SI Joint Fusion in Louisville, KY

SI Joint Fusion is a minimally invasive procedure that uses small lateral incisions, titanium iFuse implants, and same-day discharge to stabilize the sacroiliac joint and eliminate chronic SI joint pain. Dr. David McConda — AOSpine course faculty who teaches minimally invasive SI joint fusion technique to other surgeons — and Dr. Michael Casnellie lead Aptiva Health's SI joint fusion program in Louisville, Kentucky. The sacroiliac joint is responsible for an estimated 20 to 25 percent of chronic low back pain and is one of the most commonly missed diagnoses in spine care. Medically reviewed by David McConda, MD, Michael Casnellie, MD, and Steven Ganzel, DO — May 2026.

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SI Joint Fusion — Stabilizing the Joint That Connects Your Spine to Your Pelvis

The sacroiliac (SI) joint is the strong, weight-bearing joint where the bottom of your spine (the sacrum) meets the back of your pelvis (the iliac bone). You have two of them — one on each side — and together they transfer the entire load of your upper body to your hips and legs every time you stand, walk, climb stairs, or get out of a chair.

When the SI joint becomes painful, dysfunctional, or unstable — from injury, arthritis, pregnancy, prior lumbar fusion, or simple wear and tear — the result is chronic lower back, buttock, hip, or groin pain that often gets misdiagnosed as a lumbar disc problem, sciatica, or hip pain. Many SI joint patients live with the pain for years before getting the right diagnosis.

SI joint fusion is the surgical solution when conservative care has failed. The procedure stabilizes the SI joint by placing titanium implants across it, eliminating the abnormal motion that generates pain. Over the following months, bone grows directly into the porous surface of the implants for a permanent biological fusion.

At Aptiva Health in Louisville, SI joint fusion is performed using the iFuse Implant System — a set of three triangular titanium implants engineered specifically for the sacroiliac joint. The procedure is done through a small lateral incision under continuous fluoroscopic guidance, takes about an hour, and most patients go home the same day.

SI joint fusion does not fuse any part of your spine itself. The vertebrae continue to move normally afterward. Only the sacroiliac joint — which is meant to have very little motion in the first place — is locked in place.

Conditions We Treat With SI Joint Fusion

SI joint fusion is reserved for patients with chronic, confirmed sacroiliac joint pain that has not responded to a structured course of conservative and interventional care. The most common indications include:

• Chronic SI joint dysfunction — pain from abnormal motion or alignment of the sacroiliac joint, lasting six months or longer

• Post-traumatic SI joint pain — sacroiliac joint injuries from auto accidents, falls, or other trauma; one of the most common causes of SI joint pain in working-age adults

• SI joint arthritis and degeneration — wear-and-tear breakdown of the cartilage in the joint over time

• Post-pregnancy SI joint instability — sometimes called pelvic girdle pain; pregnancy hormones loosen pelvic ligaments and the SI joint sometimes does not fully restabilize after delivery

• Adjacent-segment SI joint dysfunction after lumbar fusion — approximately 30 to 40 percent of patients who have had a lumbar fusion will eventually develop SI joint dysfunction because the fusion transfers additional mechanical stress to the SI joint

• Sacroiliitis from inflammatory arthritis — selected cases of ankylosing spondylitis or psoriatic arthritis with severe joint destruction

• Work injuries involving the SI joint, especially in occupations involving repetitive lifting, bending, or twisting

The SI joint is one of the most commonly missed diagnoses in spine care because its pain pattern mimics so many other conditions. Not sure if your back pain is an SI joint problem, a lumbar disc problem, or a hip problem? Compare options on our Spine Surgery Louisville, Microdiscectomy Louisville, and Laminectomy Louisville pages, or get evaluated by an Aptiva spine provider.

