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Deciding whether or not a patient needs surgery is a very common discussion. The majority of patients I see have musculoskeletal problems and must be treated as such with conservative therapy. However, those who “fail” conservative therapy must be submitted to a series of tests to determine the diagnosis for SI joint dysfunction or another cause of the pain.
Typically, the first phase of the diagnostic process is a series of provocative maneuvers to determine the source of pain and rule out other core problems. In my practice, I’m a big believer in steroidal or therapeutic serial injections into the SI joint. When the injection numbs or eliminates the pain completely and I can duplicate the effect at least three times, I know that is a strong indicator for SI joint dysfunction.
Once diagnosed properly, the decision for surgery is a personal discussion between patient and doctor. Deciding whether or not to have surgery ultimately depends on the patient’s lifestyle. If a patient feels they can maintain their current lifestyle through conservative therapy, I recommend they continue with conservative treatment.