Sacroiliac Joint Dysfunction
SI joint pain is a common but underdiagnosed source of lower back pain. Pain in the SI joint can manifest as:
- Lower back pain (below L5)
- Sensation in lower extremity; pain, numbness, tingling, weakness
- Pelvis/buttock pain
- Hip/groin pain
- Feeling of leg instability (buckling, giving way)
- Disturbed sleeping patterns due to pain
- Disturbed sitting patterns (unable to sit for long periods, sitting on one side)
- Pain when going from sitting to standing
In 15-30% of cases, chronic low back pain may not be due to an issue in the low back - it may be caused by an issue with the sacroiliac joint. Watch as an iFuse patient discusses her transformative treatment of the SI Joint pain "Woman's mystery pain solved after years of being misdiagnosed".
"Low back pain" is a term that is broadly used to describe the pain that could have various causes including structures in the lower back, the buttocks ot the pelvic region. Is your "low back pain" truly coming from your lower back?
Low back pain is a common issue that affects many people during their lifetime. There are many structures in the lower back and pelvic area that can cause pain. Most commonly, people with low back pain believe that the lumbar spine is the cause of their pain. Occasionally, hip problems can cause pain that is sometimes confused with low back conditions. Another common cause of low back pain symptoms can be the sacroiliac joint. SI joint dysfunction can be a significant contributor to the pain in the lower back, pelvic region, buttocks, or legs.
Where is the sacroiliac (SI) joint?
The SI joint is located in the posterior pelvis, linking the iliac bones (pelvis) to the sacrum (lowest part of the spine above the tailbone).
What is the function of the sacroiliac joint?
The function of the SI joint is to transfer weight and forces due to movement from your legs, through the pelvis to your upper body and vice versa - acting as an anatomical shock absorber to protect the spine during activity. The primary role of the SI joint is to provide stability for the pelvis and to bear the load of the upper body.
What causes SI joint pain?
Trauma and degeneration are two leading causes of SI joint dysfunction. Sacroiliac joint trauma can occur during motor vehicle accidents, falls on the buttocks, lifting and/or twisting, pregnancy and childbirth. Sacroiliac joint degeneration can occur as a result of previous lumbar spine surgery, stresses to the SI joint due to leg length differences, osteoarthritis, and prior infection of the SI joint.
How is SI joint dysfunction diagnosed?
A sacroiliac joint exam includes:
- Consideration of a patient's health history and symptoms
- Asking the patient to point to where it hurts (Fortin Finger Test)
- Physical examination, including provocative tests (stressing the joint in an attempt to recreate the pain)
- Diagnostic injections (injecting anesthetic into the joint to see if the pain goes away)
Options for SI Joint Pain Treatment
Medications such as non-steroidal anti inflammatory agents can be used to treat SI joint pain.
Some patients respond to physical therapy or chiropractic manipulations. Intermittent use of a pelvic belt may provide symptomatic relief as well. These treatments are performed repetitively, and frequently symptom improvement using these therapies is temporary.
SI joint injections
Some patients respond to SI joint injections with steroids. Pain relief may last from months to years.
SI joint fusion
Patients who do not respond to non-operative therapy can many times find relief from fusion of the SI joint. Today, the most commonly performed surgical fusion procedure is iFuse Implant System (SI-BONE, Inc., San Jose, CA). This treatment involves placement of usually three small titanium implants across the SI joint, and the triangular shape and strength of the implant resists movement and rotation of the joint. The entire procedure is performed through a small incision (approximately 2-3cm long), along the side of your buttock.
During the procedure, fluoroscopy provides your surgeon with live imaging during the procedure to facilitate proper placement of the implants. Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of internal structures using X-rays. iFuse is the only device for treatment of SI joint dysfunction that is backed by significant published clinical evidence, including two randomized trials.
The following images are of the SI Joint - iFuse Implant System
The procedure takes about an hour. You may feel comfortable enough to return home a couple of days following surgery. However, your surgeon will make this decision based on your post-surgical status.
At discharge, your surgeon will arrange follow-up visits to assess your progress, health status (including the status of your incision) and may take additional images of your surgical site. Your doctor will advise you when it is appropriate to resume your daily activities and weight bearing. Return to work will depend on your postsurgical progress and occupation.
iFuse Implant System is FDA-cleared. The iFuse System is intended for sacroiliac joint fusion for conditions including sacroiliac joint disruptions and degenerative sacroiliitis. As with all surgical procedures and permanent implants, there are risks and considerations associated with surgery and use of the iFuse Implant, and should be discussed at the time of consultation.
You may be eligible to participate in a study of the iFuse procedure. Information will be collected about you before surgery and at specific times during your follow up. Your participation in the study may help other patients like you in the future as more will be known about this surgical procedure. To learn more about SI joint fusion, please view the iFuse video located at the bottom of the page or schedule an appointment with Dr. Kovalsky.