SI Joint Fusion in Elizabethtown, KY
Pain low in the back that sits off to one side, just above the buttock, and gets worse with standing from a chair, climbing stairs or lying on that side is often not coming from the spine at all. The sacroiliac (SI) joint, where the base of the spine meets the pelvis, is the source in a meaningful share of chronic low back pain, and it is frequently missed. At Aptiva Health’s Elizabethtown clinic, 529 Westport Road, Suite 2, our team can diagnose SI joint dysfunction, treat it with therapy and image-guided injections, and, when those fail, offer minimally invasive SI joint fusion with Dr. Michael Casnellie, a board-certified spine surgeon. Every visit except the operation itself takes place in Elizabethtown.
Call 270-506-4888. Monday through Friday, 8 AM to 5 PM. Same-day appointments available.
Schedule your appointment today!
Is SI joint fusion right for you?
The SI joints are built to move only a few degrees, and they transfer the weight of the upper body into the legs. When one becomes inflamed, unstable or arthritic, it produces pain in the low back and buttock that can mimic a disc problem or hip problem. Common causes include a prior lumbar fusion that shifted load onto the SI joint, pregnancy and childbirth, a fall onto the buttock, leg-length differences, and degenerative arthritis.
Fusion is considered only when all of the following are true:
Pain has lasted at least six months and limits daily activity
Examination maneuvers that stress the SI joint reproduce your pain
A diagnostic injection of numbing medicine into the joint, done under X-ray guidance, relieves at least 50 to 75 percent of the pain for the length of the anesthetic, on one or ideally two occasions
Physical therapy, medication and therapeutic injections have not provided lasting relief
Imaging has ruled out the lumbar spine and hip as the main source
Patients whose diagnostic injection does not relieve the pain are not candidates, because that result tells us the SI joint is not the generator.
What we try first, in Elizabethtown
The non-surgical pathway is available at Westport Road:
Physical therapy with Simon Hoehn, PT, DPT and Dovie Brown, PTA, addressing pelvic stability, hip strength and the mechanics that overload the joint; Dovie works one on one with patients and has extensive experience with orthopedic injuries and conditions
An SI belt and activity modification for patients whose pain is driven by instability
Image-guided SI joint injections by our interventional pain team, used both to confirm the diagnosis and, with corticosteroid, to treat it
Radiofrequency ablation of the nerves that carry pain from the joint, for patients who respond to blocks but want to avoid surgery
Most patients get adequate relief from this pathway. Fusion is for the group whose pain keeps returning despite it.
Your first visit at Westport Road
Where: 529 Westport Road, Suite 2, Elizabethtown, KY 42701.
When: Monday through Friday, 8 AM to 5 PM; same-day appointments at 270-506-4888.
What happens: history, an exam that includes specific SI joint provocation tests, a hip exam, and on-site X-rays of the pelvis and lumbar spine.
Further imaging: MRI or CT, if needed to exclude other causes, is scheduled at Aptiva Health Imaging, 3615 Newburg Road in Louisville, and reviewed at your next Elizabethtown visit.
Bring: photo ID, insurance card, medication list, records of any prior spine surgery, prior imaging, and claim details for work or auto injuries.
Surgery day
Minimally invasive SI joint fusion is performed under general anesthesia with live X-ray guidance. Through an incision about an inch long on the side of the buttock, the surgeon passes a guide pin across the joint, then places two or three implants that bridge the sacrum and the ilium. The implants stabilize the joint immediately; bone then grows across it over the following months. The procedure typically takes under an hour.
Surgery for Elizabethtown patients is performed in the Louisville metro area, usually as an outpatient procedure; if your surgeon plans an overnight stay, that is arranged in advance. The pre-operative visit where this is planned is in Elizabethtown.
Recovery and physical therapy in Hardin County
Weeks 0 to 3: walking with a walker or crutches, keeping weight on the treated side limited as your surgeon directs. First follow-up at the Elizabethtown office.
Weeks 3 to 6: weight bearing increases; physical therapy begins at Westport Road, starting with gentle mobility and progressing to strengthening.
Weeks 6 to 12: return to normal walking and most daily activity. Desk work often resumes in two to four weeks.
Months 3 to 12: fusion matures. X-rays at Elizabethtown follow-ups track it; heavy lifting and impact activity are cleared once fusion is confirmed.
Why Elizabethtown patients choose Aptiva Health for SI joint care
One spine team, one chart. From your first visit through injections, surgery and rehab, your surgeon, the Westport Road clinic team and your physical therapists share one record and one plan.
