Is There a Race to the Bottom in Sacroiliac Joint Fusion?
- Kingsley R Chin MD MBA
- 3 days ago
- 3 min read
A race creates mostly losers. A journey to improvement creates standards, fosters collaboration, and recognizes boundaries. Why the long road still matters.
Dr. Kingsley R. Chin MD, MBA
Professor, Orthopedic Spine Surgery | CEO KIC Ventures
Dr. Jason A Seale MBA
The Beginning of Sacrix
In 2013, sacroiliac joint fusion was not widely adopted.
This is where the Sacrix journey began.
A different path was taken.
Patents were filed on multithreaded designs for Sacrix. A 100% fluoroscopic posterolateral-medial-oblique (PLMO) technique was invented —through a ~1.5 cm incision, nearly bloodless.
This approach contrasted with what was emerging at the time.
SI-Bone advanced triangular titanium wedges through an open/MIS direct lateral, gluteal muscle-splitting approach.Medtronic introduced the open Rialto approach, but was never fully committed to it.
Spine surgeons largely adopted the SI-Bone approach. With strong distribution, there was little competition at the time.
A Different Sacrix Philosophy
From the beginning, Sacrix was shaped through collaboration.
Spine surgeons, interventional pain physicians, and engineers worked together—combining different perspectives to design a system grounded in both anatomy and technique.
Rather than reacting to the market, the focus remained on effectiveness and continuous improvement.
Technique was refined and standardized.Instrumentation was simplified for reproducibility. Design evolved—introducing self-harvesting capability, RBM coating for osteogenesis, and the integration of NanoFUSE biologics.
A key principle guided development:
Innovation should be durable.
And it should respect boundaries.
This included designing a system that could be revised.
Sacrix introduced a triangular infrastructure screw—the first and only design allowing reliable removal.
At the time, that decision seemed unnecessary.
Today, it is not.
Where the Market Is Heading
The SIJ space is now expanding rapidly.
New products continue to enter the market—some wedging between the joint, others crossing it.
In that expansion, a pattern is emerging:
Increasing commoditization
Downward pressure on pricing
Multiple systems with only incremental differences
Collaboration could have advanced the field.
Instead, fragmentation has.
And with it, a loss of standardization and meaningful differentiation.
The Consequences
The impact is becoming more visible.
Intra-articular and direct lateral implants are failing—often underreported.Revision procedures are increasing, highlighting the importance of implant design and approach.
Emerging clinical experience shows that revision strategies matter.
At the same time, variability in technique and outcomes remains high.
This is where standardization becomes critical.
A prospective, multicenter randomized controlled trial—published in the NASS Spine Journal—demonstrated the safety and procedural competency of SIJ fusion performed by interventional pain physicians trained in a standardized approach.
Training, standardization, and revision expertise are becoming more important than ever.
A Choice for the Field
Every field reaches this moment.
Move faster. Compete harder. Lower costs.
Or step back and ask:
What actually improves outcomes?
A race, by nature, creates mostly losers.
A journey—done well—creates standards, collaboration, and long-term progress.
The Path Forward
Progress in SIJ fusion will depend on:
Respecting boundaries, including intellectual and technical discipline
Collaborating—bringing together different strengths to build companies that sustain long-term value
Standardizing techniques and training
Continuing to improve—not just iterate
Without this, pricing pressure alone will define the market.
And in that kind of race, everyone eventually loses.
An Invitation
There is another way forward.
A slower path.
A more deliberate one.
One focused on outcomes, not just adoption.
For those aligned with this philosophy, we welcome conversations around joint ventures.
About KIC Ventures
Founded in 2013, KIC Ventures is a physician-founded and physician-led healthtech private equity firm and the creator of the LESS Exposure Spine Surgery (LESS™) treatment philosophy and technologies. Its portfolio includes MedTech spine-focused companies such as NANISX, AxioMed , and NanoFuse Biologics, and technology-driven ventures including Mediconnects and AxioMedX Smart Disc Technologies .
KIC Ventures partners with physicians to design and invest in innovative solutions that empower IPM physicians, orthopedic spine surgeons, and neurosurgeons with advanced, anatomy-preserving technologies.
We invent, innovate, and improve.
Authors
Dr. Kingsley R. Chin MBA is a board-certified Professor of Orthopedic Spine Surgery and honors graduate of Harvard Medical School and the Harvard Combined Orthopedic Residency Program. He did his spine fellowship with Dr. Henry H Bohlman. He was Chief of Spine Surgery at the University of Pennsylvania.
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Dr. Jason A. Seale MBA is a medical doctor and entrepreneur. He is the clinical director at the LES Clinic.
Disclaimer:
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