Sacroiliac Dysfunction: Causes and Treatments for SI Joint Pain

Sacroiliitis

WHAT IS THE SI JOINT?

The sacrum is 5 fused vertebral segments and is attached to the lumbar spine and the pelvis. The 2 Sacroiliac joints are where the pelvis and the sacrum meet. It often gets overlooked, as a cause of pain, by spine surgeons, but is still important to the health of your spine, as it is essential for effective load transfer between the spine and legs. Sacroiliac dysfunction is caused by improper movement at the Sacroiliac joint. The SIJ and the rest of the spine work in cohesion to carry loads, facilitate motion and shock absorption. Although this may technically be a joint, the SIJ facilitates very small movements (only 1-2mm). Over time, the joint can become inflamed and start to degenerate. This may cause too much motion in the joint and subsequently pain in the lower back, buttocks, and legs.

 

COMMON CAUSES

Each patient presenting with SIJ Dysfunction may have 1 or several different causes of pain. Sacroiliitis is a painful condition where there is inflammation in 1 or both sacroiliac joints. Often paired with sacroiliitis, Osteoarthritis occurs when the cartilage in between the joint starts to wear away and cause bone on bone contact between the sacrum and the ilium. Pregnancy can also cause movement in this joint. Hormones are released during pregnancy that causes the ligaments in the SIJ to relax and mobilize the joint, causing pain later in life. This is why the most common patient demographic for SIJ surgery is women above the age of 40 with a low BMI. Trauma is also a common cause. For example; a fall onto your buttocks or a motor vehicle accident can often cause injury to the ligaments that stabilize the sacroiliac joint, leading to abnormal motion and subsequently, pain. 

 

Some causes of pain can also be related to prior surgeries that an individual may have had previously. Prior lumbar fusions can also cause sacroiliac dysfunction. Fusing segments of the spine may cause a change of shock absorption from the fused levels of the spine to the SIJ. This excessive stress can increase motion to the SIJ and may cause degeneration or pain.  

 

HOW TO TEST FOR SI JOINT DYSFUNCTION

SI joint provocative tests must be performed to assist the clinician to include/exclude SI joint pain. The five tests to be performed are distraction, compression, Gaenslen, thigh thrust, and faber. If pain occurs in 3 out of 5 tests it may be a positive indication of dysfunction in the joint. This is when further evaluation and treatment options will be explored.

TREATMENT OPTIONS

It is important to me that my patients are receiving the correct treatment. Sacroiliac dysfunction can often be overlooked by some physicians. It’s estimated that 20% of all lower back pain is caused by SI Dysfunction. Once diagnosed, there are safe, efficacious, and reproducible surgical treatments available. Finding the right treatment varies from patient to patient. There are conservative treatment options like physical therapy and chiropractic care. SIJ injections may also be used for treatment and diagnosis. The injection is a local anesthetic paired with a steroid that may have relief for several hours or days. If the joint that is injected has relief, that is a great indicator that it is actually SI Joint pain/dysfunction and not low back pain. If this is the case, a viable surgical option is SI joint fusion. This procedure is performed percutaneously and has shown great success rates with a high fusion rate. Patients typically go home the same day and this procedure is commonly performed at an outpatient surgery center as a quick 30min-1 hour surgery.

 

 

Ref 1. Bernard et al. Recognizing specific characteristics of non-specific low back pain. Clinical Orthopedics and Related Research. April 1987; 217: 266-280

 

 

 

 

 

 

 

Author
Dr. Kenneth Nwosu As a spine surgeon specializing in neck and lower back pain, Kenneth Nwosu, MD, is skilled in the cutting-edge techniques to address chronic pain and mobility issues caused by underlying spinal disease or injury. Dr. Nwosu believes in the many benefits that minimally invasive surgical techniques can offer his patients, including minimal hospitalization and expedient pain relief and return to an active lifestyle. He offers a variety of surgical options at his multidisciplinary spine practices in Burien and Puyallup, Washington.

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