Diagnosis first. SI joint pain is one of the most commonly missed diagnoses in spine care. We confirm it with exam maneuvers, imaging and a diagnostic injection before any fusion is considered.
Conservative care first. Therapy, an SI belt, image-guided injections and radiofrequency ablation are all delivered in Elizabethtown; most patients get adequate relief without surgery.
Follow-up close to home. Pre-operative planning, follow-up visits, X-rays and physical therapy with Simon Hoehn, PT, DPT and Dovie Brown, PTA all happen in Elizabethtown.
Risks and realistic expectations
Risks include infection, bleeding, nerve irritation from implant position, implant loosening, failure to fuse, and anesthesia complications. Patients with a well-confirmed diagnosis, meaning a strongly positive diagnostic injection, have the best results; those with an uncertain diagnosis do worse. SI joint fusion does not treat pain that is coming from the lumbar spine or hip, which is why the work-up before surgery matters more than the operation itself.
Your Elizabethtown Spine Surgeon
SI joint and spine patients at Aptiva Health’s Elizabethtown clinic are evaluated and treated by Michael Casnellie, MD, a board-certified spine surgeon, with physical therapy on site from Simon Hoehn, PT, DPT and Dovie Brown, PTA. Your surgeon and therapy team share one chart, so your rehab follows your surgical protocol.
Dr. Michael Casnellie — Orthopedic Spine Surgeon
Dr. Casnellie has been treating spine patients in Kentucky since 2005 and is one of the most experienced motion-preservation spine surgeons in Kentucky. He performed Kentucky's first Prestige cervical artificial disc replacement — a procedure that preserves motion at the affected level of the cervical spine instead of fusing it — and remains one of the few surgeons in the state offering both cervical and lumbar disc replacement to appropriate candidates. He sees SI joint and spine patients at Aptiva Health’s Elizabethtown clinic on Westport Road.
Insurance accepted
Aptiva Health accepts most major insurance plans, Medicare, Medicare Advantage, most Kentucky Medicaid plans, workers’ compensation, and auto injury coverage (PIP and MedPay). Minimally invasive SI joint fusion is covered by most plans when medically necessary; coverage typically requires documentation of failed conservative care and positive diagnostic SI joint injections. We verify your benefits before surgery and explain your expected costs. We offer self-pay where there is no insurance, it is a non-covered service, and on a case-by-case basis.
Call 270-506-4888 to verify your insurance.
Get evaluated in Elizabethtown
If chronic low back, buttock, hip or groin pain, especially pain that is worse with sitting, climbing stairs, getting in and out of a car or rolling over in bed, has not settled with conservative care, it is time to find out whether the SI joint is the source. Aptiva Health Orthopedics, Elizabethtown: 529 Westport Road, Suite 2, Elizabethtown, KY 42701. Phone 270-506-4888. Monday through Friday, 8 AM to 5 PM. On-site X-ray. Same-day appointments available.
Physical therapy at Westport Road is provided by Simon Hoehn, PT, DPT and Dovie Brown, PTA. Dovie works one on one with patients and has extensive experience treating orthopedic injuries and conditions. Image-guided SI joint injections and radiofrequency ablation are performed in Elizabethtown by our interventional pain team.
MRI or CT, when needed, is scheduled at Aptiva Health Imaging, 3615 Newburg Road, Louisville, KY 40218, and reviewed with you at your next Elizabethtown visit.
Frequently asked questions about SI joint fusion in Elizabethtown
How do you know the pain is coming from the SI joint?
Exam maneuvers that stress the joint and reproduce your pain, X-ray or MRI that rules out the spine and hip, and most importantly a diagnostic injection into the joint that relieves most of the pain while the numbing medicine is working. The injection is done at our Elizabethtown clinic.
Do I have to go to Louisville for SI joint fusion?
Your evaluation, injections, pre-operative visit, follow-ups and physical therapy are all in Elizabethtown. The fusion is performed in the Louisville metro area, usually as an outpatient procedure, and you return to Elizabethtown for all follow-up care.
How long until I can walk normally?
Most patients use a walker or crutches for about three weeks, then progress over the next several weeks. Normal walking is typical by six to twelve weeks; full fusion takes months longer.
Can I have the injections and therapy in Elizabethtown?
Yes. Image-guided SI joint injections, radiofrequency ablation and physical therapy with Simon Hoehn, PT, DPT and Dovie Brown, PTA are all provided at the Westport Road clinic.
How soon can I be seen?
Same-day appointments are available Monday through Friday, 8 AM to 5 PM. Call 270-506-4888.