Sacroiliac joint pain is a very common and sometimes overlooked cause of low back pain. The SI joint (SIJ) is where the sacrum (commonly known as the tailbone) meets the iliac bone (pelvic bone). It is held together by strong ligaments resulting in very little motion at this joint. In certain instances this joint can be disrupted or damaged allowing for increased motion resulting in pain. It is more prevalent in females than males, likely due to a high association of SIJ disorders after the stress and hormonal changes of childbirth. The symptoms common with SIJ dysfunction include low back, buttock, and hip pain, as well as possible groin and proximal thigh discomfort. The pain is usually worse in the sitting position. It is also common with position changes (i.e., sit to stand, supine to sit). These same symptoms are common with other low back conditions and can mimic a herniated disc, facet joint pain, and/or radiculopathy (pain resulting from compression or irritation of a nerve of the low back).
Therefore, an adequate diagnosis requires careful and complete history, physical examination, imaging, and sometimes diagnostic procedures. A comprehensive history should include previous injury or trauma, previous lumbar surgery, recent pregnancy, leg or foot condition that has altered gait pattern, or rheumatologic condition that causes arthritic pain (i.e., gout, rheumatoid arthritis, ankylosing spondylitis). Pain description including onset and duration, severity, aggravating and alleviating factors are important as well in aiding in correct diagnosis. On physical exam, there are several diagnostic tests that can be used to try to reproduce SIJ pain by stressing or “moving” the joint. If the symptoms are reproduced with one or more tests this is indicative of sacroiliac pain. The more positive tests by examination, the more likely that patient will receive an accurate diagnosis. Imaging for SIJ dysfunction can include x-ray, CT scan, and/or MRI scans. X ray can detect bony changes common with arthritis and possible swelling or irritation of these bones. CT looks more in depth at any bony changes and can rule out fractures, lesions or other bony pathology. A MRI scan will best assess the adjacent muscles and ligaments.
The gold standard in diagnosing SIJ dysfunction is an anesthetic block into the joint itself. This is done under either fluoroscopy (x-ray guidance) or under CT guidance. This involves anesthetic, sometimes combined with steroid, to be introduced by injection into two separate regions of the joint space. If pain relief is achieved, then this indicates that the SIJ is likely the source of pain. Treating SIJ pain is wide ranged. Initially treatment is usually conservative in the form of ice, heat, and rest combined with oral and topical anti-inflammatory or pain medication. If ineffective, physical therapy or chiropractic care can be beneficial depending on the cause of the problem. A steroid injection into the joint can provide temporary to long-term relief in many cases. If conservative measures are exhausted, surgery in the form of SI joint fixation is a beneficial alternative. A minimally invasive approach to fusion is offered using the iFuse Implant System. This procedure involves placing 3 small titanium implants across the sacroiliac joint. These are designed to decrease motion and provide fixation and fusion. The benefit of minimally invasive surgery is smaller incision size, immediate post-operative stabilization, and quicker recovery. We are pleased to announce that we are now offering this advanced technology here at The Spine Center of Louisiana.
If you are suffering from low back pain or any of the other symptoms mentioned above, we would love to provide an evaluation and offer innovative treatment options by our Fellowship trained orthopedic spine physicians here at The Spine Center of Louisiana.