Approach Considerations in Sacroiliac Joint Fusion Among Patients with BMI > 47

Sacroiliac joint (SIJ) dysfunction accounts for 15–30% of chronic low back pain. Patients with a history of prior lumbar fusion, trauma, leg length discrepancy or compensatory gait alterations are particularly susceptible to SIJ instability. Once diagnosed, and after failure of conservative measures, patients may be considered for MIS SIJ fusion procedures.2 Surgical approaches have emerged, posterior allograft and lateral transfixing implant.  There is limited evidence on outcomes in patients with severe obesity (BMI > 47).