Tens of thousands of sacroiliac joint fusion surgeries are being performed each year in America. The potential number of future patients is thought to be massive due to new information showing that 15-30% of all low back pain is thought to be due to the sacroiliac joint. This translates into millions of people who could be eligible for one of these fusions. Industry clearly understands this and is currently manufacturing devices, costing approximately #10,000 per joint, for these surgeries. What started as one company creating such a device has exploded into more than 30 all searching for and hoping to see that “blue ocean” of endless financial return to make millions, if not billions. Complications with these surgeries do occur that include severe bleeding, neurological injury with paralysis, lasting morbidity, death, and countless others all numbering in the thousands. It is difficult to believe, but the surgeons implanting all these devices have not been formally trained to do so by their institutions or the national surgeon education societies leaving the very industry that manufacturers the devices, and their paid surgeon surrogates, as their primary teaching source. What is taught to the surgeons is what it takes to find patients to operate on and how to implant their specific devices. Since there are no questions on these types of patients or the fusions performed on them by America’s national board examiners, we might conclude that no surgeons in our country are board certified to be doing these surgeries. The current surgical approach used for the majority of fusions on the sacroiliac joint, which was achieved through industry’s manipulation of a profitable FDA loophole, just happens to be the one considered by many spine surgeons to be the least safe and most tissue damaging of all the available approaches.
Only in our “for profit” American capitalistic health care system can we find such a conflict of interest being tolerated and ignored by the very institutions that train surgeons, those that certify surgeon’s abilities, hospitals, insurance companies, and those institutions within our federal government tasked to keep all patients safe. Patients in this current paradigm, who suffer with chronic low back pain from their sacroiliac joint, are now simply pawns being used by industry to enhance their bottom line. When one examines what is really happening to this group of patients, it is a clear and detailed reflection of what is happening to patients across the whole landscape of health care in America today. This book goes into scrutinous detail on how we got to where we are and educates the reader on all how our societies, institutions, and industry bear the primary responsibility. Patients are being used and abused at every possible level in America’s “for profit” health care system. This book offers multiple suggestions as to how to address the many “sacroiliac pain problems” in America and offers the important steps we need to take as the culture of America to put the patient back at the top of the health care pyramid, and provide the safest surgeries possible when they are needed.

One of our SIMEG members, Dr. Clement M.L. Werner, has published a book on patient education. I read Dr. Dall's latest book and realized that patient education is an important endeavor.

This small book explains the sacroiliac joint in simple language and is clearly illustrated. Especially the pain area is helpful for patients to consider their condition. Pages 73-75 are novel in describing how to manage residual symptoms after sacroiliac fusion surgery. It contained useful information for us medical specialists as well.

As a SIMEG project, I thought it was important to create such a simple book for patients, medical students, and physicians.

Daisuke Kurosawa

John Stark, MD

Solving The Enigma of he Safe Sacroiliac Fusion: Clinical Appreciation of the Sacroiliac joint Problem

Volume I: History, clinical elements and indications
Volume II: Technical elements, physiologic and anatomic considerations
Volume III: Pricese execution of safe methods, operative and perioperative management, salvage and rescue