Sacroiliac Joint Surgery · Naples & Fort Myers, FL
SI Joint Fusion —
Treating the Pain
Most Surgeons Miss
Sacroiliac dysfunction is a real diagnosis — and when it is correctly identified, SI joint fusion is one of the most reliably successful procedures in spine surgery. Dr. Katsevman performs minimally invasive lateral SI fusion using the TORQ screw system through a 3cm incision, with intraoperative CT to confirm perfect placement. Same-day discharge. Life-changing results for the right patient.
"When we make the right diagnosis, SI joint fusion patients are some of the happiest patients I have. Years of undiagnosed pain, correctly identified, correctly treated — the relief is remarkable."
Dr. G. Katsevman, MD · Neurosurgeon & Spine Surgeonminimally invasive
titanium screws
placement before waking
hospital stay required
augmentation available
The diagnosis most doctors miss
SI joint dysfunction is real —
and it is treatable.
The sacroiliac joint connects the sacrum — the triangular bone at the base of the spine — to the iliac bones of the pelvis. When this joint becomes inflamed, hypermobile, or degenerated, it can cause deep, debilitating pain in the lower back, buttock, and hip. The problem: it is frequently mistaken for lumbar disc disease, hip arthritis, or piriformis syndrome and never correctly identified.
"Many doctors don’t even believe SI dysfunction is a real diagnosis."
It is a frustrating reality: a significant number of spine and orthopedic surgeons remain skeptical of sacroiliac dysfunction as a primary pain generator. Patients spend years being told their pain is from their lumbar discs, their hips, or is “functional” — undergoing treatments that never address the actual source.
SI dysfunction is well-documented in the medical literature as a cause of low back, buttock, and groin pain. Studies suggest it accounts for 15–25% of chronic low back pain cases. It is particularly prevalent after lumbar fusion (which transfers mechanical stress to the SI joint), after pregnancy, and after direct pelvic trauma.
Dr. Katsevman takes this diagnosis seriously — and has the clinical tools to confirm it before any surgery is considered. When the diagnosis is correct, SI joint fusion patients are among the most satisfied patients in the practice. The key is getting the diagnosis right first.
Symptoms & candidates
Could your pain be coming from the SI joint?
SI joint pain has a characteristic pattern. It is frequently confused with lumbar pathology because the pain location overlaps — but the quality, triggers, and response to specific exam maneuvers are distinct.
Deep Buttock or Lower Back Pain
Pain centered at the dimple of the lower back, just below the beltline, often one-sided. May radiate into the buttock, groin, or upper thigh — but rarely past the knee, distinguishing it from lumbar radiculopathy. Often described as a deep ache rather than electric or burning.
Pain with Positional Changes
Pain that spikes when transitioning between positions — sitting to standing, getting up from the toilet, climbing stairs, rolling over in bed, or getting in and out of a car. These shear and torsion forces load the SI joint specifically.
Post-Lumbar Fusion SI Pain
Adjacent segment disease of the SI joint — when lumbar fusion transfers mechanical stress downward to the sacroiliac joint, accelerating its degeneration. One of the most common and under-recognized consequences of multi-level lumbar fusion.
Post-Pregnancy SI Dysfunction
Pregnancy causes significant hormonal laxity of the pelvic ligaments to allow delivery. In some women, this laxity persists, causing chronic SI hypermobility and pain. Often dismissed or attributed to “normal post-partum recovery” for years before being correctly identified.
Failed Back Surgery with Persistent Buttock Pain
Patients who have had lumbar spine surgery with persistent or new-onset buttock and lower back pain should be evaluated for SI dysfunction. Surgery changes the biomechanics of the lumbar-pelvic junction, and the SI joint is frequently the next structure to become symptomatic.
Positive Exam Maneuvers + Confirmed by Injection
The SI joint cannot be definitively diagnosed by imaging alone. Positive provocative exam maneuvers — FABER, thigh thrust, compression, distraction, and Gaenslen’s test — combined with two confirmatory diagnostic SI joint injections, both providing significant pain relief, is the gold standard before any surgical consideration.