Minimally Invasive iFuse vs. Traditional Open SI Arthrodesis — and When to Choose Surgery

Minimally Invasive SI Joint Fusion (What Aptiva Performs)

• Small lateral incision approximately 1 to 2 inches

• Three triangular titanium iFuse implants placed across the joint

• No separate bone graft harvest required — porous titanium surface promotes biological bone ingrowth

• C-arm fluoroscopic image guidance throughout

• Outpatient — same-day discharge for most patients

• Surgery time: approximately one hour

• Walking same day with walker or crutches

• Full weight-bearing within a few weeks for most patients

• Return to desk work: 1 to 2 weeks

• Return to physical labor: 12 to 16 weeks

Traditional Open SI Joint Arthrodesis (What Aptiva Does NOT Perform)

• Large posterior incision

• Significant bone graft harvested from the iliac crest (an additional source of post-op pain)

• Inpatient hospital stay required

• Months of non-weight-bearing historically required

• Higher rate of wound complications and longer overall recovery

• Largely replaced by minimally invasive techniques in modern spine practice

SI Joint Fusion vs. Continued Conservative or Injection Care

Most SI joint pain can be managed without surgery. Surgical fusion is reserved for patients who have:

1. Failed at least six months of structured conservative care — physical therapy with SI joint stabilization, anti-inflammatory medication, activity modification

2. At least one positive diagnostic SI joint injection confirming the SI joint as the pain generator (most surgeons want one or two confirmatory blocks)

3. Failed or short-lived response to therapeutic interventions — fluoroscopy-guided corticosteroid SI joint injections and often SI joint radiofrequency ablation (lateral branch RFA)

4. A clear clinical picture — pain centered at the SI joint, positive provocative SI joint exam tests, and SI joint–pattern symptoms

The bottom line: Aptiva's surgeons recommend SI joint fusion only when the diagnosis is confirmed and conservative options have been exhausted. For patients who still have meaningful options short of surgery, Dr. Steven Ganzel provides the full continuum of SI joint interventional pain procedures — many of which provide lasting relief and avoid the need for fusion entirely.

What to Expect From SI Joint Fusion Surgery

Before Surgery

• Comprehensive evaluation by your Aptiva spine surgeon, including pain mapping and provocative SI joint physical exam tests (Patrick/FABER, Gaenslen, thigh thrust, distraction, and compression maneuvers)

• Lumbar MRI and/or pelvic CT at Aptiva Health Imaging in Louisville to rule out other sources of pain such as lumbar disc herniation, spinal stenosis, or hip pathology

• One or two diagnostic SI joint injections performed under fluoroscopic guidance by Dr. Ganzel to confirm the SI joint as the pain generator

• Confirmation that conservative care has been exhausted (physical therapy, anti-inflammatories, activity modification, therapeutic SI joint injections, and typically SI joint radiofrequency ablation)

• Pre-operative consultation with your Aptiva spine surgeon to review imaging, symptoms, and surgical plan

• Medical clearance and pre-operative labs

• Fasting instructions per anesthesia protocol

• Arrange a ride home — you cannot drive yourself the day of surgery, and you'll need help at home for the first few days

Day of Surgery

• Arrive 1 to 2 hours before surgery start time at the outpatient ambulatory surgery center

• General anesthesia administered

• Patient positioned on the operative side

• Small lateral incision (approximately 1 to 2 inches) made over the affected SI joint

• Under continuous C-arm fluoroscopic guidance, three triangular titanium iFuse implants are placed across the SI joint, anchoring the sacrum to the ilium

• The porous titanium plasma spray coating on the implants is designed to allow bone to grow directly into the implant surface for long-term biological fusion

• Incision closed in layers

• Total surgical time: approximately one hour

• 2 to 3 hours in post-anesthesia recovery

• Discharge home the same day for most patients

• You will leave with a walker or crutches

After Surgery

• Walking with walker or crutches the same day of surgery

• Partial weight-bearing on the operative side for approximately 2 to 3 weeks (many patients progress rapidly to full weight-bearing)

• Most patients report meaningful relief of SI joint pain within the first few weeks

• Pain medication tapered as tolerated

• Desk work: typically 1 to 2 weeks

• Driving: typically 2 to 3 weeks (once off narcotic pain medication and you can safely operate the pedals)

• Light exercise: 6 to 8 weeks

• Physical labor and high-impact activity: 12 to 16 weeks

• Bone-to-implant fusion continues to mature over 6 to 12 months

• Post-operative follow-up at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months

