SI Joint Arthrodesis Guidelines

Diagnostic Requirements

The American College of Radiology recommends radiography as the first-line imaging modality for suspected sacroiliitis, with MRI of SI joints appropriate when radiographs are negative or equivocal to assess acute inflammatory changes 2, 3, 4, 5
Diagnostic confirmation through intra-articular SI joint injections is essential to confirm the SI joint as the primary pain generator, with at least two separate injections demonstrating ≥70% pain relief required before surgical arthrodesis can be considered 1

The established stepwise approach for SI joint pain management includes conservative management, diagnostic intra-articular SI joint injections, therapeutic interventions, and surgical arthrodesis, with each step requiring proper documentation and positive outcomes before proceeding to the next 1

Proper surgical candidacy requires specific documentation, including confirmatory diagnostic block(s) showing >70% pain relief, exclusion of hip or spine as primary pain generator, and rigorous application of selection criteria to achieve success rates exceeding 80% 1

Minimally invasive SI joint fusion demonstrates >80% success rate, low complication rate, sustained improvement in pain and function, and high patient satisfaction when patients meet appropriate selection criteria, including confirmatory diagnostic blocks 1