Confirming the diagnosis
Getting the diagnosis right before surgery
No patient should have SI joint fusion without a rigorous diagnostic workup. Dr. Katsevman uses a structured two-step process to confirm the SI joint is truly the primary pain generator before any surgical conversation begins.
Step 1 — Clinical Examination
A series of targeted provocative physical exam maneuvers that stress the SI joint specifically: FABER (flexion, abduction, external rotation), thigh thrust (posterior shear), compression, distraction, and Gaenslen’s test. Three or more positive maneuvers has strong predictive value for SI joint involvement as the pain source. Imaging (X-ray, CT, MRI) is used to rule out other causes but is the least reliable tool for confirming SI dysfunction — the exam and the injection are what matter.
Step 2 — Two Diagnostic Injections
A fluoroscopy-guided or CT-guided injection of local anesthetic directly into the SI joint, performed by a pain management specialist. If the patient experiences ≥50–75% relief of their typical pain for the duration of the anesthetic, the SI joint is confirmed as a primary pain source. But Dr. Katsevman requires this to be demonstrated twice — on two separate occasions.
Why two injections? A single positive injection could reflect placebo effect, anesthetic spread to adjacent structures, or coincidental relief. A second confirmatory injection that also produces significant relief removes that uncertainty. Dr. Katsevman will not take a patient to the operating room based on one shot alone. This is about doing the right surgery on the right patient — not guessing.
When both diagnostic injections are positive, the patient and Dr. Katsevman have genuine confidence that the SI joint is the pain generator, and that permanently stabilizing it is the right surgical answer. This is why the outcomes are so good — the diagnosis was confirmed rigorously before any surgical decision was made.
The procedure
How minimally invasive SI fusion works
SI joint fusion stabilizes the sacroiliac joint by creating a rigid bone bridge across it — eliminating the abnormal motion and inflammation that generate the pain. Dr. Katsevman performs this through a lateral approach using the TORQ screw system: the hardware with the most clinical data in SI fusion.
A 3cm lateral incision — direct access, minimal disruption
The patient is positioned face-down (prone). A single 3cm incision is made laterally over the buttock — providing direct access to the sacroiliac joint from the side. This lateral approach allows precise screw trajectory across the SI joint into the sacrum without disturbing the major posterior gluteal muscles or the neurovascular structures of the pelvis.
Fluoroscopic imaging guides every step of the procedure, confirming the entry point and screw trajectory in real time. The surgical field is small. Blood loss is minimal. No drain is required.
TORQ screws — stabilize, harvest, and fuse simultaneously
Three TORQ SI bone screws are placed across the sacroiliac joint under fluoroscopic guidance. The TORQ system is unique:
Self-harvesting design — as each screw is advanced across the SI joint, it collects bone graft from the cortical and cancellous bone it passes through. This autograft bone material is deposited at the joint surface, providing a natural biological fusion stimulus — without the need for a separate bone graft harvest from the hip (donor-site morbidity eliminated entirely).
Three-screw construct — the three screws span the SI joint in a triangulated configuration, providing rotational control, shear resistance, and compression across the joint in all planes. This multi-point fixation is why the TORQ system has the most robust biomechanical and clinical outcome data of any lateral SI fusion system available.
The screws are placed one at a time under live fluoroscopic control, with each position confirmed before advancing to the next level.
Intraoperative CT — confirming perfect placement before waking
After all three TORQ screws are placed, Dr. Katsevman performs an intraoperative CT scan — while the patient is still under anesthesia. This real-time 3D imaging confirms the precise position of every screw: correct trajectory across the SI joint, adequate bone purchase, no encroachment on the neural foramen or neurovascular structures.
Most surgeons performing SI fusion do not take an intraoperative CT. They rely on fluoroscopy alone — a 2D imaging modality that cannot provide the full three-dimensional confirmation of screw position that CT delivers. If any screw position needs adjustment, it is corrected while the patient is still on the table — before they wake up, before they begin recovery, before any potential complication becomes a post-operative problem.