• Post-operative physical therapy at Aptiva typically begins around 2 to 4 weeks

Why Choose Aptiva Health for Your SI Joint Fusion

A surgeon who teaches this procedure nationally. Dr. David McConda is fellowship-trained at OrthoCarolina Spine Center through the AOSpine North America Spine Surgery Fellowship — the program of AOSpine, the international foundation that sets clinical standards for spine surgery worldwide. He also serves as AOSpine course faculty teaching minimally invasive SI joint fusion technique to other surgeons. When you have your SI joint fusion at Aptiva Health, you're being treated by a surgeon who trains other surgeons in this exact procedure.

Decades of Louisville spine experience. Dr. Michael Casnellie has been treating spine patients in Louisville since 2005 and is one of the most experienced spine surgeons in Kentucky.

Minimally invasive technique only. Aptiva does not perform traditional open SI joint arthrodesis. All SI joint fusions at Aptiva are performed using the minimally invasive lateral approach with the iFuse Implant System — small incision, image guidance, outpatient setting, rapid return to weight-bearing.

A dedicated spine team. Spine and SI joint care isn't a side specialty at Aptiva — it's a focus. Our Louisville team includes board-certified spine and orthopedic surgeons, an interventional pain physician, and dedicated PAs and an NP who care for spine and SI joint patients every day.

The full SI joint diagnostic and treatment continuum. Dr. Steven Ganzel, our interventional pain specialist, performs diagnostic and therapeutic SI joint injections, SI joint lateral branch blocks, and SI joint radiofrequency ablation — non-surgical procedures that confirm the diagnosis and often provide lasting relief that avoids the need for fusion entirely.

Honest guidance — fusion only when conservative care has failed. Most SI joint pain can be effectively managed without surgery. We recommend SI joint fusion only after the diagnosis has been confirmed with positive diagnostic injections and conservative care has been fully exhausted.

Fast access. Most patients see an Aptiva spine provider within days of calling. Stop waiting weeks for an answer.

One team, start to finish. From your first call to your final post-op visit, you'll work with the same Aptiva team. We handle insurance verification, scheduling, and post-op care in-house.

Cash-pay options available. For patients without insurance — or with high deductibles — we offer transparent, all-inclusive cash-pay pricing for SI joint fusion that includes the surgeon, facility, anesthesia, and post-operative visits. No surprise hospital bills.

Schedule your appointment today!

Your Louisville Spine Care Team

At Aptiva Health, your spine and SI joint care is delivered by a team of board-certified surgeons and advanced practice providers who focus on the diagnosis, treatment, and follow-up of conditions of the spine and sacroiliac joint — including SI joint dysfunction, spinal stenosis, herniated discs, sciatica, and degenerative spine conditions.

Insurances Accepted

Aptiva Health accepts most major insurance plans, Medicare, Medicaid Managed Care, workers' compensation, and auto insurance (PIP and Medpay). We verify benefits and provide a clear cost estimate before surgery.

Minimally invasive SI joint fusion using the iFuse Implant System is a well-established procedure covered by Medicare and most major commercial insurance plans when medically necessary. Coverage typically requires documentation of failed conservative care, positive diagnostic SI joint injections, and a clinical picture consistent with SI joint pain.

For patients paying out of pocket, we offer transparent, bundled cash-pay pricing for SI joint fusion that includes the surgeon, facility, anesthesia, and post-operative visits — no surprise itemized hospital bills.

Call 502-414-0036 to verify your insurance or request a cash-pay quote.

Ready for Relief From Chronic SI Joint Pain?

If you've been suffering with chronic lower back, buttock, hip, or groin pain — especially pain that's worse with sitting, climbing stairs, getting in and out of a car, or rolling over in bed — and conservative care hasn't worked, it's time to talk to Aptiva's spine team about whether SI joint fusion is right for you.

