General Guideline Principles for Sacroiliac
Surgery for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Sacroiliac Surgery.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Sacroiliac Surgery of Therapeutic Procedures: Operative

Sacroiliac joint fusion is not included on the list of pre-authorized procedures. Providers who want to perform one of these procedures must request preauthorization from the carrier before performing the procedure.

Sacroiliac Surgery

Sacroiliac Surgery is recommended for some patients as prescribed by the doctor. Pain in the lower back and buttocks that radiates to the lower hip, groyne, or upper thigh is a common symptom of sacroiliac (SI) joint pain.

Although the pain is typically on one side, it can also be on the other. Sitting, standing, sleeping, walking, or climbing stairs may make symptoms worse. Sitting or sleeping on the affected side frequently causes pain in the SI joint.

Some people find it challenging to stand, sit, or walk for extended periods of time or ride in a car. Moving from a sitting to a standing position, standing on one leg, or climbing stairs might make pain worse.

Before assuming the SI joint is the source of the discomfort, other possible causes, such as the lumbar spine or hip, must be eliminated.

SI joint fusion may be considered when all of the following criteria are met:

  1. The pain is centred over the posterior sacroiliac joint, caudal to the lumbar spine (L5 vertebra), and consistent with sacroiliac joint pain.


  2. The discomfort is at least 5 on a scale of 0 to 10, negatively affects quality of life, or interferes with everyday activities, and


  3. There are no symptoms of generalised pain illnesses like fibromyalgia or widespread pain behaviours like somatoform disorder;


  4. Patient has attempted and failed at least six months of comprehensive nonoperative therapy, which must involve medication optimization, activity modification, bracing, and active therapeutic exercise directed at the lumbar spine, pelvis, sacroiliac joint, and hip, as well as a home exercise regimen;


  5. On physical examination, the sacral sulcus (Fortin’s point) is localizedly tender on palpation, and there are no other areas of the body that are painful to the same degree; and


  6. There is a positive reaction to at least three of the provocative tests listed below (for example,


    • thigh thrust test


    • compression test


    • Gaenslen sign


    • distraction test


    • Patrick test


    • Posterior provocation test); and


  7. ALL of the following diagnostic imaging investigations are included:

    The existence of destructive lesions (such as tumours, infections, or inflammatory arthropathy) or sacroiliac joint arthropathy is ruled out by conventional radiography, computed tomography, or magnetic resonance imaging;

    A pelvic anteroposterior plain radiograph excludes concurrent hip disease; and

    To rule out neural compression or other problems with the lumbar spine, computed tomography or magnetic resonance imaging is performed. It is important to rule out possibility of a degenerative ailment producing low back or buttock pain; and

    Imaging of the sacroiliac joint reveals signs of damage and/or deterioration; and


  8. Using an image-guided, contrast-enhanced, intra-articular sacroiliac joint injection, diagnostic injections were carried out on two consecutive occasions; they showed at least a 75% reduction in pain throughout the anticipated duration of the anaesthetic; and


  9. There has been at least one trial of a corticosteroid injection into the sacroiliac joint for therapeutic purposes; and


  10. A doctor with training in orthopaedic spine surgery or neurosurgery performs the procedure; and


  11. The surgeon carrying out the procedure has either completed training specific to the procedure or has been given hospital privileges to carry out the particular type(s) of sacroiliac joint surgery(ies) being considered. With the possibility of SI joint fusion


    • as a supplement to medical care for sepsis or sacroiliac joint infection; or


    • pelvic ring fracture and serious traumatic injury; Or


    • when performing lumbar spine fusion surgeries, which are deemed medically required, multisegment spinal constructions are extended to the sacrum/ilium.

What our office can do if you have workers compensation injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.


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Dr. Nakul Karkare

I am fellowship trained in joint replacement surgery, metabolic bone disorders, sports medicine and trauma. I specialize in total hip and knee replacements, and I have personally written most of the content on this page.

You can see my full CV at my profile page.