This single step — which adds minutes to the procedure — is one of the most meaningful quality-of-care distinctions in how Dr. Katsevman performs SI joint fusion versus the standard of care at most practices.
PRP — biologic support for fusion and recovery
At the conclusion of surgery, Dr. Katsevman can deliver Platelet-Rich Plasma (PRP) — concentrated growth factors from the patient’s own blood — to two targeted sites:
Through the screw — PRP can be injected down the cannulated center of the TORQ screw directly into the SI joint space, delivering growth factors and anti-inflammatory proteins to the fusion site itself. This provides a biological stimulus for bone healing and fusion consolidation alongside the mechanical fixation of the screws.
Into the incision — PRP applied to the surgical wound at closure promotes soft-tissue healing, reduces post-operative inflammation, and minimizes scar formation at the incision site.
PRP is derived entirely from the patient’s own blood — no synthetic additives, no rejection risk. Clinical data shows 36% back pain reduction at 12 months and 73% disability improvement with PRP in lumbar spine patients. It is currently off-label for SI fusion and is offered as an optional patient-elected add-on, not covered by insurance.
What sets this practice apart
Not all SI fusion is performed the same way
Multiple SI fusion implant systems exist. The TORQ lateral screw system from SI-BONE has the most published clinical outcome data of any lateral SI fusion hardware. Dr. Katsevman chose it specifically because the evidence supports it — not because of marketing. Three self-harvesting screws, triangulated fixation, no separate bone graft harvest, same-day discharge. This is the hardware that gives patients the best documented chance of durable pain relief and solid fusion.
Dr. Katsevman takes an intraoperative CT scan after every SI joint fusion — while the patient is still asleep. This provides full three-dimensional confirmation of screw position before the patient begins recovery. Most surgeons performing SI fusion do not do this — relying on fluoroscopy alone, which cannot give the same positional certainty. If any adjustment is needed, it happens in the OR — not in a revision surgery weeks later.
Dr. Katsevman requires two positive diagnostic injections — on two separate occasions, each producing ≥50–75% relief — plus positive provocative exam maneuvers (FABER, thigh thrust, compression, distraction, Gaenslen’s), before surgical consideration. One injection is not enough. No guessing.
This two-injection standard exists because Dr. Katsevman wants to be certain he is doing the right surgery for the right diagnosis. A single positive injection could be coincidental. Two positive injections, on separate days, with consistent relief of the patient’s typical pain — that is confirmation. The outstanding outcomes SI fusion patients achieve are a direct result of this diagnostic discipline.
The TORQ screw’s cannulated design allows PRP to be delivered directly into the SI joint space through the screw itself at the end of the case. This is a technique that delivers concentrated healing growth factors exactly where fusion is occurring — potentially accelerating bone consolidation and reducing post-operative joint pain. Combined with incision-site PRP for wound healing, this optional biologic augmentation adds a regenerative dimension to an already proven mechanical construct.
Common questions
What patients ask most
How do I know if my pain is from the SI joint? +
SI joint pain typically presents as deep pain at the base of the spine or in the buttock, usually one-sided, that radiates into the groin or upper thigh but rarely past the knee. It is often worst with positional transitions — sitting to standing, getting up from the toilet, climbing stairs, or rolling over in bed. The diagnosis is confirmed through a combination of physical exam maneuvers — FABER, thigh thrust, compression, distraction, and Gaenslen’s test — and two fluoroscopy-guided diagnostic injections, both of which must provide significant temporary relief before surgery is considered. If you have had lumbar spine surgery and developed new or worsening lower back and buttock pain, the SI joint should be evaluated.
Is SI joint dysfunction a real diagnosis? +
Yes — absolutely. This is a source of frustration for many patients who have been dismissed or told their pain has no structural basis. Sacroiliac dysfunction is well-documented in peer-reviewed medical literature as a cause of 15–25% of chronic low back pain. It has defined clinical criteria (FABER, thigh thrust, compression, distraction, Gaenslen’s), validated diagnostic tests, and evidence-based surgical treatment. The skepticism some physicians express reflects a gap in training and exposure to this diagnosis — not a lack of evidence for its existence. Dr. Katsevman takes this diagnosis seriously and has seen the outcomes when it is correctly identified and treated.
