If low back or buttock pain keeps coming back despite physical therapy, medication and injections, the source may be your sacroiliac (SI) joint. For select patients, minimally invasive SI joint fusion with the iFuse INTRA X Allograft Implant System from SI-BONE may be an option to discuss. Dr. Rema performs it right in our Kingston office. It is a short procedure designed to help the joint fuse.

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What Is the SI Joint?

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The sacroiliac joints connect the base of the spine (the sacrum) to the pelvis, one on each side. They carry the weight of your upper body down to your legs and normally move very little. When an SI joint is injured, worn, or moves too much, it can become a significant source of pain. SI joint problems are an often-overlooked cause of chronic low back pain.

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Common symptoms of SI joint dysfunction:

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- Pain in the low back, buttock, or one side of the pelvis

- Pain that may spread to the hip, groin, or upper thigh

- Pain when sitting for long periods, standing from a chair, climbing stairs, or rolling over in bed

- A feeling of instability or "giving way" in the pelvis or leg

- Difficulty sleeping on the affected side

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SI joint pain can follow a fall or accident, pregnancy, prior lumbar spine fusion, arthritis, or develop without a clear cause.

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Who May Be a Candidate?

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SI joint fusion may be worth discussing if:

- SI joint pain has limited your daily activities for many months

- Your exam points to the SI joint, typically with three or more specific provocative tests reproducing your pain

- An image-guided diagnostic SI joint injection gave strong temporary relief

- You have tried conservative care, such as physical therapy or a home exercise program, medications, activity changes, and therapeutic SI joint injections, without lasting benefit

- Imaging of the SI joint, hip and lumbar spine has been reviewed to rule out other causes of your pain

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A consultation is required. Dr. Rema will review your history, exam and imaging, and tell you honestly whether fusion makes sense for you, or whether another option may serve you better.

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How the Procedure Works

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- Small incision. The procedure is done through a small incision in the lower back, usually in less than an hour.

- Image guidance. Using live X-ray (fluoroscopy), Dr. Rema guides instruments precisely into the SI joint.

- Two small bone grafts. Two small cylindrical bone allografts (donor bone) are inserted into the SI joint. They are designed to stabilize the joint and promote fusion, with the aim of reducing or eliminating pain.

- No metal screws or rods. The graft is bone, not a metal implant.

- In our office. Dr. Rema performs the procedure in our Kingston office, and you go home the same day.

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Recovery

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- Most patients are walking the same day.

- Many patients return to work and non-strenuous activities about 2 weeks after the procedure, depending on their healing.

- Expect some soreness at the incision site for a few days.

- Dr. Rema will give you activity and weight-bearing instructions; avoid strenuous activity until he clears you.

- Avoiding smoking supports bone healing.

- Physical therapy and short walks are often part of recovery.

- Return to daily activities and work depends on your healing and your occupation; fusion develops over several months.

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What Does the Evidence Show?

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Research on minimally invasive SI joint fusion is growing. Published studies of allograft systems such as iFuse INTRA X are more limited and mostly come from smaller observational studies rather than large randomized trials. Dr. Rema will review the current evidence with you and help you weigh the benefits and risks for your situation.

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Results vary from person to person, and no treatment works for everyone. As with any procedure, there are risks, which Dr. Rema will review with you.

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Why Choose Dr. Rema?

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- Board certified in Anesthesiology and Pain Medicine

- Fellowship trained in pain medicine at Columbia University-NewYork-Presbyterian

- Recognized as a Castle Connolly Top Doctor

- A full range of SI joint care under one roof, from diagnosis and injections to minimally invasive fusion performed in our office

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Frequently Asked Questions

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Is SI joint fusion major surgery?

No. It is a minimally invasive procedure through a small incision, done in our Kingston office, and you go home the same day.

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How do I know my pain is coming from the SI joint?

Diagnosis is based on your history, a physical exam with specific tests, imaging, and diagnostic SI joint injections. Significant relief after a numbing injection helps confirm the SI joint as the source.

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Will I lose motion or flexibility?

The SI joint normally moves very little, so fusing it is not expected to noticeably limit how you bend or move. Dr. Rema can discuss this with you.

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What is the bone graft?

It is donor bone (allograft) prepared for medical use. Over time it is designed to help your own bone bridge across the joint.

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When can I go back to work?

It depends on your healing and your job. Desk work usually resumes sooner than physically demanding work. We will discuss your timeline at your visit.

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Take the Next Step

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If SI joint pain is limiting your life, call 845-245-6033 to schedule a consultation.

Hudson Valley Pain Management, 33 Grand Street, Suite 33A, Kingston, NY 12401

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Disclaimer: This page is for general information only and is not medical advice. Individual results vary, and no outcome is guaranteed. Please consult a qualified physician about your condition. iFuse and SI-BONE are trademarks of SI-BONE, Inc.