Full Spectrum of SI Joint Treatments | Austin, TX

SI Joint Procedures

From diagnostic injections to cooled radiofrequency ablation and minimally invasive fusion — the complete interventional pathway for sacroiliac joint pain.

Overview

Sacroiliac joint procedures encompass the full range of interventional treatments for SI joint dysfunction — from initial diagnostic injections through therapeutic options including cooled radiofrequency ablation and, for refractory cases, minimally invasive SI joint fusion. The SI joint is responsible for an estimated 15–30% of chronic low back pain, but its treatment requires a systematic, stepped approach to confirm diagnosis and select the appropriate intervention. Dr. Migdale offers the complete SI joint treatment pathway.

Step 1: Diagnostic SI Joint Injection

The first step in evaluating SI joint pain is a fluoroscopically guided SI joint injection with local anesthetic. A positive response — typically 50–80% or greater pain relief during the anesthetic period — confirms the SI joint as the primary pain source and guides subsequent treatment. A corticosteroid is typically added for therapeutic benefit.

Step 2: Lateral Branch Blocks and Cooled RFA

For patients who respond well to SI joint injections but experience only temporary benefit, lateral branch blocks of the sacral nerve roots (S1-S3) that supply the SI joint confirm neural involvement. Positive lateral branch blocks are followed by cooled radiofrequency ablation of the lateral branches — providing more sustained relief typically lasting 12 months or longer. Cooled RFA is preferred over conventional RFA for the SI joint because the complex nerve supply requires the larger ablation zone that cooled technology produces.

Step 3: Minimally Invasive SI Joint Fusion

For patients with confirmed SI joint pain who have not achieved adequate sustained relief from injections and RFA, minimally invasive SI joint fusion is the next step. The Liberty-SI Lateral Fusion System uses a lateral approach to place implants across the SI joint, stabilizing it and reducing painful motion. The procedure is performed through a small incision, typically allows same-day discharge, and has strong evidence supporting its effectiveness for properly selected patients.

Common Questions

Frequently Asked Questions

What makes SI joint procedures different from lumbar spine procedures?
The SI joint has a different anatomy, nerve supply, and treatment pathway than the lumbar spine. Lumbar facet pain is treated with medial branch blocks and RFA; SI joint pain is treated with intra-articular injections and lateral branch blocks/RFA. The two treatment pathways are distinct and not interchangeable. This is why accurate diagnosis — confirming whether pain is coming from the SI joint or the lumbar spine — is so important before proceeding with treatment.
Is SI joint fusion surgery?
Minimally invasive SI joint fusion is a procedure performed through a small incision under fluoroscopic guidance — not open surgery. It is an outpatient procedure that typically allows same-day discharge, and recovery is significantly faster than open spinal surgery. The term 'fusion' refers to the stabilization of the joint, not an extensive surgical exposure.
How do I know if I need fusion versus RFA?
RFA is the appropriate next step for patients who respond to lateral branch blocks but experience only temporary benefit. Fusion is typically considered for patients who have failed RFA or who have significant SI joint instability and structural pathology. Dr. Migdale will guide you through this decision based on your specific diagnosis, imaging, and response to prior treatments.

Medical Disclaimer: The information on this page is for general educational purposes only and does not constitute medical advice. It is not a substitute for professional medical evaluation, diagnosis, or treatment by a qualified physician.

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