What is the TORQ system and why does Dr. Katsevman use it? +
The TORQ system is a lateral SI joint fusion system from SI-BONE that uses three titanium screws placed across the SI joint from the side. Its key features are: self-harvesting design (the screw collects autograft bone as it advances, eliminating the need for a separate hip graft), triangulated three-screw construct (rotational control in all planes), and the largest published clinical outcome dataset of any lateral SI fusion hardware. Dr. Katsevman selected the TORQ system because the evidence base supports it — not for marketing reasons. For patients undergoing SI fusion, hardware selection matters, and choosing the system with the most clinical data is the right call.
Why does Dr. Katsevman take an intraoperative CT? +
After placing all three screws, Dr. Katsevman performs a CT scan while the patient is still asleep. CT provides three-dimensional confirmation of screw position — exact trajectory across the SI joint, bone purchase, and clearance from the neural foramen and blood vessels — that fluoroscopy (the 2D imaging used intraoperatively) cannot fully provide. If any screw needs repositioning, it is done on the table before the patient wakes up. Most SI fusion surgeons do not take an intraoperative CT. This additional step, which adds only minutes to the surgery, is one of the clearest ways Dr. Katsevman sets a higher standard for this procedure.
What is recovery like after SI joint fusion? +
Most patients go home the same day as surgery. Protected weight-bearing with a walker or crutches is typical for the first 2–4 weeks while the bone begins to consolidate around the screws. Most patients can transition to full weight-bearing within 4–6 weeks. Return to light activity and desk work is typically 2–4 weeks. Bone fusion consolidates over 3–6 months, and the full benefit of surgery is often felt at the 3–6 month mark. Most patients describe significant pain reduction beginning within the first few weeks as the mechanical stabilization of the joint takes effect.
Will insurance cover SI joint fusion? +
SI joint fusion is covered by most major insurance plans when medically indicated — criteria typically include documented SI joint pain, failure of conservative treatment (physical therapy, injections), and a positive diagnostic injection. The prior authorization process can be detailed and is specific to each insurer. Dr. Katsevman’s team will verify your benefits, build the prior authorization documentation, and navigate the process with you. PRP augmentation is off-label and not covered. We work with all insurance plans and are transparent about costs before any decisions are made.
"SI patients are some of the most rewarding to treat. They’ve often been dismissed for years, told their pain isn’t real or isn’t structural. When we make the right diagnosis and fix it, the gratitude is unlike anything else in spine surgery."
Gennadiy (Gene) A. Katsevman, MD
Neurosurgeon & Minimally Invasive Spine Surgeon
Performs minimally invasive lateral SI joint fusion using the TORQ screw system — the most clinically studied SI fusion hardware
Intraoperative CT scan on every SI fusion case to confirm screw placement before patient wakes
Requires two positive diagnostic injections (≥50–75% relief each, on separate occasions) plus positive FABER, thigh thrust, compression, distraction & Gaenslen’s maneuvers — no guessing before surgery
PRP biologic augmentation available through the TORQ screw and at incision closure (optional)
Fellowship-trained at Barrow Neurological Institute under Dr. Juan Uribe — minimally invasive spine surgery
30+ peer-reviewed publications in spine surgery and neurosurgery
Naples Top Doctor in Neurosurgery — 2024, 2025, and 2026
5-star Google rating · Healthgrades Choice Provider · WebMD Preferred Provider
Offices in Naples & Fort Myers · Telemedicine second opinions available
Take the next step
Could your pain be
coming from the SI joint?
If you have deep buttock or lower back pain that has not been explained by your MRI or prior treatments, schedule a consultation with Dr. Katsevman. A thorough clinical evaluation — in person or by telemedicine — is the first step toward the right diagnosis.
6101 Pine Ridge Road #101
Naples, FL 34119
Fort Myers, FL 33919
Available statewide & nationwide