evaluation begins with diagnosis-first care. The most important question is not whether surgery is available. The most important question is whether the SI joint is truly the primary pain generator.
SI joint pain can feel like lower back pain, buttock pain, hip pain, groin pain, pelvic-region pain, or pain that travels into the thigh. It can be confused with lumbar disc disease, sciatica, facet arthropathy, spinal stenosis, hip pathology, cluneal neuralgia, pelvic floor dysfunction, inflammatory sacroiliitis, scoliosis, spondylolisthesis, or hypermobility-related instability.
Because symptoms overlap, imaging alone may not fully confirm that the SI joint is responsible for pain. MPM reviews the pain pattern, provocative exam findings, imaging, functional limitations, prior treatments, and response to diagnostic SI joint injections when available. This helps determine whether the SI joint is likely to be the main source of symptoms or one contributor within a more complex pain picture.
SI joint fixation or fusion may be considered when the SI joint has been confirmed as a meaningful pain generator and non-surgical treatment has not provided enough improvement. Non-surgical care may include physical therapy, bracing, medication management, activity modification, SI joint injections, spine injections, rheumatology care, pelvic pain care, prolotherapy, PRP, or regenerative medicine when appropriate.
Fixation generally refers to stabilizing the SI joint, while fusion aims to create long-term bony union between the sacrum and ilium. The exact procedure, device, and approach are determined by the surgical specialist. MPM’s role is to help confirm the diagnosis, review treatment sequencing, and coordinate referral when surgical evaluation may be appropriate.
Patients with hypermobility, EDS, joint instability, anterior pelvic tilt, scoliosis, or pelvic mechanics issues require especially careful assessment. In these patients, the SI joint may be painful because of instability, compensation, muscle guarding, spine mechanics, hip mechanics, or ligamentous laxity. At the same time, pain may also come from other joints, nerves, muscles, or centralized pain mechanisms.
Surgery may help selected patients when the SI joint is clearly involved, but it does not cure hypermobility or EDS. It also may not address pain from other unstable joints, spine conditions, pelvic floor dysfunction, nerve irritation, or chronic pain sensitization. MPM evaluates the full pattern before recommending surgical coordination.
SI joint injections can help confirm the pain source and may reduce inflammation temporarily. Prolotherapy and PRP may be considered for selected instability-related or musculoskeletal pain patterns. Regenerative medicine may be appropriate in certain cases when the diagnosis and tissue target support it. Spine injections may be more appropriate when symptoms are related to disc disease, facet pain, or nerve root irritation.
SI joint fusion is a more advanced option and carries surgical risks. It should generally be considered only when less invasive treatments have been reviewed and the diagnostic evidence supports the SI joint as the primary pain generator.
SI joint fixation or fusion is not appropriate for every patient. Surgery may not be recommended when the pain generator is unclear, symptoms are widespread or better explained by another condition, medical risks are uncontrolled, infection is present, bone healing risk is high, or the expected benefit does not outweigh the risk.
Possible risks include infection, bleeding, anesthesia complications, persistent pain, new or worsening pain, implant-related issues, nonunion or incomplete fusion, adjacent pain, nerve or vascular injury, limited SI joint motion, rehabilitation demands, and need for revision surgery. Even when surgery is technically successful, some patients may still have pain from the spine, hip, nerves, muscles, inflammation, pelvic floor, or central sensitization.
Patients should seek urgent evaluation for fever, wound drainage, spreading redness, severe swelling, new weakness, new numbness, bowel or bladder dysfunction, saddle anesthesia, severe back or pelvic pain after trauma, sudden inability to walk, severe abdominal or pelvic pain, suspected infection, chest pain, shortness of breath, blood clot symptoms, or rapidly worsening symptoms.
For selected patients, SI joint fixation or fusion may be an important part of care. MPM’s role is to help determine whether the SI joint has been confirmed as the correct target, whether non-surgical options have been appropriately considered, and whether surgical coordination fits the patient’s broader diagnosis-first care plan.
