Low back pain is extremely common today affecting more than 90% of all adults at some point in their lives and has become the most common reason for visits to the primary care doctor.
Loss of productivity, income and medical expenses average $60 billion each year in the United States.
Successful treatment of low back pain is based on correctly identifying the cause. In the past, problems stemming from the sacroiliac (SI) joint were difficult to identify and many times misdiagnosed because its symptoms can overlap with other conditions. Now more reliable detection methods show that 15-30% of patients with low back pain have SI joint problems. In addition, 75% of patients who have had a postlumbar fusion will develop significant SI joint degeneration after 5 years.
What is the Sacroiliac (SI) Joint?
The sacroiliac (SI) joint is located in the pelvis. It connects the pelvis (or iliac) bone to the lowest part of the spine (called the sacrum), just above the tailbone. Its function is shock absorption. When you walk/run the sacroiliac (SI) joint is protecting the spine from the impact force of each step.
Cause of Sacroiliac (SI) Joint Pain
The ligaments that encase the sacroiliac joint may be injured or degenerate due to age causing excessive motion in the joint. This excessive motion results in inflammation and irritation in the joint and surrounding nerves. Causes include:
- The SI joint becoming prone to problems with the onset of other joint conditions such as arthritis, age-related degeneration, and trauma
- A loss of elasticity and strength in the joints
- Lumbar Fused Patients
- Pelvic Trauma
- Pregnancy (when ligaments loosen in readiness for childbirth)
- Congenital problem discovered at birth
- Leg length discrepancy (when one leg is longer than the other)
- Abnormal thickening of bone
- Ankylosing spondylitis
- Rheumatoid arthritis
- Reiter’s syndrome
- Fractures of the pelvic, sacral, iliac, or lower back
- Benign or malignant tumors
Possible Symptoms of Sacroiliac (SI) Joint Pain:
- Lower back
- Hips
- Buttocks
- Groin
- Thighs and legs
- Numbness, tingling, and/or weakness.
How is Sacroiliac (SI) Joint Pain Diagnosed?
Your doctor will perform a variety of tests during your physical examination that will include an X-rays, a CT-scan, and/or an MRI. It is also important to remember that it is possible that there may be more than one condition present with SI joint disorder.
Another accurate method of determining whether the SI joint is the cause of your low back pain is to inject Lidocaine (a local anesthetic) into the SI joint. The injection is performed with either fluoroscopic or CT guidance to make sure the needle is placed directly in the SI joint. If your symptoms decreased by at least 75% it is likely that the SI joint is either the source or a major contributor to your low back pain.
Treatment Options
Some patients respond to:
- Physical therapy
- Chiropractic care
- Oral medications
- Injection therapy
- Pelvic belt
These types of ongoing treatments will improve your condition but may only be temporary. If these treatment options have been tried and you are still experiencing pain, surgery may be necessary. The good news is the surgery is minimally invasive; meaning there is less injury to the body. It is safer and allows you to recover and heal much faster with less pain and scarring.
The iFuse Implant System (Surgical Procedure)
If you are a candidate for this procedure, it only takes about an hour and involves the insertion of three small titanium implants across the SI joint for stabilization. The entire procedure is done through a small incision, with no soft tissue damage and minimal tendon irritation. Patients leave the hospital the same day of the procedure can usually resume normal daily activities within six weeks.
Call Dr. Cash to see if you have SI joint disease and inflammation!
