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Sacroiliac Joint Syndrome

In the first part of the 20th century, sacroiliac (SI) joint syndrome was the most common diagnosis for lumbago (low back pain). Any pain in the low back, buttock, or leg was usually referred to as SI joint syndrome. Before 1932, SI joint syndrome was a very popular diagnosis. There was actually a period referred to as the “Era of the SI Joint.”

In the late 1980s, many doctors “rediscovered” the SI joints as a possible source of back pain. Yet even today, SI joint pain is often overlooked. Many doctors have not been trained to consider it. Many are still reluctant to believe a joint that has so little movement can cause back pain.

What Causes Sacroiliac Joint Syndrome

Many problems can cause degenerative arthritis of the SI joints. It is often hard to tell exactly what caused the wear and tear to the joints. One of the most common causes is an injury. The injury can come from a direct fall on the buttocks, a motor vehicle accident, or even a blow to the side of your pelvis. The force from these injuries can strain the ligaments around the joint. Ligaments are the tough bands of connective tissue that hold joints together. Tearing of these ligaments can lead to too much motion in the joint. The excess motion can lead to wear and tear of the joint and pain from degenerative arthritis. Injuries can also cause direct injury of the cartilage lining the surfaces of the joint where motion occurs. Over time, this will also lead to degenerative arthritis in the joint.

Pain can also be caused by an abnormality of the sacrum bone. The sacrum bone is actually a very specialized set of vertebrae. When your body is undergoing development in the womb, several vertebrae fuse together to form the sacrum. In some people the bones that make up the sacrum never fuse together. In these cases, two or more of the vertebra that should fuse together remain separated. This creates an odd situation where the SI joint is not formed properly and a false joint occurs (sometimes called a “transitional syndrome”). This abnormality can be seen on X-rays. People who have this syndrome seem to have more problems with their SI joints, as well as back pain that appears to come from that area.

Women are at special risk for developing SI joint problems later in life due to childbirth. Female hormones are released during pregnancy that allow the connective tissues in the body to relax. The relaxation is needed so the pelvis can stretch enough to allow the baby to be born. This stretching causes changes to the SI joints, making them extra or overly mobile. Over a period of years these changes can lead to wear-and-tear arthritis. During pregnancy, the SI joints can cause discomfort both from the effects of the hormones that loosen them and from the stress of the growing baby. The more pregnancies a woman has, the more chance she has of developing SI joint problems.

Symptoms of Sacroiliac Joint Syndrome

Symptoms of SI joint syndrome are often hard to distinguish from other types of low back pain. In most cases, there is a confusing pattern of back and pelvic pain that mimic each other, making diagnosis of SI joint syndrome very difficult. The most common symptoms of SI joint syndrome include:

  • Low back pain
  • Buttock pain
  • Thigh pain
  • Difficulty sitting in one place for too long due to pain

Treatment Options

The sacroiliac joint has long been overlooked as a source for spinal pain. There are a large number of patients with SI pain who have had failed spinal surgery including discectomy, decompression, and fusions with residual back, buttock and leg pain that is often described as failed back surgery or post-laminectomy syndrome. There are another group of patients who have not had spine surgery and no lumbar source of their pain can be identified. These patients have typically undergone extensive conservative treatment and multiple diagnostic studies without a definitive diagnosis or effective long-term treatment.

Chiropractors and physical therapists have been making the diagnosis of sacroiliac joint pain with associated syndromes of instability and dysfunction for many years. Unfortunately, spinal surgeons including orthopedic surgeons and neurosurgeons have not had adequate training in recognizing this potential source of pain and providing their patients with appropriate surgical care for chronic disabling pain. Fortunately, there are a few concerned surgeons have identified the legitimacy of this diagnosis and the associated potential disability and life altering pain.

On 9/3/09, a small group of recognized surgeons throughout the country came together to help develop a reasonable pathway for diagnosing and surgically treating chronic disabling sacroiliac joint pain despite conservative treatment just as one would do for neck and back conditions. It is recognized in the literature that approximately 15-20 % of chronic back pain is related to the sacroiliac joint, and fluoroscopic or CT-guided sacroiliac joint injections with anesthetic are the best way to diagnose the condition and separate it from other lumbar and hip pathologies. Steroids are typically injected along with the anesthetic in hopes that this injection technique alone will provide some patients with long-term pain relief. If the pain is significantly relieved but recurs, then the patient would be a candidate for surgical intervention.

The literature is sparse in terms of sacroiliac joint surgical treatment, but several patients have obtained pain relief and functional improvement following surgery that is equal to that of a lumbar fusion. Due to the potential to help a large number of patients needlessly suffering from this condition, the sacroiliac study group, including multiple university based spinal surgeons, will continue to meet and develop algorithms for diagnosing and finding the most effective treatment including surgical fusion for this condition. Dr. E. Jeffrey Donner was asked to be a part of this small group due to his extensive experience over the past 16 years related to diagnosing and surgically treating this condition with exceptionally good outcomes based on patient satisfaction and pain relief. He feels honored to be able to enlighten other surgeons to this condition so they too can provide their patients with similar hope and outcomes.

Souce: DePuy Spine, Inc.

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