Schedule a Consultation in Louisville — Schedule Now

Aptiva Health - Spine Center of Excellence 3615 Newburg Road, Suite 101, Louisville, KY 40218 Phone: 1-844-999-3627 (DOCS) | Direct: 502-414-0036

Additional Louisville locations also serving spine and SI joint patients:

• Louisville East - 10100 Linn Station Road, Suite 1A, Louisville, KY 40223 - Tel: 502-465-8254

• Louisville Downtown - 300 South 13th Street, Louisville, KY 40203 - Tel: 502-583-1011

• Louisville Imaging - 3615 Newburg Road, Suite 106, Louisville, KY 40218 - Tel: 502-465-8254

• Louisville Middletown - 401 N English Station Road, Suite 1A, Louisville, KY 40223 - Tel: 502-465-8254

• Concussion & Sports Medicine Institute (on-site MRI) - 3611 Newburg Road, Louisville, KY 40218 - Tel: 502-465-8254

Elizabethtown location serving spine and SI joint patients:

• Aptiva Health Orthopedics — Elizabethtown - 529 Westport Road, Suite 2, Elizabethtown, KY 42701 - Tel: 270-512-5480

Mt. Washington location serving spine and SI joint patients:

• Aptiva Health Orthopedics — Mt. Washington - 737 N Hwy 31e Bypass, Suite 2, Mt. Washington, KY 40047 - Tel: 502-465-8254

SI Joint Fusion: Frequently Asked Questions

What is SI joint fusion?

SI joint fusion is a surgical procedure that stabilizes the sacroiliac joint — the joint where the bottom of the spine (sacrum) meets the pelvis (ilium) — to eliminate painful abnormal motion. The procedure places titanium implants across the joint to lock the sacrum and ilium together. Over the following months, bone grows into the porous titanium surface to create a permanent biological fusion. At Aptiva Health in Louisville, SI joint fusion is performed using the iFuse Implant System through a small lateral incision under fluoroscopic guidance on an outpatient basis.

What conditions does SI joint fusion treat?

SI joint fusion is used to treat chronic sacroiliac joint pain caused by SI joint dysfunction that has not responded to at least six months of conservative care. The most common indications are post-traumatic SI joint pain (after a car accident or fall), SI joint arthritis and degeneration, post-pregnancy SI joint instability (pelvic girdle pain), adjacent segment SI joint dysfunction that develops after a previous lumbar fusion, and selected cases of sacroiliitis from inflammatory arthritis. The SI joint is responsible for approximately 20 to 25 percent of chronic low back pain and is often misdiagnosed as lumbar disc or facet pain.

How do I know if my SI joint is actually the source of my pain?

SI joint pain is notoriously difficult to diagnose because it mimics lumbar disc pain, sciatica, hip pain, and piriformis syndrome. Diagnosis at Aptiva Health follows a structured pathway: a focused history (pain location typically in the lower back, buttock, and sometimes back of the thigh), provocative physical exam tests (Patrick or FABER, Gaenslen, thigh thrust, distraction, and compression maneuvers), MRI or CT to rule out other causes, and most importantly, one or two diagnostic SI joint injections under fluoroscopic guidance. Significant pain relief immediately after an SI joint injection of local anesthetic confirms the SI joint as the pain generator.

Is SI joint fusion an outpatient procedure?

Yes. At Aptiva Health in Louisville, minimally invasive SI joint fusion is performed in an outpatient ambulatory surgery center. Patients arrive in the morning, undergo surgery lasting approximately one hour, recover for two to three hours, and are discharged home the same day. This is a significant change from traditional open SI joint arthrodesis, which historically required several days in the hospital and months of non-weight-bearing.

Am I a candidate for SI joint fusion?

SI joint fusion is generally considered when a patient has chronic lower back, buttock, or hip pain confirmed to originate from the SI joint, and at least six months of conservative care has failed to provide lasting relief. Conservative care typically includes physical therapy with SI joint stabilization, anti-inflammatory medication, fluoroscopy-guided SI joint injections, and often SI joint radiofrequency ablation. Candidates must have at least one positive diagnostic SI joint injection confirming the SI joint as the pain generator. A consultation with Dr. McConda or Dr. Casnellie determines whether SI joint fusion is appropriate.

How long does SI joint fusion surgery take?

The SI joint fusion procedure itself typically takes about one hour. Including pre-operative preparation, anesthesia, and post-anesthesia recovery, most patients are at the surgical facility for four to six hours before being discharged home the same day.

