Many patients suffering from chronic sacroiliac (SI) joint pain are told the joint itself is the problem. However, for a significant number of patients, the true source of pain is irritation of the middle cluneal nerves—small sensory nerves that transmit pain signals from the SI joint region to the brain.
In this video, Dr. Demetrio Aguila, pain-focused peripheral nerve surgeon, explains how these nerves exit the sacrum and why treatments such as steroid injections or radiofrequency ablation often provide only short-term relief. While injections temporarily numb the nerves, they do not address the underlying nerve pathology.
Dr. Aguila also discusses middle cluneal nerve surgery, also known as SI joint denervation, and explains the difference between traditional open surgery and a minimally invasive endoscopic approach. Using small incisions and a specialized camera, the endoscopic technique allows surgeons to precisely disconnect the pain-transmitting nerves without extensive muscle disruption—often resulting in faster recovery and lasting pain relief.
Patients who experience temporary relief from SI joint injections, persistent low back or buttock pain, or repeated treatment failures may be candidates for middle cluneal nerve surgery.
If SI joint pain continues to limit your quality of life, a nerve-focused evaluation may help identify the true cause—and the right solution.
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