How long is the recovery after SI joint fusion?

Most patients begin walking with a walker or crutches the same day as surgery. Partial weight-bearing on the operative side is typically maintained for two to three weeks, with rapid progression to full weight-bearing for many patients. Desk work typically resumes within one to two weeks. Driving generally resumes within two to three weeks once off narcotic pain medication. Light exercise resumes around six to eight weeks. Physical labor and high-impact activity typically resume at twelve to sixteen weeks. Bone-to-implant fusion continues to mature for six to twelve months after surgery.

What is the success rate of SI joint fusion?

Published peer-reviewed studies of minimally invasive SI joint fusion using the iFuse Implant System report patient satisfaction rates of approximately 80 to 90 percent in properly selected patients, with significant reductions in pain scores and meaningful improvements in disability scores at one, two, and five years after surgery. Two-year patient satisfaction in clinical trials has reached 88 percent. Outcomes are most predictable when the procedure is performed by a fellowship-trained spine surgeon on patients who have a clear diagnosis of SI joint pain confirmed by positive diagnostic injections.

What is the iFuse Implant System?

The iFuse Implant System (manufactured by SI-BONE) is a set of triangular titanium implants designed specifically to stabilize and fuse the sacroiliac joint. The triangular cross-section resists rotation across the joint, and the porous titanium plasma spray coating allows bone to grow directly into the implant surface for long-term biological fusion. Typically three iFuse implants are placed across the SI joint during the procedure. The iFuse system has been supported by more than 80 published peer-reviewed articles demonstrating its safety, effectiveness, and durability.

What is the difference between minimally invasive SI joint fusion and traditional open SI arthrodesis?

Traditional open SI joint arthrodesis required a large incision, significant bone harvesting from the iliac crest, an inpatient hospital stay, and several months of non-weight-bearing recovery. Minimally invasive SI joint fusion uses a small lateral incision (approximately one to two inches), no separate bone graft harvesting, fluoroscopic image guidance, and an outpatient ambulatory surgery setting. Recovery is dramatically faster, with most patients discharged the same day and progressing to full weight-bearing within a few weeks. Aptiva Health exclusively performs the minimally invasive technique.

Will my insurance cover SI joint fusion?

Most major commercial insurance plans, Medicare, and workers' compensation cover medically necessary minimally invasive SI joint fusion when documented diagnostic and conservative care criteria are met. Aptiva Health accepts most major insurance plans, Medicare, Medicaid Managed Care, workers' compensation, and auto insurance (PIP and Medpay). Our team verifies benefits and provides a clear cost estimate before surgery. We also offer transparent, bundled cash-pay pricing that includes the surgeon, facility, anesthesia, and post-operative visits.

Who performs SI joint fusion at Aptiva Health in Louisville?

Minimally invasive SI joint fusion at Aptiva Health Spine in Louisville is performed by Dr. David McConda and Dr. Michael Casnellie — both board-certified orthopedic spine surgeons. Dr. McConda is fellowship-trained at OrthoCarolina Spine Center through the AOSpine North America Spine Surgery Fellowship and serves as course faculty teaching minimally invasive SI joint fusion technique to other surgeons. Dr. Casnellie has been performing spine surgery in Louisville since 2005. The full Aptiva spine team — including Dr. Steven Ganzel for diagnostic SI joint injections and SI joint radiofrequency ablation, plus Kayla Troutman, PA-C, David Koonce, DNP, and Michael Gilbert, PA-C — supports evaluation, surgical care, and post-operative follow-up.

Can SI joint pain develop after a previous lumbar fusion?

Yes. Approximately 30 to 40 percent of patients who have had a previous lumbar fusion will eventually develop SI joint dysfunction. This is because lumbar fusion eliminates motion at the fused spinal levels, which transfers additional mechanical stress to the next mobile segment below the fusion — the SI joint. Aptiva Health's spine team commonly evaluates and treats SI joint pain in patients who have had previous lumbar fusion surgery, including patients whose original fusion was performed elsewhere.

Questions? Call us today! 502-909-0772